Racial and ethnic differences in mortality of hemodialysis patients

Role of dietary and nutritional status and inflammation

Nazanin Noori, Csaba Kovesdy, Ramanath Dukkipati, Usama Feroze, Miklos Z. Molnar, Rachelle Bross, Allen R. Nissenson, Joel D. Kopple, Keith C. Norris, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Background: Racial/ethnic disparities prevail among hemodialysis patients. We hypothesized that significant differences exist between Black and non-Hispanic and Hispanic White hemodialysis patients in nutritional status, dietary intake and inflammation, and that they account for racial survival disparities. Methods: In a 6-year (2001-2007) cohort of 799 hemodialysis patients, we compared diet and surrogates of nutritional-inflammatory status and their mortality-predictabilities between 279 Blacks and 520 Whites using matched and regression analyses and Cox with cubic splines. Results: In age-, gender- and diabetes-matched analyses, Blacks had higher lean body mass and serum prealbumin, creatinine and homocysteine levels than Whites. In case-mix-adjusted analyses, dietary intakes in Blacks versus Whites were higher in energy (+293 ± 119 cal/day) and fat (+18 ± 5 g/day), but lower in fiber (-2.9 ± 1.3 g/day) than Whites. In both races, higher serum albumin, prealbumin and creatinine were associated with greater survival, whereas CRP and IL-6, but not TNF-α, were associated with increased mortality. The highest (vs. lowest) quartile of IL-6 was associated with a 2.4-fold (95% CI: 1.3-3.8) and 4.1-fold (2.2-7.2) higher death risk in Blacks and Whites, respectively. Conclusions: Significant racial disparities exist in dietary, nutritional and inflammatory measures, which may contribute to hemodialysis outcome disparities. Testing race-specific dietary and/or anti-inflammatory interventions is indicated.

Original languageEnglish (US)
Pages (from-to)157-167
Number of pages11
JournalAmerican Journal of Nephrology
Volume33
Issue number2
DOIs
StatePublished - Mar 1 2011
Externally publishedYes

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Nutritional Status
Renal Dialysis
Inflammation
Prealbumin
Mortality
Interleukin-6
Creatinine
Survival
Diagnosis-Related Groups
Homocysteine
Hispanic Americans
Serum Albumin
Anti-Inflammatory Agents
Fats
Regression Analysis
Diet
Serum
hydroquinone

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Racial and ethnic differences in mortality of hemodialysis patients : Role of dietary and nutritional status and inflammation. / Noori, Nazanin; Kovesdy, Csaba; Dukkipati, Ramanath; Feroze, Usama; Molnar, Miklos Z.; Bross, Rachelle; Nissenson, Allen R.; Kopple, Joel D.; Norris, Keith C.; Kalantar-Zadeh, Kamyar.

In: American Journal of Nephrology, Vol. 33, No. 2, 01.03.2011, p. 157-167.

Research output: Contribution to journalArticle

Noori, N, Kovesdy, C, Dukkipati, R, Feroze, U, Molnar, MZ, Bross, R, Nissenson, AR, Kopple, JD, Norris, KC & Kalantar-Zadeh, K 2011, 'Racial and ethnic differences in mortality of hemodialysis patients: Role of dietary and nutritional status and inflammation', American Journal of Nephrology, vol. 33, no. 2, pp. 157-167. https://doi.org/10.1159/000323972
Noori, Nazanin ; Kovesdy, Csaba ; Dukkipati, Ramanath ; Feroze, Usama ; Molnar, Miklos Z. ; Bross, Rachelle ; Nissenson, Allen R. ; Kopple, Joel D. ; Norris, Keith C. ; Kalantar-Zadeh, Kamyar. / Racial and ethnic differences in mortality of hemodialysis patients : Role of dietary and nutritional status and inflammation. In: American Journal of Nephrology. 2011 ; Vol. 33, No. 2. pp. 157-167.
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T2 - Role of dietary and nutritional status and inflammation

AU - Noori, Nazanin

AU - Kovesdy, Csaba

AU - Dukkipati, Ramanath

AU - Feroze, Usama

AU - Molnar, Miklos Z.

AU - Bross, Rachelle

AU - Nissenson, Allen R.

AU - Kopple, Joel D.

AU - Norris, Keith C.

AU - Kalantar-Zadeh, Kamyar

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N2 - Background: Racial/ethnic disparities prevail among hemodialysis patients. We hypothesized that significant differences exist between Black and non-Hispanic and Hispanic White hemodialysis patients in nutritional status, dietary intake and inflammation, and that they account for racial survival disparities. Methods: In a 6-year (2001-2007) cohort of 799 hemodialysis patients, we compared diet and surrogates of nutritional-inflammatory status and their mortality-predictabilities between 279 Blacks and 520 Whites using matched and regression analyses and Cox with cubic splines. Results: In age-, gender- and diabetes-matched analyses, Blacks had higher lean body mass and serum prealbumin, creatinine and homocysteine levels than Whites. In case-mix-adjusted analyses, dietary intakes in Blacks versus Whites were higher in energy (+293 ± 119 cal/day) and fat (+18 ± 5 g/day), but lower in fiber (-2.9 ± 1.3 g/day) than Whites. In both races, higher serum albumin, prealbumin and creatinine were associated with greater survival, whereas CRP and IL-6, but not TNF-α, were associated with increased mortality. The highest (vs. lowest) quartile of IL-6 was associated with a 2.4-fold (95% CI: 1.3-3.8) and 4.1-fold (2.2-7.2) higher death risk in Blacks and Whites, respectively. Conclusions: Significant racial disparities exist in dietary, nutritional and inflammatory measures, which may contribute to hemodialysis outcome disparities. Testing race-specific dietary and/or anti-inflammatory interventions is indicated.

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