Role of nutritional status and inflammation in higher survival of African American and Hispanic hemodialysis patients.
BACKGROUND
Observational studies indicate greater survival in African American and Hispanic maintenance hemodialysis patients compared with their non-Hispanic white counterparts, although African Americans have shorter life expectancy than whites in the general population. We hypothesized that this apparent survival advantage is due to a more favorable nutritional/inflammatory profile in minority hemodialysis patients.


METHODS
We examined the association between race/ethnicity and 5-year survival before and after adjustment for case-mix and surrogates of the malnutrition-inflammation complex syndrome (MICS) using Cox regression with or without matched sampling in a large cohort of adult hemodialysis patients.


METHODS
124,029 adult hemodialysis patients, including 16% Hispanics, 49% non-Hispanic whites, and 35% African Americans.


METHODS
Race/ethnicity before and after adjustment for MICS, including values for body mass index, serum albumin, total iron-binding capacity, ferritin, creatinine, phosphorus, calcium, bicarbonate, white blood cell count, lymphocyte percentage, hemoglobin, and protein intake.


RESULTS
5-year (July 2001 to June 2006) survival.


RESULTS
In dialysis patients, blacks and Hispanics had lower mortality overall than non-Hispanic whites after traditional case-mix adjustment. However, after additional control for MICS, Hispanics had mortality similar to non-Hispanic whites, and African Americans had even higher mortality. Unadjusted, case-mix-, and MICS-adjusted HRs for African Americans versus whites were 0.68 (95% CI, 0.66-0.69), 0.89 (95% CI, 0.86-0.91), and 1.06 (95% CI, 1.03-1.09) in the unmatched cohort and, 0.95 (95% CI, 0.90-0.99), 0.89 (95% CI, 0.84-0.94), and 1.16 (95% CI, 1.07-1.26) in the matched cohort, and for Hispanics versus whites, 0.66 (95% CI, 0.64-0.69), 0.84 (95% CI, 0.81-0.87), and 0.97 (95% CI, 0.94-1.00) in the unmatched cohort and 0.89 (95% CI, 0.84-0.95), 0.88 (95% CI, 0.83-0.95), and 0.98 (95% CI, 0.91-1.06) in the matched cohort, respectively.


CONCLUSIONS
Adjustment cannot be made for unmeasured confounders.


CONCLUSIONS
Survival advantages of African American and Hispanic hemodialysis patients may be related to differences in nutritional and inflammatory status. Further studies are required to explore these differences.
Harold Simmons Center for Chronic Disease Research and Epidemiology, Torrance, CA, USA.
Elani
E
Streja
Csaba P
CP
Kovesdy
Miklos Z
MZ
Molnar
Keith C
KC
Norris
Sander
S
Greenland
Allen R
AR
Nissenson
Joel D
JD
Kopple
Kamyar
K
Kalantar-Zadeh
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino; D006801:Humans; D007249:Inflammation / Q000401:mortality*; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D006435:Renal Dialysis / Q000401:mortality*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
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