Abstract
There are counterintuitive but consistent observations that African American maintenance dialysis patients have greater survival despite their less favorable socioeconomic status, high burden of cardiovascular risks including hypertension and diabetes, and excessively high chronic kidney disease prevalence. The fact that such individuals have a number of risk factors for lower survival and yet live longer when undergoing dialysis treatment is puzzling. Similar findings have been made among Israeli maintenance dialysis patients, in that those who are ethnically Arab have higher end-stage renal disease but exhibit greater survival than Jewish Israelis. The juxtaposition of these two situations may provide valuable insights into racial/ethnic-based mechanisms of survival in chronic diseases. Survival advantages of African American dialysis patients may be explained by differences in nutritional status, inflammatory profile, dietary intake habits, body composition, bone and mineral disorders, mental health and coping status, dialysis treatment differences, and genetic differences among other factors. Prospective studies are needed to examine similar models in other countries and to investigate the potential causes of these paradoxes in these societies. Better understanding the roots of racial/ethnic survival differences may help improve outcomes in both patients with chronic kidney disease and other individuals with chronic disease states.
Highlights
11% of the United States (US) adult population may have chronic kidney disease (CKD), a progressive and irreversible disease with currently no cure [1]
In the US general population, disparities in income, education, and health have been implicated as causes of the higher total mortality and shorter life expectancy of African Americans compared with whites over the past several decades (Fig. 1) [15,16,17]
Even though the prevalence of type 2 diabetes is 2–5 times higher in Hispanics [31,32], when diabetic Hispanics undergo dialysis treatment, they are more likely to survive than non-Hispanic white diabetics [33,34], which can be considered as yet another example of a paradox-within-paradox [5]
Summary
11% of the United States (US) adult population may have chronic kidney disease (CKD), a progressive and irreversible disease with currently no cure [1]. The ESRD incident rates for African Americans are 3.6 times greater than non-Hispanic whites [4]. ESRD prevalent rates are higher in African Americans compared to non-Hispanic whites, i.e., 5004 vs 1194 per million US population, respectively [4]. Across virtually all age groups, 1/3 of US dialysis patients are African Americans, when compared to 14% of the US general population [4,5,6]. Over one-half of the ESRD deaths are caused by cardiovascular or infectious events [9] The etiology of this excessively poor outcome is unknown. Discovering novel mechanisms of high CKD mortality in a population where minorities are exceptionally over-represented may help to identify the causes of their poor outcomes
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