title: Association of ethnicity and survival in peritoneal dialysis: a cohort study of incident patients in Brazil.
abstract: BACKGROUND
  There are no available epidemiologic studies about the impact of ethnicity on outcomes of patients treated with peritoneal dialysis (PD) in South America. This study aims to assess the effect of ethnicity on the mortality of incident PD patients in Brazil.
  
  
  METHODS
  Prospective observational cohort study of incident patients treated with PD.
  
  
  METHODS
  Patients 18 years or older who started PD therapy between December 2004 and October 2007 in 114 Brazilian dialysis centers.
  
  
  METHODS
  Self-reported ethnicity defined by the Brazilian Institute of Geography and Statistics as black and brown versus white patients and baseline demographic, socioeconomic, clinical, and laboratory data were collected at baseline.
  
  
  RESULTS
  Mortality, using cumulative mortality curves in which kidney transplantation and transfer to hemodialysis therapy were treated as competing end points. Multivariate Cox proportional hazards analysis was used to adjust for gradually more potential explanatory variables, censored for kidney transplantation and transfer to hemodialysis therapy. Analyses were performed for all patients, as well as stratified for elderly (aged ≥65 years) and nonelderly patients.
  
  
  RESULTS
  1,370 patients were white, 516 were brown, and 273 were black. The competing-risk model showed higher mortality in white patients compared with black and brown patients. With white patients as the reference, Cox proportional hazards analysis showed a crude HR for mortality of 0.77 (95% CI, 0.56-1.05) for black and 0.74 (95% CI, 0.59-0.94) for brown patients. After adjusting for potential explanatory factors, HRs were 0.67 (95% CI, 0.48-0.95) and 0.77 (95% CI, 0.43-1.01), respectively. The same results were observed in elderly and nonelderly patients.
  
  
  CONCLUSIONS
  Ethnicity was self-determined and some misclassification might have occurred.
  
  
  CONCLUSIONS
  Black and brown Brazilian incident PD patients have a lower mortality risk compared with white patients.
authors.affiliation: Department of Medicine, Federal University of Juiz de Fora, Minas Gerais, Brazil. nataliafernandes02@gmail.com
authors.forename: Natália Maria da Silva
authors.initials: NM
authors.lastname: Fernandes
authors.forename: Tiny
authors.initials: T
authors.lastname: Hoekstra
authors.forename: Tessa O
authors.initials: TO
authors.lastname: van den Beukel
authors.forename: Luciana
authors.initials: L
authors.lastname: Tirapani
authors.forename: Kleyton
authors.initials: K
authors.lastname: Bastos
authors.forename: Roberto
authors.initials: R
authors.lastname: Pecoits-Filho
authors.forename: Abdul Rashid
authors.initials: AR
authors.lastname: Qureshi
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
authors.forename: Marcus G
authors.initials: MG
authors.lastname: Bastos
authors.forename: José Carolino
authors.initials: JC
authors.lastname: Divino-Filho
mesh_terms: D000328:Adult; D000368:Aged; D044383:Black People / Q000208:ethnology*; D001938:Brazil / Q000208:ethnology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality*; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D044465:White People / Q000208:ethnology*