African-Americans on maintenance dialysis: a review of racial differences in incidence, treatment, and survival.
African-Americans are the fasting growing racial minority with end stage renal disease (ESRD) in the United States. Currently, African-Americans comprise approximately 31% of the ESRD population. African-Americans are almost a decade younger than their white (referring to non-Hispanic white) counterparts with ESRD with a mean age of 58 years old. Although African-Americans systematically receive less dialysis than whites (Kt/V of 1.05 versus 1.18, respectively), their survival is higher. The 2-year survival probability of African-Americans is 66.2% in comparison with 59.8% for whites. This improved survival with ESRD is accompanied by an improved quality of life for African-Americans. Their enhanced quality of life is reflected by a greatly decreased frequency of withdrawing from dialysis treatments. In this article, we will examine the reasons why African-Americans have an excessive incidence of selective diseases that culminate in ESRD. We will explore the factors that influence the difference in dialysis modality selection between African-Americans and whites. Lastly, we will pose and judge several hypotheses that may account for the improved survival enjoyed by African-Americans with ESRD. We contend that research to clarify the basis for these differences between African-Americans and whites with ESRD will improve outcomes for both populations and is fiscally sound health policy.
Price
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DA
Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Owen
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WF
D001741:Black or African American; D000368:Aged; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000208:ethnology / Q000628:therapy*; D008875:Middle Aged; D006435:Renal Dialysis; D015996:Survival Rate