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Race and Mortality after Acute Renal Failure

Sushrut S. Waikar^*, Gary C. Curhan^*,, John Z. Ayanian and Glenn M. Chertow

^* Renal Division and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, and the Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts; and Division of Nephrology, Departments of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California

Correspondence: Dr. Sushrut S. Waikar, Brigham and Women's Hospital, MRB-4, 75 Francis Street, Boston, MA 02115. Phone: 617-732-8474; Fax: 617-732-6392; E-mail: swaikar{at}partners.org

Received for publication September 27, 2006. Accepted for publication June 2, 2007.

Black patients receiving dialysis for end-stage renal disease in the United States have lower mortality rates than white patients. Whether racial differences exist in mortality after acute renal failure is not known. We studied acute renal failure in patients hospitalized between 2000 and 2003 using the Nationwide Inpatient Sample and found that black patients had an 18% (95% confidence interval [CI] 16 to 21%) lower odds of death than white patients after adjusting for age, sex, comorbidity, and the need for mechanical ventilation. Similarly, among those with acute renal failure requiring dialysis, black patients had a 16% (95% CI 10 to 22%) lower odds of death than white patients. In stratified analyses of patients with acute renal failure, black patients had significantly lower adjusted odds of death than white patients in settings of coronary artery bypass grafting, cardiac catheterization, acute myocardial infarction, congestive heart failure, pneumonia, sepsis, and gastrointestinal hemorrhage. Black patients were more likely than white patients to be treated in hospitals that care for a larger number of patients with acute renal failure, and black patients had lower in-hospital mortality than white patients in all four quartiles of hospital volume. In conclusion, in-hospital mortality is lower for black patients with acute renal failure than white patients. Future studies should assess the reasons for this difference.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673