Race Differences in Dialysis Survival Linked to Inflammation

Differences in the level of inflammation among dialysis patients may explain, in part, why African Americans have better survival than Caucasians, study findings suggest.

Deidra C. Crews, MD, of Johns Hopkins University School of Medicine in Baltimore, and colleagues prospectively studied 816 dialysis patients–554 Caucasians and 262 African Americans–for a median of three years (range four months to 9.5 years). The mortality rate at five years was 34% for Africans Americans compared with 56% for Caucasians, Dr. Crews’ team reported in the Journal of the American Society of Nephrology (2011;22:2279-2286). After adjusting for gender, age, dialysis modality, and numerous other confounders, African Americans had a 30% decreased risk of death compared with Caucasians. The risk varied by tertile of C-reactive protein (CRP), a marker of systemic inflammation. Compared with Caucasians in the first quartile of CRP level, African Americans in the third tertile had a significant 49% decreased risk of death in a fully adjusted model.

“In our model, the survival advantage among African American dialysis patients was found to only exist in the setting of high levels of inflammation,” the authors wrote. “Racial differences in the presence and response to inflammation may underlie the long-observed survival paradox seem among dialysis patients and is worthy of further investigation.”

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