Kalantar-Zadeh Kamyar, Golan Eliezer, Shohat Tamy, Streja Elani, Norris Keith C, Kopple Joel D
Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA, Harold Simmons Center for Chronic Disease Research and Epidemiology, Torrance, California 90509-2910, USA.
Semin Dial. 2010 Nov-Dec;23(6):586-94. doi: 10.1111/j.1525-139X.2010.00795.x.
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.
有一些违反直觉但一致的观察结果表明，非裔美国维持性透析患者尽管社会经济地位较差、心血管疾病风险负担较高（包括高血压和糖尿病）以及慢性肾病患病率过高，但生存率更高。这些个体有许多导致较低生存率的风险因素，然而在接受透析治疗时却活得更长，这一事实令人困惑。在以色列维持性透析患者中也有类似的发现，即那些阿拉伯族裔的患者终末期肾病发病率更高，但比犹太裔以色列人表现出更高的生存率。这两种情况的并列可能为慢性病基于种族/民族的生存机制提供有价值的见解。非裔美国透析患者的生存优势可能由营养状况、炎症指标、饮食摄入习惯、身体组成、骨与矿物质紊乱、心理健康和应对状况、透析治疗差异以及基因差异等其他因素的不同来解释。需要进行前瞻性研究，以检验其他国家的类似模式，并调查这些社会中这些矛盾现象的潜在原因。更好地理解种族/民族生存差异的根源可能有助于改善慢性肾病患者以及其他慢性病患者的治疗结果。
