Journal of the American Society of Nephrology, Vol 5, 1231-1242, Copyright © 1994 by American Society of Nephrology

REGULAR ARTICLES

Causes of death in dialysis patients: racial and gender differences

WE Bloembergen, FK Port, EA Mauger and RA Wolfe
Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor.

The risk of death in the dialysis population is high and has previously been shown to be accentuated in male (versus female) and white (versus black) subgroups. To better understand the difference in mortality among these subgroups, the causes of death between males and females as well as between whites and blacks adjusting for age, cause of ESRD (diabetic versus nondiabetic), dialysis modality, and time on dialysis (< 1 yr versus > 1 yr) were compared, with national data obtained from the U.S. Renal Data System. A total of 42,372 deaths occurring over 170,700 patient years at risk were analyzed. Males had a 22% higher risk of death than females (P < 0.001), attributable to a higher risk of death due to acute myocardial infarction (relative death rate ratio (RR) = 1.48; P = 0.001), all other cardiac causes (RR = 1.3; P = 0.001), and malignancy (RR = 1.59; P < 0.001). Whites had a 29% higher risk of death than blacks (P < 0.001), accounted for by an increased risk of death due to acute myocardial infarction (RR = 1.34), all other cardiac causes (RR = 1.30), withdrawal from dialysis (RR = 2.72) (all P < 0.001), and infection (RR = 1.09; P = 0.005). This analysis expands the knowledge and understanding of the excess mortality seen in male and white subgroups, which is a necessary step in designing strategies to reduce the high mortality in dialysis patients.

This article has been cited by other articles:

				J. T. Park, T. I. Chang, D. K. Kim, J. E. Lee, H. Y. Choi, H. W. Kim, J. H. Chang, S. Y. Park, E. Kim, T.-H. Yoo, et al. Metabolic syndrome predicts mortality in non-diabetic patients on continuous ambulatory peritoneal dialysis Nephrol. Dial. Transplant., February 1, 2010; 25(2): 599 - 604. [Abstract] [Full Text] [PDF]

				D. J. de Jager, D. C. Grootendorst, K. J. Jager, P. C. van Dijk, L. M. J. Tomas, D. Ansell, F. Collart, P. Finne, J. G. Heaf, J. De Meester, et al. Cardiovascular and Noncardiovascular Mortality Among Patients Starting Dialysis JAMA, October 28, 2009; 302(16): 1782 - 1789. [Abstract] [Full Text] [PDF]

				A. A. Lopes, J. L. Bragg-Gresham, S. P. B. Ramirez, V. E. Andreucci, T. Akiba, A. Saito, S. H. Jacobson, B. M. Robinson, F. K. Port, N. A. Mason, et al. Prescription of antihypertensive agents to haemodialysis patients: time trends and associations with patient characteristics, country and survival in the DOPPS Nephrol. Dial. Transplant., September 1, 2009; 24(9): 2809 - 2816. [Abstract] [Full Text] [PDF]

				C. P. Kovesdy, J. E. Anderson, S. F. Derose, and K. Kalantar-Zadeh Outcomes Associated with Race in Males with Nondialysis-Dependent Chronic Kidney Disease Clin. J. Am. Soc. Nephrol., May 1, 2009; 4(5): 973 - 978. [Abstract] [Full Text] [PDF]

				H. Trivedi, Q. Xiang, and J. P. Klein Risk factors for non-fatal myocardial infarction and cardiac death in incident dialysis patients Nephrol. Dial. Transplant., January 1, 2009; 24(1): 258 - 266. [Abstract] [Full Text] [PDF]

				T. O. van den Beukel, F. W. Dekker, and C. E. H. Siegert Increased survival of immigrant compared to native dialysis patients in an urban setting in the Netherlands Nephrol. Dial. Transplant., November 1, 2008; 23(11): 3571 - 3577. [Abstract] [Full Text] [PDF]

				K. L. Lentine, L. A. R. Rey, S. Kolli, G. Bacchi, M. A. Schnitzler, K. C. Abbott, H. Xiao, and D. C. Brennan Variations in the Risk for Cerebrovascular Events after Kidney Transplant Compared with Experience on the Waiting List and after Graft Failure Clin. J. Am. Soc. Nephrol., July 1, 2008; 3(4): 1090 - 1101. [Abstract] [Full Text] [PDF]

				M. Wolf, J. Betancourt, Y. Chang, A. Shah, M. Teng, H. Tamez, O. Gutierrez, C. A. Camargo Jr., M. Melamed, K. Norris, et al. Impact of Activated Vitamin D and Race on Survival among Hemodialysis Patients J. Am. Soc. Nephrol., July 1, 2008; 19(7): 1379 - 1388. [Abstract] [Full Text] [PDF]

				S. S. Waikar, G. C. Curhan, J. Z. Ayanian, and G. M. Chertow Race and Mortality after Acute Renal Failure J. Am. Soc. Nephrol., October 1, 2007; 18(10): 2740 - 2748. [Abstract] [Full Text] [PDF]

				R. A. Rodriguez, S. Sen, K. Mehta, S. Moody-Ayers, P. Bacchetti, and A. M. O'Hare Geography Matters: Relationships among Urban Residential Segregation, Dialysis Facilities, and Patient Outcomes Ann Intern Med, April 3, 2007; 146(7): 493 - 501. [Abstract] [Full Text] [PDF]

