Stephanie Desmon, Johns Hopkins Medicine, August 15, 2011
For years, medical studies have reached the same conclusion: African-American patients do better on kidney dialysis than their white counterparts. But new Johns Hopkins research, published Aug. 10 in the Journal of the American Medical Association, shows that younger blacks–those under the age of 50–actually do much worse on dialysis than equally sick whites who undergo the same blood-filtering process.
The findings, called “surprising” by the research team, could have a serious impact on long-held practices guiding who gets referred for lifesaving kidney transplantation and who remains on dialysis indefinitely.
Previous research on this issue, according to the Johns Hopkins team, has been based on analysis of racial differences in dialysis outcomes for all patients with end-stage kidney disease, a majority of whom are over the age of 50.
The new analysis continues to show a survival benefit for black patients over 50, though not a large one. But when the investigators looked at racial differences stratified by age, they found that the population-based analyses were camouflaging the fact that younger black patients do much worse on dialysis than white patients with a similar health status.
Specifically, results of the new study of 1.3 million patients with end-stage kidney disease show that black patients between the ages of 18 and 30 are twice as likely to die on dialysis than their white counterparts, and those ages 31 to 40 are 1.5 times as likely to die.
Segev, a transplant surgeon, says that the results raise new questions about why this racial disparity in outcomes occurs at all. It is possible, he suggests, that the differences could be attributed to the lower socioeconomic status of many young African-Americans, who are less likely to have good insurance and may receive inadequate or no health care at the earlier stages of their disease. There is also the possibility that there are biological reasons for the disparity, perhaps involving hypertension, which is more prevalent and often more aggressive among African-Americans.