Wong J S, Port F K, Hulbert-Shearon T E, Carroll C E, Wolfe R A, Agodoa L Y, Daugirdas J T
United States Renal Data System, University of Michigan, Ann Abor, USA.
Kidney Int. 1999 Jun;55(6):2515-23. doi: 10.1046/j.1523-1755.1999.00464.x.
Survival advantage in Asian American end-stage renal disease patients.
An earlier study documented a lower mortality risk for end-stage renal disease (ESRD) patients in Japan compared with the United States. We compared the mortality of Caucasian (white) and Asian American dialysis patients in the United States to evaluate whether Asian ancestry was associated with lower mortality in the United States.
The study sample from the U.S. Renal Data System census of ESRD patients treated in the United States included 84,192 white or Asian patients starting dialysis during May 1995 to April 1997, of whom 18,435 died by April 30, 1997. Patient characteristics were described by race. Relative mortality risks (RRs) for Asian Americans relative to whites were analyzed by Cox proportional hazards regression models adjusting for characteristics and comorbidities. Population death rates were derived from vital statistics for the United States and Japan by age and sex.
Adjusting for demographics, diabetes, comorbidities, and nutritional factors, the RR for Asian Americans was 0.75 (P = 0.0001). Race-specific background population death rates accounted for over half of the race-related mortality difference. For whites, mortality decreased as the body mass index (BMI) increased. For Asians, the relationship between BMI and survival was u-shaped. The ratio of Asian American/white dialysis death rates and the ratio of Asian American/white general population death rates both varied by age in a similar pattern. The population death rates of Asian American and Japanese were also similar.
Among dialysis patients, Asian Americans had a markedly lower adjusted RR than whites. The effect of BMI on survival differed by race. Compared with the respective general population, dialysis patients had the same relative increase in death rates for both races. The difference in death rates between the United States and Japan does not appear to be primarily treatment related, but rather is related to background death rates.
美国亚裔终末期肾病患者的生存优势。
一项较早的研究记录了日本终末期肾病（ESRD）患者的死亡风险低于美国。我们比较了美国白种人和亚裔美国透析患者的死亡率，以评估在美国亚裔血统是否与较低的死亡率相关。
该研究样本来自美国肾脏数据系统对在美国接受治疗的ESRD患者的普查，包括1995年5月至1997年4月开始透析的84192名白种人或亚裔患者，其中18435人在1997年4月30日前死亡。按种族描述患者特征。通过Cox比例风险回归模型分析亚裔美国人相对于白种人的相对死亡风险（RRs），并对特征和合并症进行调整。人口死亡率来自美国和日本按年龄和性别的生命统计数据。
在调整了人口统计学、糖尿病、合并症和营养因素后，亚裔美国人的RR为0.75（P = 0.0001）。特定种族的背景人口死亡率占种族相关死亡差异的一半以上。对于白种人，死亡率随着体重指数（BMI）的增加而降低。对于亚裔，BMI与生存之间的关系呈U形。亚裔美国/白种人透析死亡率之比和亚裔美国/白种人总体人口死亡率之比在不同年龄组中均呈现相似的变化模式。亚裔美国人和日本人的人口死亡率也相似。
在透析患者中，亚裔美国人经调整后的RR显著低于白种人。BMI对生存的影响因种族而异。与各自的总体人口相比，两个种族的透析患者死亡率的相对增幅相同。美国和日本之间的死亡率差异似乎主要不是与治疗相关，而是与背景死亡率相关。
