title: Survival on dialysis among American Indians and Alaska Natives with diabetes in the United States, 1995-2010.
abstract: OBJECTIVE
  We assessed survival in American Indians and Alaska Natives (AI/ANs) with end-stage renal disease attributed to diabetes who initiated hemodialysis between 1995 and 2009.
  
  
  METHODS
  Follow-up extended from the first date of dialysis in the United States Renal Data System until December 31, 2010, kidney transplantation, or death. We used the Kaplan-Meier method to compute survival on dialysis by age and race/ethnicity and Cox regression analysis to compute adjusted hazard ratios (HRs).
  
  
  RESULTS
  Our study included 510,666 persons-48% Whites, 2% AI/AN persons, and 50% others. Median follow-up was 2.2 years (interquartile range = 1.1-4.1 years). At any age, AI/AN persons survived longer on hemodialysis than Whites; this finding persisted after adjusting for baseline differences. Among AI/AN individuals, those with full Indian blood ancestry had the lowest adjusted risk of death compared with Whites (HR = 0.58; 95% confidence interval = 0.55, 0.61). The risk increased with declining proportion of AI/AN ancestry.
  
  
  CONCLUSIONS
  Survival on dialysis was better among AI/AN than White persons with diabetes. Among AI/AN persons, the inverse relationship between risk of death and level of AI/AN ancestry suggested that cultural or hereditary factors played a role in survival.
authors.affiliation: Nilka Ríos Burrows, Pyone Cho, and Kai McKeever Bullard are with the Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Andrew S. Narva and Paul W. Eggers are with National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
authors.forename: Nilka Ríos
authors.initials: NR
authors.lastname: Burrows
authors.forename: Pyone
authors.initials: P
authors.lastname: Cho
authors.forename: Kai
authors.initials: K
authors.lastname: McKeever Bullard
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Narva
authors.forename: Paul W
authors.initials: PW
authors.lastname: Eggers
mesh_terms: D000413:Alaska / Q000453:epidemiology / Q000208:ethnology; D003928:Diabetic Nephropathies / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D004930:Inuit / Q000706:statistics & numerical data*; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D006435:Renal Dialysis / Q000401:mortality*; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
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