Young Black patients do worse on dialysis than White counterparts
MedWire News: Young Black patients are nearly twice as likely as their White peers to die while receiving kidney dialysis for end-stage renal disease (ESRD), US researchers report.
"This study challenges the widespread notion that Black patients undergoing dialysis survive longer than their White counterparts," Dorry Segev (Johns Hopkins Medical Institutions, Baltimore, Maryland) and colleagues remark.
"The commonly cited survival advantage for Black patients undergoing dialysis applies only to those older than 50 years of age," they add.
The researchers explain that many studies have reported that Black individuals undergoing dialysis survive longer than those who are White.
"This observation is paradoxical given racial disparities in access to and quality of care, and is inconsistent with observed lower survival among Black patients with chronic kidney disease," they write in JAMA.
To investigate whether age and differential rates of kidney transplantation modify the racial disparities seen in dialysis survival, Segev and team conducted an observational cohort study of over 1.3 million incident ESRD patients (31% Black) registered in the United States Renal Data System between 1995 and 2009.
They found that, during a median follow-up period of 6.7 years, significantly fewer Black patients died when on dialysis compared with White patients, at 57.1% versus 63.5%.
The difference occurred even though Black patients were significantly less likely to receive kidney transplants than White patients (9.1% vs 14.5%), and when Black patients did receive a transplant it was less likely to be from a live donor (25.7% vs 42.8%).
Adjusting for differences in demographics and comorbidity, and censoring for transplantation, confirmed that, overall, Black patients had a 16% lower risk for death when receiving dialysis than White patients.
However, when the researchers stratified the data by age and treated kidney transplantation as a competing risk, Black patients had significantly higher mortality than their White counterparts at ages 18 to 50 years, but lower mortality after the age of 50 years.
Specifically, Black patients aged 18 to 30 years had a 1.93-fold increased risk for death compared with their White peers (27.6% vs 14.2% mortality). The risk was 1.46-fold higher among Black than White patients aged 31 to 40 years (37.4% vs 26.8% mortality).
By contrast, the risk for death was 7-15% lower among Black patients aged 50 years or older compared with White patients in the same age group.
"As a medical community, we have been advising young Black patients of treatment options for kidney failure based on the notion that they do better on dialysis than their white counterparts," Segev said. "This new study shows that, actually, young Blacks have a substantially higher risk of dying on dialysis, and we should instead be counselling them based on this surprising new evidence."
"Determining why younger Black patients are at increased risk of death as dialysis recipients is critical in order to improve clinical decision making and inform policies aimed at achieving equity in ESRD care," the researchers conclude.
By Laura Dean