Differences in intermediate outcomes for Asian and non-Asian adult hemodialysis patients in the United States.
BACKGROUND
There is a paucity of information regarding the clinical experience of Asian hemodialysis patients. This paper describes intermediate outcomes for adult Asian hemodialysis patients compared to Caucasians and African Americans.


METHODS
Dialysis facility staff abstracted clinical information on a national random sample of adult hemodialysis patients from October through December 2000. Associations of race with intermediate outcomes were tested by bivariate analyses and multivariable logistic regression modeling.


RESULTS
A total of 429 patients were identified as Asian, 4403 as Caucasians, and 3103 as African Americans. Asian and Caucasian patients were older than African Americans [mean 63.2 (+/-15.6), 63.9 (+/-15.2), and 57.7 (+/-14.7) years, P < 0.001], and had fewer years on dialysis [mean 3.5 (+/-3.8), 3.1 (+/-3.8), and 4.1 (+/-4.1) years, P < 0.001]. Ninety three percent of Asians, 87% of Caucasians, and 84% of African Americans had a mean Kt/V > or =1.2 (P < 0.001). In addition, 36% of Asians, 32% of Caucasians, and 26% of African Americans had an arteriovenous (AV) fistula as their vascular access (P < 0.001). Hemoglobin profiles were only slightly different among the three racial groups. More Asians and African Americans had a mean serum albumin > or =4.0/3.7 g/dL compared to Caucasians (33% and 31% compared to 27%, respectively, P < 0.001). In the final multivariable logistic regression model, Asians were twice as likely to have a mean Kt/V > or =1.2 compared to Caucasians (the referent group) [odds ratio (OR) (95% CI) 2.10 (1.33, 3.32), P < 0.01]. They experienced similar intermediate outcomes for vascular access, anemia management, and serum albumin compared to the majority racial group.


CONCLUSIONS
These findings indicate that adult hemodialysis Asian patients experience similar or better intermediate outcomes compared to the majority racial group. Further study is needed to determine if these results are associated with improved survival and less morbidity in this minority group.
Frankenfield
Diane L
DL
Centers for Medicare & Medicaid Services, Center for Beneficiary Choices, Baltimore, Maryland 21244, USA. dfrankenfield@cms.hhs.gov
Ramirez
Sylvia P B
SP
McClellan
William M
WM
Frederick
Pamela R
PR
Rocco
Michael V
MV
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000740:Anemia / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data; D044466:Asian People / Q000208:ethnology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D006435:Renal Dialysis / Q000401:mortality*; D012709:Serum Albumin; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
D012709:Serum Albumin