title: Racial and ethnic differences in mortality of hemodialysis patients: role of dietary and nutritional status and inflammation.
abstract: BACKGROUND
  Racial/ethnic disparities prevail among hemodialysis patients. We hypothesized that significant differences exist between Black and non-Hispanic and Hispanic White hemodialysis patients in nutritional status, dietary intake and inflammation, and that they account for racial survival disparities.
  
  
  METHODS
  In a 6-year (2001-2007) cohort of 799 hemodialysis patients, we compared diet and surrogates of nutritional-inflammatory status and their mortality-predictabilities between 279 Blacks and 520 Whites using matched and regression analyses and Cox with cubic splines.
  
  
  RESULTS
  In age-, gender- and diabetes-matched analyses, Blacks had higher lean body mass and serum prealbumin, creatinine and homocysteine levels than Whites. In case-mix-adjusted analyses, dietary intakes in Blacks versus Whites were higher in energy (+293 ± 119 cal/day) and fat (+18 ± 5 g/day), but lower in fiber (-2.9 ± 1.3 g/day) than Whites. In both races, higher serum albumin, prealbumin and creatinine were associated with greater survival, whereas CRP and IL-6, but not TNF-α, were associated with increased mortality. The highest (vs. lowest) quartile of IL-6 was associated with a 2.4-fold (95% CI: 1.3-3.8) and 4.1-fold (2.2-7.2) higher death risk in Blacks and Whites, respectively.
  
  
  CONCLUSIONS
  Significant racial disparities exist in dietary, nutritional and inflammatory measures, which may contribute to hemodialysis outcome disparities. Testing race-specific dietary and/or anti-inflammatory interventions is indicated.
authors.affiliation: Harold Simmons Center for Chronic Disease Research and Epidemiology, Torrance, Calif., USA.
authors.forename: Nazanin
authors.initials: N
authors.lastname: Noori
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
authors.forename: Ramanath
authors.initials: R
authors.lastname: Dukkipati
authors.forename: Usama
authors.initials: U
authors.lastname: Feroze
authors.forename: Miklos Z
authors.initials: MZ
authors.lastname: Molnar
authors.forename: Rachelle
authors.initials: R
authors.lastname: Bross
authors.forename: Allen R
authors.initials: AR
authors.lastname: Nissenson
authors.forename: Joel D
authors.initials: JD
authors.lastname: Kopple
authors.forename: Keith C
authors.initials: KC
authors.lastname: Norris
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
mesh_terms: D000367:Age Factors; D000893:Anti-Inflammatory Agents / Q000494:pharmacology; D001823:Body Composition; D002097:C-Reactive Protein / Q000096:biosynthesis; D005006:Ethnicity; D005260:Female; D006801:Humans; D007249:Inflammation; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000208:ethnology*; D008297:Male; D009752:Nutritional Status; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000379:methods*; D012737:Sex Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D000893:Anti-Inflammatory Agents; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein