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      Ethnicity and Renal Replacement Therapy

      review-article
      Blood Purification
      S. Karger AG
      Renal transplantation, Ethnic minorities, Renal replacement therapy, Haemodialysis, Peritoneal dialysis

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          Abstract

          There are significant ethnic variations in the incidence of kidney disease. White European populations appear to be uniquely protected compared to increased incidences of end-stage renal disease in indigenous and migrant ethnic minority populations. This increase is partly explained by a high prevalence of diabetic nephropathy, but there is also an increased susceptibility to a range of other renal diseases. The relative contributions of genetic, environmental and fetal environmental factors to this susceptibility are not yet well understood. Strategies for early detection and management of chronic kidney disease to delay progression are particularly critical in countries where access to renal replacement therapy (RRT) is restricted. In developed countries with wide availability of RRT, resources to provide dialysis will need to be increased in regions with substantial minority populations. There is apparently counterintuitive evidence that survival on dialysis is increased in many minority populations. Access to renal transplantation, both from deceased and living donors, is also restricted in many minority populations, and graft survival is often inferior. Analysis of the explanations for these differences is complex because of the many confounding factors (for example cultural, social and economic) which typically cosegregate with ethnicity. Nevertheless, reduction of the varied and substantial inequities faced by ethnic minority populations with kidney disease is an important responsibility for the renal community.

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          Most cited references18

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          Racial differences in the progression from chronic renal insufficiency to end-stage renal disease in the United States.

          Black Americans experience a disproportionate burden of ESRD compared with whites. Whether this is caused by the increased prevalence of chronic renal insufficiency (CRI) among blacks or by their increased progression from CRI to ESRD was investigated. A birth cohort analysis was performed using data from the Third National Health and Nutrition Examination Survey and the United States Renal Data System. It was assumed that those who developed ESRD in 1996 aged 25 to 79 yr came from the source population with CRI aged 20 to 74 yr that was sampled in the Third National Health and Nutrition Examination Survey (midpoint 1991). GFR was estimated using the Modification of Diet in Renal Disease study equation. The prevalence of CRI (GFR 15 to 59 ml/min per 1.73 m(2)) was not different among black compared with white adults (2060 versus 2520 per 100,000; P = 0.14). For each 100 blacks with CRI in 1991, five new cases of ESRD developed in 1996, whereas only one case of ESRD developed per 100 whites with CRI (risk ratio, 4.8; 95% confidence interval, 2.9 to 8.4). The increased risk for blacks compared with whites was only modestly affected by adjustment for age, gender, and diabetes. Blacks with CRI had higher systolic (147 versus 136 mmHg; P = 0.001) and diastolic (82 versus 77 mmHg; P = 0.02) BP and greater albuminuria (422 versus 158 micro g urine albumin/mg urine creatinine; P = 0.01). The higher incidence of ESRD among blacks is not due to a greater prevalence of CRI among blacks. The key to understanding black-white differences in ESRD incidence lies in understanding the extreme differences in their progression from CRI to ESRD.
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            Economic Consequences of Diabetes Mellitus in the U.S. in 1997

            (1998)
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              Health-related quality of life and associated outcomes among hemodialysis patients of different ethnicities in the United States: the Dialysis Outcomes and Practice Patterns Study (DOPPS).

              In the United States, an association between mortality risk and ethnicity has been observed among hemodialysis patients. This study was developed to assess whether health-related quality of life (HRQOL) scores also vary among patients of different ethnic backgrounds. Associations between HRQOL and adverse dialysis outcomes (ie, death and hospitalization) also were assessed for all patients and by ethnicity. Data are from the Dialysis Outcomes and Practice Patterns Study for 6,151 hemodialysis patients treated in 148 US dialysis facilities who filled out the Kidney Disease Quality of Life Short Form. We determined scores for three components of HRQOL: Physical Component Summary (PCS), Mental Component Summary (MCS), and Kidney Disease Component Summary (KDCS). Patients were classified by ethnicity as Hispanic and five non-Hispanic categories: white, African American, Asian, Native American, and other. Multiple linear regression models were used to estimate differences in HRQOL scores among ethnic groups, using whites as the referent category. Cox regression models were used for associations between HRQOL and outcomes. Regression models were adjusted for sociodemographic variables, delivered dialysis dose (equilibrated Kt/V), body mass index, years on dialysis therapy, and several laboratory/comorbidity variables. Compared with whites, African Americans showed higher HRQOL scores for all three components (MCS, PCS, and KDCS). Asians had higher adjusted PCS scores than whites, but did not differ for MCS or KDCS scores. Compared with whites, Hispanic patients had significantly higher PCS scores and lower MCS and KDCS scores. Native Americans showed significantly lower adjusted MCS scores than whites. The three major components of HRQOL were significantly associated with death and hospitalization for the entire pooled population, independent of ethnicity. The data indicate important differences in HRQOL among patients of different ethnic groups in the United States. Furthermore, HRQOL scores predict death and hospitalization among these patients. Copyright 2003 by the National Kidney Foundation, Inc.
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                Author and article information

                Journal
                BPU
                Blood Purif
                10.1159/issn.0253-5068
                Blood Purification
                S. Karger AG
                978-3-8055-9340-3
                978-3-8055-9341-0
                0253-5068
                1421-9735
                2010
                January 2010
                08 January 2010
                : 29
                : 2
                : 125-129
                Affiliations
                John Walls Renal Unit, Leicester General Hospital, and Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
                Article
                245638 Blood Purif 2010;29:125–129
                10.1159/000245638
                20093817
                bbb6cb09-5146-4a36-a83f-4eb661cd89a0
                © 2010 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Page count
                References: 29, Pages: 5
                Categories
                Paper

                Cardiovascular Medicine,Nephrology
                Renal replacement therapy,Ethnic minorities,Peritoneal dialysis,Haemodialysis,Renal transplantation

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