Survival difference are not black and white

December 06, 2011

Highlights Washington, DC -- In the general population, African Americans die at earlier ages than whites, but among patients on dialysis, African Americans live longer than whites. A new study helps explain this paradox and could help prolong the lives of all patients on dialysis. The study appears in the Journal of the American Society Nephrology (JASN), a publication of the American Society of Nephrology.

High levels of inflammation--which may be due to conditions such as infections, inflammatory illnesses, periodontal disease, chronic lung disease, and obesity--increase dialysis patients' risk of dying prematurely. Deidra Crews, MD (Johns Hopkins University) and her colleagues wondered whether racial differences in inflammation might explain the survival paradox among dialysis patients.

The investigators followed 554 white and 262 African American dialysis patients from 81 clinics for an average of three years (range four months to 9.5 years). Among the major findings: What is it about inflammation that could lead to these findings? It's not clear yet, but the authors note that inflammation in whites may be caused mostly by heart disease, while in African Americans it may be due to other causes that have less detrimental effects on survival. (At the start of dialysis, half of whites in the study had heart disease compared with a third of African Americans.) Alternatively, African Americans and whites may simply respond differently to inflammation, which implies that some genetic trait allows African Americans to "handle" it better than whites.

"Our findings challenge the long held notion that African Americans do better than whites on dialysis. If we can determine, and somehow modify the impact of inflammation, we may be able to improve survival for all patients treated with dialysis," said Dr. Crews.
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Study co-authors include Stephen Sozio, MD, Josef Coresh, MD, PhD (Johns Hopkins University); Yongmei Liu, MD, PhD (Wake Forest University School of Medicine); and Neil Powe, MD (San Francisco General Hospital).

Disclosures: The authors reported no financial disclosures.

The article, entitled "Inflammation and the Paradox of Racial Differences in Dialysis Survival," is online at http://jasn.asnjournals.org/. doi: 10.1681/ASN.2011030305.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 12,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

American Society of Nephrology

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