title: Survival advantage for adult Hispanic hemodialysis patients? Findings from the end-stage renal disease clinical performance measures project.
abstract: One-year follow-up mortality in Hispanic and non-Hispanic patients and its association with intermediate outcomes of dialytic care were examined utilizing the Center for Medicare & Medicaid Services' (CMS) ESRD Clinical Performance Measures (CPM) Project and administrative data. Demographic and clinical information was collected on a national random sample of adult in-center hemodialysis (HD) patients for the period of October through December, 1998. Patients were categorized as Hispanic, non-Hispanic White, or non-Hispanic Black. Of 8336 patients 994 (12%) were identified as Hispanic, 3618 (43%) as non-Hispanic White, and 3111 (37%) as non-Hispanic Black. The adjusted 12-mo mortality risk (99% CI) for Hispanics was 0.76 (0.60 to 0.96; P < 0.01) and for non-Hispanic Blacks 0.66 (0.56 to 0.78, P < 0.001) compared with non-Hispanic Whites (referent). Similar 12-mo mortality risks were noted in the groups with diabetes mellitus or hypertension as the causes of ESRD and among patients > or = 65 yr. After controlling for demographic and geographic variables, Hispanics compared with the referent group, non-Hispanic Whites, were more likely to have a mean serum albumin > or = 4.0/3.7 g/dL (BCG/BCP) (1.5 [1.2 to 1.7]; P < 0.001) and as likely to have a mean Kt/V > or = 1.2, mean hemoglobin > or = 11 g/dL, and an arteriovenous fistula as their vascular access. These data suggest that adult Hispanic HD patients have a 12-mo survival intermediate to non-Hispanic Blacks and non-Hispanic Whites and experience equivalent or better intermediate outcomes of dialytic care compared with non-Hispanic Whites.
authors.affiliation: Centers for Medicare & Medicaid Services, Center for Beneficiary Choices, Baltimore, Maryland 21244, USA. dfrankenfield@cms.hhs.gov
authors.forename: Diane L
authors.initials: DL
authors.lastname: Frankenfield
authors.forename: Michael V
authors.initials: MV
authors.lastname: Rocco
authors.forename: Sheila H
authors.initials: SH
authors.lastname: Roman
authors.forename: William M
authors.initials: WM
authors.lastname: McClellan
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011897:Random Allocation; D006435:Renal Dialysis / Q000401:mortality*; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data