Increased Risk of Death in Young African American Dialysis Patients

Abstract

Context: Many studies have reported that black individuals undergoing dialysis survive longer than those who are white. This observation is paradoxical given racial disparities in access to and quality of care, and is inconsistent with observed lower survival among black patients with chronic kidney disease. We hypothesized that age and the competing risk of transplantation modify survival differences by race. Objective: To estimate death among dialysis patients by race, accounting for age as an effect modifier and kidney transplantation as a competing risk. Design, Setting, and Participants: An observational cohort study of 1 330 007 incident end-stage renal disease patients as captured in the United States Renal Data System between January 1, 1995, and September 28, 2009 (median potential follow-up time, 6.7 years; range, 1 day-14.8 years). Multivariate age-stratified Cox proportional hazards and competing risk models were constructed to examine death in patients who receive dialysis. Main Outcome Measures: Death in black vs white patients who receive dialysis. Results: Similar to previous studies, black patients undergoing dialysis had a lower death rate compared with white patients (232 361 deaths [57.1% mortality] vs 585 792 deaths [63.5% mortality], respectively; adjusted hazard ratio [aHR], 0.84; 95% confidence interval [CI], 0.83-0.84; P Conclusions: Overall, among dialysis patients in the United States, there was a lower risk of death for black patients compared with their white counterparts. However, the commonly cited survival advantage for black dialysis patients applies only to older adults, and those younger than 50 years have a higher risk of death.