Age, Race, Diabetes, Blood Pressure, and Mortality among Hemodialysis Patients

Myers, Orrin; Adams, Christopher D.; Rohrscheib, Mark; Servilla, Karen S.; Miskulin, Dana C.; Bedrick, Edward J.; Zager, Philip G.

doi:10.1681/asn.2010010125

Cited by 79 publications

(61 citation statements)

References 53 publications

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“…We noted that the African American-Caucasian survival advantage in the setting of significant inflammation was particularly strong among individuals older than 60 years of age, men, and those with diabetes. Consistent with our findings is a recent study of BP among hemodialysis patients by Myers et al 22 that also found the survival advantage for African Americans to be only among their older age group (greater than 40 years) regardless of systolic BP. Furthermore, African American patients with diabetic nephropathy (pre-ESRD) treated in the Department of Veterans Affairs were found to have decreased risk of CVD and mortality when compared with Caucasians.…”

Section: Discussionsupporting

confidence: 93%

Inflammation and the Paradox of Racial Differences in Dialysis Survival

Crews

Sozio

Liu

et al. 2011

Journal of the American Society of Nephrology

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African Americans experience a higher mortality rate and an excess burden of ESRD compared with Caucasians in the general population, but among those treated with dialysis, African Americans typically survive longer than Caucasians. We examined whether differences in inflammation may explain this paradox. We prospectively followed a national cohort of incident dialysis patients in 81 clinics for a median of 3 years (range 4 months to 9.5 years). Among 554 Caucasians and 262 African Americans, we did not detect a significant difference in median CRP between African Americans and Caucasians (3.4 versus 3.9 mg/L). Mortality was significantly lower for African Americans versus Caucasians (34% versus 56% at 5 years); the relative hazard was 0.7 (95% CI, 0.5 to 0.9) after adjusting for age, gender, dialysis modality, smoking, body mass index, diabetes, BP, cholesterol, cardiovascular disease, congestive heart failure, comorbid disease, hemoglobin, albumin, CRP, and IL-6. However, the risk varied by CRP tertile: the relative hazards for African Americans compared with Caucasians were 1.0 (95% CI, 0.7 to 1.4), 0.7 (95% CI, 0.4 to 1.3), and 0.5 (95% CI, 0.3 to 0.8) in the lowest, middle, and highest tertiles, respectively. We obtained similar results when we accounted for transplantation as a competing event, and we examined mortality across tertiles of IL-6. In summary, racial differences in survival among dialysis patients are not present at low levels of inflammation but are large at higher levels. Differences in inflammation may explain, in part, the racial paradox of ESRD survival.

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Section: Discussionsupporting

confidence: 93%

Inflammation and the Paradox of Racial Differences in Dialysis Survival

Crews

Sozio

Liu

et al. 2011

Journal of the American Society of Nephrology

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“…Additionally, with this estimated rate of underdiagnosis in mind, the risk of diagnoses with dementia and Alzheimer's disease after hemodialysis initiation compared with in the general older adult population is potentially even more substantial than what comparing incidence rates would suggest. Additionally, we identified black and Hispanic patients on hemodialysis as being at an elevated risk of being diagnosed with dementia, which is consistent with findings from the geriatric literature (32); these racial and ethnic differences have been attributed to the greater burden of chronic comorbidity in older adults (33,34) as well as older adults with ESKD (35). It is also possible that these black and Hispanic patients on hemodialysis are now receiving routine medical care, which allows for the diagnosis with dementia after hemodialysis initiation, because dementia is often undiagnosed in this population.…”

Section: Discussionsupporting

confidence: 88%

Dementia, Alzheimer’s Disease, and Mortality after Hemodialysis Initiation

McAdams‐DeMarco

Daubresse²,

Bae

et al. 2018

CJASN

105

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Background and objectives Older patients with ESKD experience rapid declines in executive function after initiating hemodialysis; these impairments might lead to high rates of dementia and Alzheimer's disease in this population. We estimated incidence, risk factors, and sequelae of diagnosis with dementia and Alzheimer's disease among older patients with ESKD initiating hemodialysis.Design, setting, participants, & measurements We studied 356,668 older (age $66 years old) patients on hemodialysis (January 1, 2001 to December 31, 2013) from national registry data (US Renal Data System) linked to Medicare. We estimated the risk (cumulative incidence) of diagnosis of dementia and Alzheimer's disease and studied factors associated with these disorders using competing risks models to account for death, change in dialysis modality, and kidney transplant. We estimated the risk of subsequent mortality using Cox proportional hazards models.Results The 1-and 5-year risks of diagnosed dementia accounting for competing risks were 4.6% and 16% for women, respectively, and 3.7% and 13% for men, respectively. The corresponding Alzheimer's disease diagnosis risks were 0.6% and 2.6% for women, respectively, and 0.4% and 2.0% for men, respectively. The strongest independent risk factors for diagnosis of dementia and Alzheimer's disease were age $86 years old (dementia: hazard ratio, 2.11; 95% confidence interval, 2.04 to 2.18; Alzheimer's disease: hazard ratio, 2.11; 95% confidence interval, 1.97 to 2.25), black race (dementia: hazard ratio, 1.70; 95% confidence interval, 1.67 to 1.73; Alzheimer's disease: hazard ratio, 1.78; 95% confidence interval, 1.71 to 1.85), women (dementia: hazard ratio, 1.10; 95% confidence interval, 1.08 to 1.12; Alzheimer's disease: hazard ratio, 1.12; 95% confidence interval, 1.08 to 1.16), and institutionalization (dementia: hazard ratio, 1.36; 95% confidence interval, 1.33 to 1.39; Alzheimer's disease: hazard ratio, 1.10; 95% confidence interval, 1.05 to 1.15). Older patients on hemodialysis with a diagnosis of dementia were at 2.14-fold (95% confidence interval, 2.07 to 2.22) higher risk of subsequent mortality; those with a diagnosis of Alzheimer's disease were at 2.01-fold (95% confidence interval, 1.89 to 2.15) higher mortality risk.Conclusions Older patients on hemodialysis are at substantial risk of diagnosis with dementia and Alzheimer's disease, and carrying these diagnoses is associated with a twofold higher mortality.

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“…1,2 Recent studies confirmed and extended these findings by illustrating the progressive increase in mortality by degree of albuminuria. 3,4 The excess mortality is due primarily to ESRD 5 and to cardiovascular disease, 6 which share many risk factors. Differential expression of these risk factors within an individual may play an important role in determining which disease ultimately prevails.…”

mentioning

confidence: 99%

Is Treatment of Nephropathy in Type 1 Diabetes Efficacious but Ineffective?

Nelson¹

2011

Journal of the American Society of Nephrology

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Age, Race, Diabetes, Blood Pressure, and Mortality among Hemodialysis Patients

Cited by 79 publications

References 53 publications

Inflammation and the Paradox of Racial Differences in Dialysis Survival

Inflammation and the Paradox of Racial Differences in Dialysis Survival

Dementia, Alzheimer’s Disease, and Mortality after Hemodialysis Initiation

Is Treatment of Nephropathy in Type 1 Diabetes Efficacious but Ineffective?

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