Salahudeen A K, Deogaygay B, Fleischmann E, Bower J D
Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA.
Am J Kidney Dis. 2000 Dec;36(6):1147-54. doi: 10.1053/ajkd.2000.19828.
The mortality rate on hemodialysis therapy remains unacceptably high, and it is worse in whites than blacks. Substantially elevated serum aluminum levels have been shown to predict mortality on hemodialysis. However, whether this is a factor in the race-dependent survival difference on hemodialysis therapy is presently unknown. To determine the relevance of serum aluminum level on race-dependent survival disparity on chronic hemodialysis therapy, 1-year survival of 118 whites was prospectively compared with 473 age- and sex-matched blacks. The variables predictive for survival, including serum aluminum level, were defined separately in whites and blacks using Cox univariate and multivariate analyses. The 1-year mortality rate was significantly greater in whites than blacks (18% versus 12%; P: < 0.001). Serum albumin level, body mass index (BMI), and creatinine level had a positive influence, whereas age had a negative influence on survival in both groups in the univariate analysis. The mean serum aluminum level was significantly greater in whites (n = 118) than blacks (n = 473; 20 +/- 2.3 versus 14 +/- 0.6 [SE] ng/mL; P: = 0.0009) and was not caused by increased duration on dialysis, increased prescription of aluminum-containing phosphate binders, or reduced delivered dose of dialysis. Unlike the blacks, serum aluminum levels had a significant negative influence on the survival of whites, and this persisted in multivariate analysis after controlling for age, sex, diabetes, albumin level, creatinine level, and BMI (relative risk, 1.013; 95% confidence interval, 1.004 to 1.023; P: < 0.007). In summary, this study suggests that whites undergoing hemodialysis may have greater serum aluminum levels than blacks, which might contribute to the whites' greater rate of mortality. Because hyperaluminemia is a modifiable risk factor, studies are required to verify our findings, explore the mechanism of elevated aluminum levels in whites, and test the hypothesis that reducing serum aluminum levels in whites may improve their survival.
血液透析治疗的死亡率仍然高得令人难以接受，而且白人的死亡率比黑人更高。血清铝水平大幅升高已被证明可预测血液透析的死亡率。然而，目前尚不清楚这是否是血液透析治疗中种族依赖性生存差异的一个因素。为了确定血清铝水平与慢性血液透析治疗中种族依赖性生存差异的相关性，对118名白人的1年生存率与473名年龄和性别匹配的黑人进行了前瞻性比较。使用Cox单变量和多变量分析分别在白人和黑人中定义预测生存的变量，包括血清铝水平。白人的1年死亡率显著高于黑人（18%对12%；P：<0.001）。在单变量分析中，血清白蛋白水平、体重指数（BMI）和肌酐水平对两组的生存有积极影响，而年龄对生存有负面影响。白人（n = 118）的平均血清铝水平显著高于黑人（n = 473；20±2.3对14±0.6[SE]ng/mL；P：= 0.0009），这不是由透析时间延长、含铝磷结合剂处方增加或透析剂量减少引起的。与黑人不同，血清铝水平对白人的生存有显著负面影响，在控制年龄、性别、糖尿病、白蛋白水平、肌酐水平和BMI后，多变量分析中这种影响仍然存在（相对风险，1.013；95%置信区间，1.004至1.023；P：<0.007）。总之，本研究表明，接受血液透析的白人可能比黑人有更高的血清铝水平，这可能导致白人更高的死亡率。由于高铝血症是一个可改变的危险因素，需要进行研究来验证我们的发现，探索白人铝水平升高的机制，并检验降低白人血清铝水平可能改善其生存的假设。
