Bleyer A J, Tell G S, Evans G W, Ettinger W H, Burkart J M
Department of Internal Medicine, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC 27157, USA.
Am J Kidney Dis. 1996 Jul;28(1):72-81. doi: 10.1016/s0272-6386(96)90133-x.
This study compared racial differences in end-stage renal disease (ESRD) in 550 patients starting renal replacement therapy at a large academic dialysis center between January 1, 1990, and December 31, 1993, with follow-up through December 31, 1994. Patient groups were compared with respect to cause of ESRD, comorbid factors at the start of dialysis therapy, choice of modality, transplantation rate, and survival. Fifty-eight percent of the patients were white and 42% were African-American. There was a similar distribution of causes of ESRD between races. African-American patients were less likely to choose peritoneal dialysis as initial therapy (11.6% v 29.3%; P < 0.001) and were less likely to change dialysis modality. Transplantation rates were significantly different between African-American and white patients (9.3% v 27.6%; P < 0.001). African-Americans less frequently received living-related, living-nonrelated, and cadaveric renal transplants. Given differences in transplantation rates and in survival of transplanted patients versus patients on dialysis, survival analysis was performed without censoring for transplantation. A multivariate Cox proportional hazards model was formed, and the following were identified as being significant independent predictors of survival: age, race, age-race interaction, serum albumin at the start of dialysis, activity level at the start of dialysis, and presence of congestive heart failure and cancer. Age had little effect on survival among African-American patients, while it was a significant predictor of survival in white patients. In the group of patients starting dialysis before the age of 30 years, African-American patients had a significantly increased mortality risk compared with white patients. However, white patients older than 50 years had a higher mortality risk; this risk difference increased with age. Racial differences in mortality among older white patients could not be explained by differences in comorbid conditions, transplantation rates, or withdrawal from dialysis.
本研究比较了1990年1月1日至1993年12月31日期间在一家大型学术透析中心开始接受肾脏替代治疗的550例患者的终末期肾病（ESRD）种族差异，并随访至1994年12月31日。比较了患者组在ESRD病因、透析治疗开始时的合并因素、治疗方式选择、移植率和生存率方面的差异。58%的患者为白人，42%为非裔美国人。不同种族间ESRD病因分布相似。非裔美国患者选择腹膜透析作为初始治疗的可能性较小（11.6%对29.3%；P<0.001），且更换透析方式的可能性也较小。非裔美国人和白人患者的移植率存在显著差异（9.3%对27.6%；P<0.001）。非裔美国人接受亲属活体、非亲属活体和尸体肾移植的频率较低。鉴于移植率以及移植患者与透析患者生存率的差异，进行生存分析时未对移植进行删失。构建了多变量Cox比例风险模型，以下因素被确定为生存的显著独立预测因素：年龄、种族、年龄-种族交互作用、透析开始时的血清白蛋白、透析开始时的活动水平以及是否存在充血性心力衰竭和癌症。年龄对非裔美国患者的生存影响较小，而对白人患者的生存是一个显著预测因素。在30岁之前开始透析的患者组中，非裔美国患者的死亡风险显著高于白人患者。然而，50岁以上的白人患者死亡风险更高；这种风险差异随年龄增加而增大。老年白人患者死亡率的种族差异无法通过合并症、移植率或透析退出率的差异来解释。
