Differences in use of peritoneal dialysis and survival among East Asian, Indo Asian, and white ESRD patients in Canada.
BACKGROUND
Racial differences in health outcomes in general are well documented; however, few studies examined the impact of East Asian and Indo Asian race on choice of dialytic modality and survival among patients with end-stage renal disease (ESRD).


METHODS
We compared the use of peritoneal dialysis (PD) and survival among East Asian, Indo Asian, and white patients with ESRD initiating dialysis therapy in Canada between January 1, 1990, and December 31, 2000.


RESULTS
Of 10,338 patients, 5.7% were East Asian, 3.2% were Indo Asian, and 91% were white. After controlling for sociodemographics and comorbidities, East Asian and Indo Asian patients were significantly more likely to initiate dialysis therapy on PD compared with white patients (odds ratio, 1.63; 95% confidence interval [CI], 1.36 to 1.96; odds ratio, 1.52; 95% CI, 1.21 to 1.93, respectively), with no difference in likelihood of technique failure. East Asian and Indo Asian patients had a lower risk for death after the initiation of dialysis therapy (irrespective of modality) compared with white patients, with adjusted hazard ratios of 0.66 (95% CI, 0.58 to 0.76) for East Asian patients and 0.63 (95% CI, 0.53 to 0.75) for Indo Asian patients. The survival benefit for East Asian and Indo Asian patients was similar in the subgroup that initiated dialysis therapy with PD.


CONCLUSIONS
We found that Asian patients with ESRD were more likely to initiate dialysis therapy using PD, with improved survival after the initiation of dialysis therapy, compared with white patients. Elucidation of factors in East Asian and Indo Asian ESRD populations that result in improved outcomes may have implications for ESRD treatment for other racial groups.
Hemmelgarn
Brenda R
BR
Department of Medicine, Division of Nephrology, University of Calgary, Canada. brenda.hemmelgarn@calgaryhealthregion.ca
Chou
Sophia
S
Wiebe
Natasha
N
Culleton
Bruce F
BF
Manns
Braden J
BJ
Klarenbach
Scott
S
Khan
Nadia A
NA
Gourishankar
Sita
S
Yeates
Karen E
KE
Gill
John S
JS
Tonelli
Marcello
M
D000368:Aged; D001208:Asia / Q000208:ethnology; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D005202:Asia, Eastern / Q000208:ethnology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000401:mortality / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D012923:Social Class; D016019:Survival Analysis; D044465:White People / Q000706:statistics & numerical data