Survival disparities within American and Israeli dialysis populations: learning from similarities and distinctions across race and ethnicity

Abstract

There are counterintuitive but consistent observations that African American maintenance dialysis patients have greater survival despite their less favorable socioeconomic status, high burden of cardiovascular risks including hypertension and diabetes, and excessively high chronic kidney disease prevalence. The fact that such individuals have a number of risk factors for lower survival and yet live longer when undergoing dialysis treatment is puzzling. Similar findings have been made among Israeli maintenance dialysis patients, in that those who are ethnically Arab have higher end-stage renal disease but exhibit greater survival than Jewish Israelis. The juxtaposition of these two situations may provide valuable insights into racial/ethnic-based mechanisms of survival in chronic diseases. Survival advantages of African American dialysis patients may be explained by differences in nutritional status, inflammatory profile, dietary intake habits, body composition, bone and mineral disorders, mental health and coping status, dialysis treatment differences, and genetic differences among other factors. Prospective studies are needed to examine similar models in other countries and to investigate the potential causes of these paradoxes in these societies. Better understanding the roots of racial/ethnic survival differences may help improve outcomes in both patients with chronic kidney disease and other individuals with chronic disease states.

Conflict of interest statement

Relevant Potential Conflict of Interest: None declared.

© 2010 Wiley Periodicals, Inc.

Figures

Fig. 1

Comparing mortality in the general population of African Americans and Caucasians in the United States (US Census Bureau Vital Statistics, 2010). The y-axis is mortality rate.

Fig. 2

Crude annual mortality US dialysis patients: African Americans vs. whites (USRDS data 2009).

Fig. 3

Rise in the incidence of end-stage renal disease in Israel in both Arabs and Jews (39).

Fig. 4

Kaplan–Meier survival graphs comparing the survival rates from the time of first dialysis treatment in Israeli dialysis patients between Arabs and Jews (39).

Fig. 5

Rise in the prevalence of patients with a functioning kidney transplant in Israel in both Arabs and Jews (39).

Fig. 6

Potential mechanisms leading to survival disparities of African American dialysis patients.