The Color of Dialysis

Dialysis outcomes for young black kidney disease patients realize worse outcomes

(RxWiki News) For some time, studies have suggested that African-Americans do better on dialysis than whites. Such findings have affected practices guiding who gets kidney transplants. Now, those practices may need to change.

African-Americans do not do better on dialysis than whites. In fact, blacks under the age of 50 do worse than whites who are just as sick.

"More African-Americans should be referred for transplants."

These findings are surprising, says the study's research team, which was led by Dorry L. Segev, M.D., Ph.D., from Johns Hopkins University School of Medicine.

It is possible that less blacks were getting referred for kidney transplants because of this long-standing belief that black patients did better on dialysis, says Dr. Segev. Yet, the results of this study show that doctors should be advising their black patients based on the fact that they are more likely than whites to suffer - or even die - while on dialysis.

When the kidneys fail, they are no longer filtering blood, which can put a person at a high risk for death. Dialysis is a process that keeps these patients alive. In dialysis, a patient is connected to a machine that removes waste and excess water from the blood. Dialysis patients have to go through the tiring and difficult process several times a week for many hours at a time.

In past studies, researchers were comparing racial differences in dialysis outcomes for kidney disease patients of all ages. Most of these patients are over 50 years old. Findings showed that older black patients did better on dialysis.

When Dr. Segev and colleagues compared racial differences between patients under 50 years of age, they found a totally different story for younger African-American patients on dialysis for end-stage kidney disease.

For their study, the researchers looked at 1.3 million patients with end-stage kidney disease. They found that black patients between 18 and 30 years of age are two times more likely to die on dialysis than white patients. Black patients between 31 and 40 years of age are 1.5 times more likely to die, compared to whites.

According to Dr. Segev, these findings bring up new questions about why there is such a racial disparity when it comes dialysis outcomes. He says that it is possible that the disparity is caused by the generally lower socioeconomic status of many young African-Americans. These poorer patients are less likely to have insurance. They may not be getting health care in the earliest stages of the disease. Biological reasons may also be to blame for the disparity in dialysis outcomes.

Regardless of what is causing the differences, doctors need to let their black patients know that they are not likely to do better on dialysis, says Dr. Segev. He adds that more African-Americans need to be referred for transplants.

The study - which is published in the Journal of the American Medical Association - received funding from the National Institutes of Diabetes and Digestive and Kidney Diseases and by a Paul Beeson Career Development Award.

Review Date: 
August 11, 2011