Original Investigation
Racial differences in survival in an urban peritoneal dialysis program

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Abstract

We retrospectively evaluated 233 incident patients (61% black, 27% white, and 12% Hispanic/Asian) to our peritoneal dialysis (PD) program from January 1987 to September 1997 to identify any possible racial differences in patient survival. Information collected included clinical features, comorbid conditions, nutritional status, and dialysis dose at initiation of dialysis. The average age was 52 ± 16 (SD) years, and 49% were men. Diabetes mellitus was present in 41% of patients. Overall follow-up was 31 ± 24 (median 26) months during which time 21% of patients underwent transplant, 29% of patients transferred to hemodialysis (HD), and 42% of patients died. The Cox proportional hazards analysis, based on intent-to-treat, identified age (RR: 1.03), race (RR: 2.35, white versus black), cardiac disease (RR: 1.97), and serum albumin (RR: 0.44) to independently predict mortality. Further analysis was performed based on diabetic status, and the analysis identified age (RR: 1.06), race (RR: 2.45, white versus black), and peripheral vascular disease (RR: 2.88) as predictors of mortality in diabetic patients. In nondiabetic patients, age (RR: 1.03), race (RR: 2.24, white versus black), cardiac disease (RR: 2.48), cerebrovascular disease (RR: 3.17), and serum albumin (RR: 0.39) were significant predictors of mortality. The significance of race persisted even after adjusting patients transferring to hemodialysis. The adjusted patient survival at 1, 2, and 5 years was 94%, 87% and 53% for black patients, and 86%, 72%, and 23% for white patients. The adjusted patient survival in diabetics at 1, 2, and 5 years was 92%, 79%, and 37% for black patients, and 82%, 56%, and 9% for white patients. The adjusted patient survival in nondiabetics at 1, 2, and 5 years was 94%, 91%, and 63% for black patients, and 88%, 82%, and 35% for white patients. In conclusion, long-term patient survival is better for black patients than white patients in our peritoneal dialysis program. Peritoneal dialysis should be considered a viable dialytic option for black patients entering an end-stage renal disease program.

Section snippets

Methods

From January 1, 1987 to September 30, 1997, 527 incident patients (356 black, 110 white, 53 Hispanic, and 8 Asian) entered the end-stage renal disease program at Rush-Presbyterian-St. Lukes Medical Center. A patient's dialysis modality was defined by the therapy they were on by the third month on chronic dialysis. A total of 294 (56%) patients were treated in our in-center hemodialysis program. The remaining 233 (44%) patients were treated with continuous ambulatory PD and form the basis of

Results

Two-hundred thirty-three patients, 44% of all incident dialysis patients, were treated with PD during the study period. Of the patients treated with PD, 142 (61%) were black, 62 (27%) white, and 29 (12%) categorized as other (24 Hispanic and 5 Asian). Baseline clinical, comorbid conditions, as well as laboratory and adequacy information for all patients are shown in Tables 1 to 3. Racial differences in the baseline characteristics were evaluated for black and white patients. Black patients were

Discussion

During the 10-year period of evaluation a large proportion of patients (44%) incident to our dialysis program chose to be treated with PD and of those, 61% were black. Using an intent-to-treat analysis, adjusting for baseline clinical, biochemical, and adequacy parameters, we found age, CAD, serum albumin, and race to be predictive of patient survival in our PD patients. The risk of mortality for white patients was 2.4 times that of black patients. This significant effect of race on patient

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  • Cited by (0)

    Received June 14, 1999; accepted in revised form July 23, 1999.

    Address reprint requests to Stephen M. Korbet, MD, 1653 W. Congress Parkway, Chicago, IL 60612.

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