August 16, 2011

Dangerous Dialysis for African Americans

(Ivanhoe Newswire)"”New research questions the validity of kidney dialysis beliefs. For years, medical studies have suggested that African-American patients experience a better recovery on kidney dialysis than their white counterparts. However, research from Johns Hopkins shows that young black patients on kidney dialysis actually do much worse and thus has the potential to reverse longstanding guidelines and advice given to African-American patients with kidney disease.

These surprising findings could seriously affect practices developed to guide the decision of which patients get referred for lifesaving kidney transplantation and who remains on dialysis indefinitely. Dialysis is a process in which waste and excess water are removed from the blood and acts as an artificial replacement for lost kidney function in patients with renal failure. This new study shows that there is a survival benefit for black patients over 50, but not a significant one. When investigators of the study examined racial differences stratified by age, they concluded that the population-based analyses were disguising the fact that younger black patients do much worse of kidney dialysis than white patients with similar health issues.

Leader of the study, Dorry L. Segev, M.D., Ph.D., associate professor of surgery at Johns Hopkins University School of Medicine was quoted saying, "As a medical community, we have been advising young black patients of treatment options for kidney failure based on the notion that they do better on dialysis than their white counterparts. This new study shows that, actually, young blacks have a substantially higher risk of dying on dialysis, and we should instead be counseling them based on this new surprising evidence."

The specific results of this study, which consisted of 1.3 million patients with end-stage kidney disease, show that black patients between the ages of 18 and 30 are twice as likely to die on dialysis as their white counterparts; and those ages 31 to 40 are 1.5 times as likely not to survive. As a result of this long-held belief that black patients did better on dialysis, it may be possible that fewer black patients of all ages were referred for transplants.

Segev says that this study raises the question of why racial disparity outcomes occur at all. He suggests they could be due to differences in socioeconomic status for many young African-Americans who are less likely to have health insurance or receive adequate health care, and there is also the possibility of biological reasons such as hyper tension. Whatever the reason may be, more African-American patients need to be referred to transplants.

SOURCE: JAMA, August 15, 2011