Survival of patients undergoing renal replacement therapy in one center with special emphasis on racial differences

Bleyer, Anthony J.; Tell, Grethe S.; Evans, Gregory W.; Ettinger, Walter H.; Burkart, John M.

« Previous Next »American Journal of Kidney Diseases
Volume 28, Issue 1 , Pages 72-81, July 1996

Survival of patients undergoing renal replacement therapy in one center with special emphasis on racial differences

Anthony J. Bleyer, MD, MS
- Address reprint requests to Anthony J. Bleyer, MD, MS, Section on Nephrology, Bowman Gray School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157.
- Departments of Internal Medicine and Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC USA
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
Grethe S. Tell, PhD, MPH
- Departments of Internal Medicine and Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC USA
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
Gregory W. Evans, MA
- Departments of Internal Medicine and Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC USA
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
Walter H. Ettinger Jr, MD
- Departments of Internal Medicine and Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC USA
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
John M. Burkart, MD
- Departments of Internal Medicine and Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC USA
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway

Received 10 October 1995; accepted 27 February 1996.

Abstract

This study compared racial differences in end-stage renal disease (ESRD) in 550 patients starting renal replacement therapy at a large academic dialysis center between January 1, 1990, and December 31, 1993, with follow-up through December 31, 1994. Patient groups were compared with respect to cause of ESRD, comorbid factors at the start of dialysis therapy, choice of modality, transplantation rate, and survival. Fifty-eight percent of the patients were white and 42% were African-American. There was a similar distribution of causes of ESRD between races. African-American patients were less likely to choose peritoneal dialysis as initial therapy (11.6% v 29.3%; P < 0.001) and were less likely to change dialysis modality. Transplantation rates were significantly different between African-American and white patients (9.3% v 27.6%; P < 0.001). African-Americans less frequently received living-related, living-nonrelated, and cadaveric renal transplants. Given differences in transplantation rates and in survival of transplanted patients versus patients on dialysis, survival analysis was performed without censoring for transplantation. A multivariate Cox proportional hazards model was formed, and the following were identified as being significant independent predictors of survival: age, race, age-race interaction, serum albumin at the start of dialysis, activity level at the start of dialysis, and presence of congestive heart failure and cancer. Age had little effect on survival among African-American patients, while it was a significant predictor of survival in white patients. In the group of patients starting dialysis before the age of 30 years, African-American patients had a significantly increased mortality risk compared with white patients. However, white patients older than 50 years had a higher mortality risk; this risk difference increased with age. Racial differences in mortality among older white patients could not be explained by differences in comorbid conditions, transplantation rates, or withdrawal from dialysis.

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