文章基本信息

标题：Survival on Dialysis Among American Indians and Alaska Natives With Diabetes in the United States, 1995–2010
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作者：Nilka Ríos Burrows ; Pyone Cho ; Kai McKeever Bullard 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2014
卷号：104
期号：Suppl 3
页码：S490-S495
DOI：10.2105/AJPH.2014.301942
语种：English
出版社：American Public Health Association
摘要：Objectives. We assessed survival in American Indians and Alaska Natives (AI/ANs) with end-stage renal disease attributed to diabetes who initiated hemodialysis between 1995 and 2009. Methods. Follow-up extended from the first date of dialysis in the United States Renal Data System until December 31, 2010, kidney transplantation, or death. We used the Kaplan-Meier method to compute survival on dialysis by age and race/ethnicity and Cox regression analysis to compute adjusted hazard ratios (HRs). Results. Our study included 510 666 persons—48% Whites, 2% AI/AN persons, and 50% others. Median follow-up was 2.2 years (interquartile range = 1.1–4.1 years). At any age, AI/AN persons survived longer on hemodialysis than Whites; this finding persisted after adjusting for baseline differences. Among AI/AN individuals, those with full Indian blood ancestry had the lowest adjusted risk of death compared with Whites (HR = 0.58; 95% confidence interval = 0.55, 0.61). The risk increased with declining proportion of AI/AN ancestry. Conclusions. Survival on dialysis was better among AI/AN than White persons with diabetes. Among AI/AN persons, the inverse relationship between risk of death and level of AI/AN ancestry suggested that cultural or hereditary factors played a role in survival. End-stage renal disease (ESRD), which is kidney failure requiring dialysis or transplantation, is a costly and disabling condition that disproportionately affects racial/ethnic minority populations. 1 In 2010, approximately 408 000 people in the United States were living on dialysis, 2 including approximately 6000 patients who were American Indian/Alaska Native (AI/AN) persons, and nearly half of the new dialysis patients belonged to racial/ethnic minorities. 2,3 Diabetes is the leading cause of ESRD, accounting for approximately 45% of new cases in the United States. Because both diabetes and dialysis disproportionately affect racial/ethnic minority populations, 1,3–5 a greater proportion of incident ESRD is attributed to diabetes among AI/AN persons (71%), Hispanics (60%), and Asians (50%) than among Whites. 2 Although survival on dialysis has improved across treatment modalities, it remains much reduced; half of the patients with ESRD attributed to diabetes die within 3 years of beginning dialysis in the United States. 1 Regardless of the type of ESRD treatment, survival is generally poorer in diabetic ESRD patients than in those without diabetes, primarily because of the higher coexistent morbidity associated with diabetes, particularly cardiovascular diseases. 6–9 Survival on dialysis, however, is generally longer among non-White than White patients, although a few smaller studies have focused on the ESRD population with diabetes. 6,10,11 In this study, we assessed survival in persons in the US Renal Data System (USRDS) who initiated hemodialysis between 1995 and 2009 with diabetes as the primary cause of kidney failure. Adjusted risk of death during hemodialysis was compared across the AI/AN population and 4 other mutually exclusive racial/ethnic groups, including Whites, in an attempt to explain the survival differences among these groups.