				S. Rajagopalan, S. Dellegrottaglie, A. L. Furniss, B. W. Gillespie, S. Satayathum, N. Lameire, A. Saito, T. Akiba, M. Jadoul, N. Ginsberg, et al. Peripheral Arterial Disease in Patients With End-Stage Renal Disease: Observations From the Dialysis Outcomes and Practice Patterns Study (DOPPS) Circulation, October 31, 2006; 114(18): 1914 - 1922. [Abstract] [Full Text] [PDF]

				B. M. Robinson, M. M. Joffe, R. L. Pisoni, F. K. Port, and H. I. Feldman Revisiting Survival Differences by Race and Ethnicity among Hemodialysis Patients: The Dialysis Outcomes and Practice Patterns Study J. Am. Soc. Nephrol., October 1, 2006; 17(10): 2910 - 2918. [Abstract] [Full Text] [PDF]

				B. B. Newsome, W. M. McClellan, C. S. Coffey, J. J. Allison, C. I. Kiefe, and D. G. Warnock Survival Advantage of Black Patients with Kidney Disease after Acute Myocardial Infarction Clin. J. Am. Soc. Nephrol., September 1, 2006; 1(5): 993 - 999. [Abstract] [Full Text] [PDF]

				B. I. Freedman, D. W. Bowden, M. M. Sale, C. D. Langefeld, and S. S. Rich Genetic Susceptibility Contributes to Renal and Cardiovascular Complications of Type 2 Diabetes Mellitus Hypertension, July 1, 2006; 48(1): 8 - 13. [Full Text] [PDF]

				R. M. Merion, V. B. Ashby, R. A. Wolfe, D. A. Distant, T. E. Hulbert-Shearon, R. A. Metzger, A. O. Ojo, and F. K. Port Deceased-Donor Characteristics and the Survival Benefit of Kidney Transplantation JAMA, December 7, 2005; 294(21): 2726 - 2733. [Abstract] [Full Text] [PDF]

				R. S. Parekh, L. Zhang, B. A. Fivush, and M. J. Klag Incidence of Atherosclerosis by Race in the Dialysis Morbidity and Mortality Study: A Sample of the US ESRD Population J. Am. Soc. Nephrol., May 1, 2005; 16(5): 1420 - 1426. [Abstract] [Full Text] [PDF]

				H. C. Rayner, R. L. Pisoni, J. Bommer, B. Canaud, E. Hecking, F. Locatelli, L. Piera, J. L. Bragg-Gresham, H. I. Feldman, D. A. Goodkin, et al. Mortality and hospitalization in haemodialysis patients in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS) Nephrol. Dial. Transplant., January 1, 2004; 19(1): 108 - 120. [Abstract] [Full Text] [PDF]

				S. L. Seliger, D. L. Gillen, D. Tirschwell, H. Wasse, B. R. Kestenbaum, and C. O. Stehman-Breen Risk Factors for Incident Stroke among Patients with End-Stage Renal Disease J. Am. Soc. Nephrol., October 1, 2003; 14(10): 2623 - 2631. [Abstract] [Full Text] [PDF]

				T. S. Ahuja, J. Grady, and S. Khan Changing Trends in the Survival of Dialysis Patients with Human Immunodeficiency Virus in the United States J. Am. Soc. Nephrol., July 1, 2002; 13(7): 1889 - 1893. [Abstract] [Full Text] [PDF]

				A. K. Jha, M. G. Shlipak, W. Hosmer, C. D. Frances, and W. S. Browner Racial Differences in Mortality Among Men Hospitalized in the Veterans Affairs Health Care System JAMA, January 17, 2001; 285(3): 297 - 303. [Abstract] [Full Text] [PDF]

				R. G. Luke Hypertensive nephrosclerosis: pathogenesis and prevalence : Essential hypertension is an important cause of end-stage renal disease Nephrol. Dial. Transplant., October 1, 1999; 14(10): 2271 - 2278. [Full Text] [PDF]

				G. L. Daumit, J. A. Hermann, J. Coresh, and N. R. Powe Use of Cardiovascular Procedures among Black Persons and White Persons: A 7-Year Nationwide Study in Patients with Renal Disease Ann Intern Med, February 2, 1999; 130(3): 173 - 182. [Abstract] [Full Text] [PDF]

				W. F. Owen Jr, G. M. Chertow, J. M. Lazarus, and E. G. Lowrie Dose of Hemodialysis and Survival: Differences by Race and Sex JAMA, November 25, 1998; 280(20): 1764 - 1768. [Abstract] [Full Text] [PDF]

				C. A. Herzog, J. Z. Ma, and A. J. Collins Poor Long-Term Survival after Acute Myocardial Infarction among Patients on Long-Term Dialysis N. Engl. J. Med., September 17, 1998; 339(12): 799 - 805. [Abstract] [Full Text] [PDF]

				G. M. Chertow, A. D. Paltiel, W. F. Owen Jr, and J. M. Lazarus Cost-effectiveness of Cancer Screening in End-Stage Renal Disease Arch Intern Med, June 24, 1996; 156(12): 1345 - 1350. [Abstract] [PDF]

Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673