Harold Simmons Center for Chronic Disease Research and Epidemiology, Torrance, CA, USA.
Am J Kidney Dis. 2011 Jun;57(6):883-93. doi: 10.1053/j.ajkd.2010.10.050. Epub 2011 Jan 15.
Observational studies indicate greater survival in African American and Hispanic maintenance hemodialysis patients compared with their non-Hispanic white counterparts, although African Americans have shorter life expectancy than whites in the general population. We hypothesized that this apparent survival advantage is due to a more favorable nutritional/inflammatory profile in minority hemodialysis patients.
We examined the association between race/ethnicity and 5-year survival before and after adjustment for case-mix and surrogates of the malnutrition-inflammation complex syndrome (MICS) using Cox regression with or without matched sampling in a large cohort of adult hemodialysis patients.
SETTING & PARTICIPANTS: 124,029 adult hemodialysis patients, including 16% Hispanics, 49% non-Hispanic whites, and 35% African Americans.
Race/ethnicity before and after adjustment for MICS, including values for body mass index, serum albumin, total iron-binding capacity, ferritin, creatinine, phosphorus, calcium, bicarbonate, white blood cell count, lymphocyte percentage, hemoglobin, and protein intake.
5-year (July 2001 to June 2006) survival.
In dialysis patients, blacks and Hispanics had lower mortality overall than non-Hispanic whites after traditional case-mix adjustment. However, after additional control for MICS, Hispanics had mortality similar to non-Hispanic whites, and African Americans had even higher mortality. Unadjusted, case-mix-, and MICS-adjusted HRs for African Americans versus whites were 0.68 (95% CI, 0.66-0.69), 0.89 (95% CI, 0.86-0.91), and 1.06 (95% CI, 1.03-1.09) in the unmatched cohort and, 0.95 (95% CI, 0.90-0.99), 0.89 (95% CI, 0.84-0.94), and 1.16 (95% CI, 1.07-1.26) in the matched cohort, and for Hispanics versus whites, 0.66 (95% CI, 0.64-0.69), 0.84 (95% CI, 0.81-0.87), and 0.97 (95% CI, 0.94-1.00) in the unmatched cohort and 0.89 (95% CI, 0.84-0.95), 0.88 (95% CI, 0.83-0.95), and 0.98 (95% CI, 0.91-1.06) in the matched cohort, respectively.
Adjustment cannot be made for unmeasured confounders.
Survival advantages of African American and Hispanic hemodialysis patients may be related to differences in nutritional and inflammatory status. Further studies are required to explore these differences.
观察性研究表明，与非西班牙裔白人相比，非裔美国人和西班牙裔维持性血液透析患者的生存率更高，尽管非裔美国人的预期寿命比普通人群中的白人短。我们假设这种明显的生存优势是由于少数血液透析患者的营养/炎症状况更有利。
我们使用 Cox 回归，在一个大型成年血液透析患者队列中，通过匹配采样或不匹配采样，在调整病例组合和营养不良-炎症综合征（MICS）替代指标之前和之后，检查种族/族裔与 5 年生存率之间的关联。
包括 16%的西班牙裔、49%的非西班牙裔白人、35%的非裔美国人在内的 124029 名成年血液透析患者。
MICS 之前和之后的种族/族裔，包括体重指数、血清白蛋白、总铁结合能力、铁蛋白、肌酐、磷、钙、碳酸氢盐、白细胞计数、淋巴细胞百分比、血红蛋白和蛋白质摄入量的值。
5 年（2001 年 7 月至 2006 年 6 月）生存率。
在透析患者中，在传统病例组合调整后，黑人和西班牙裔的死亡率总体上低于非西班牙裔白人。然而，在进一步控制 MICS 后，西班牙裔与非西班牙裔白人的死亡率相似，而非裔美国人的死亡率甚至更高。未调整、病例组合调整和 MICS 调整的非裔美国人与白人的 HR 分别为 0.68（95%CI，0.66-0.69）、0.89（95%CI，0.86-0.91）和 1.06（95%CI，1.03-1.09）在未匹配队列中，0.95（95%CI，0.90-0.99）、0.89（95%CI，0.84-0.94）和 1.16（95%CI，1.07-1.26）在匹配队列中，以及西班牙裔与白人的 HR 分别为 0.66（95%CI，0.64-0.69）、0.84（95%CI，0.81-0.87）和 0.97（95%CI，0.94-1.00）在未匹配队列中，以及 0.89（95%CI，0.84-0.95）、0.88（95%CI，0.83-0.95）和 0.98（95%CI，0.91-1.06）在匹配队列中。
无法对未测量的混杂因素进行调整。
非裔美国人和西班牙裔血液透析患者的生存优势可能与营养和炎症状况的差异有关。需要进一步研究来探讨这些差异。
