Ethnicity and Renal Replacement Therapy

Abstract

There are significant ethnic variations in the incidence of kidney disease. White European populations appear to be uniquely protected compared to increased incidences of end-stage renal disease in indigenous and migrant ethnic minority populations. This increase is partly explained by a high prevalence of diabetic nephropathy, but there is also an increased susceptibility to a range of other renal diseases. The relative contributions of genetic, environmental and fetal environmental factors to this susceptibility are not yet well understood. Strategies for early detection and management of chronic kidney disease to delay progression are particularly critical in countries where access to renal replacement therapy (RRT) is restricted. In developed countries with wide availability of RRT, resources to provide dialysis will need to be increased in regions with substantial minority populations. There is apparently counterintuitive evidence that survival on dialysis is increased in many minority populations. Access to renal transplantation, both from deceased and living donors, is also restricted in many minority populations, and graft survival is often inferior. Analysis of the explanations for these differences is complex because of the many confounding factors (for example cultural, social and economic) which typically cosegregate with ethnicity. Nevertheless, reduction of the varied and substantial inequities faced by ethnic minority populations with kidney disease is an important responsibility for the renal community.

Influence of Vascular Access Type on Sex and Ethnicity-Related Mortality in Hemodialysis-Dependent Patients

“…The present study confirms the earlier findings that minority ethnicity in hemodialysis patients confers significantly improved survival over that seen in white hemodialysis patients. 7,8,22,23 Previous reports have also noted that, in particular, Hispanic hemodialysis patients have a survival advantage over nonHispanic hemodialysis patients. 24…”

Health-Related Quality of Life in Hemodialysis Patients: An Iranian Multi-Center Study

“…Since the prevalence of ESRD varies widely among different ethnic groups (35); for example, the south Asian population who live in United Kingdom and suffering from CKD has also a younger age than the indigenous white population (36). In addition, some risk factors of CKD such as diabetes and hypertension are more frequent in this population.…”

Examining Determinants of Patient Outcome in a Low Clearance Clinic

“…Overall, 99% of the patient cohort was Caucasian. Ethnicity, genetics, and socioeconomics are intertwined in influencing the rate of progression of renal failure [17,18]. Data for proteinuria were not included and would have been of interest to investigate the effect on primary and secondary outcomes.…”