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Comparative Study
. 2009 Dec;24(12):3774-82.
doi: 10.1093/ndt/gfp348. Epub 2009 Jul 21.

Survival of patients from South Asian and Black populations starting renal replacement therapy in England and Wales

Paul Roderick  1 , Catherine Byrne, Anna Casula, Retha Steenkamp, David Ansell, Richard Burden, Dorothea Nitsch, Terry Feest
Affiliations
Comparative Study

Survival of patients from South Asian and Black populations starting renal replacement therapy in England and Wales

Paul Roderick et al. Nephrol Dial Transplant. 2009 Dec.

Abstract

Background: South Asian and Black ethnic minorities in the UK have higher rates of acceptance onto renal replacement therapy (RRT) than Caucasians. Registry studies in the USA and Canada show better survival; there are few data in the UK.

Methods: Renal Association UK Renal Registry data were used to compare the characteristics and survival of patients starting RRT from both groups with those of Caucasians, using incident cases accepted between 1997 and 2006. Survival was analysed by multivariate Cox's proportional hazards regression split by haemodialysis and peritoneal dialysis (PD) due to non-proportionality, and without censoring at transplantation.

Results: A total of 2495 (8.2%) were South Asian and 1218 (4.0%) were Black. They were younger and had more diabetic nephropathy. The age-adjusted prevalence of vascular co-morbidity was higher in South Asians and lower in Blacks; other co-morbidities were generally common in Caucasians. Late referral did not differ. They were less likely to receive a transplant or to start PD. South Asians and Blacks had significantly better survival than Caucasians both from RRT start to Day 90 and after Day 90, and for those on HD or PD at Day 90. Fully adjusted hazard ratios after Day 90 on haemodialysis were 0.70 (0.55-0.89) for South Asians and 0.56 (0.41-0.75) for Blacks.

Conclusion: South Asian and Black minorities have better survival on dialysis. An understanding of the mechanisms may provide general insights for all patients on RRT.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier (KM) plots of age-adjusted survival on haemodialysis after Day 90 by ethnic group for patients without diabetes as primary renal disease.
Fig. 2
Fig. 2
Kaplan–Meier (KM) plots of age-adjusted survival on haemodialysis after Day 90 by ethnic group for patients with diabetes as primary renal disease.
See this image and copyright information in PMC

References

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