Role of nutritional status and inflammation in higher survival of African American and hispanic hemodialysis patients

Elani Streja, Csaba Kovesdy, Miklos Z. Molnar, Keith C. Norris, Sander Greenland, Allen R. Nissenson, Joel D. Kopple, Kamyar Kalantar-Zadeh

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Abstract

Background Observational studies indicate greater survival in African American and Hispanic maintenance hemodialysis patients compared with their non-Hispanic white counterparts, although African Americans have shorter life expectancy than whites in the general population. We hypothesized that this apparent survival advantage is due to a more favorable nutritional/inflammatory profile in minority hemodialysis patients. Study Design We examined the association between race/ethnicity and 5-year survival before and after adjustment for case-mix and surrogates of the malnutrition-inflammation complex syndrome (MICS) using Cox regression with or without matched sampling in a large cohort of adult hemodialysis patients. Setting & Participants 124,029 adult hemodialysis patients, including 16% Hispanics, 49% non-Hispanic whites, and 35% African Americans. Predictors Race/ethnicity before and after adjustment for MICS, including values for body mass index, serum albumin, total iron-binding capacity, ferritin, creatinine, phosphorus, calcium, bicarbonate, white blood cell count, lymphocyte percentage, hemoglobin, and protein intake. Outcomes 5-year (July 2001 to June 2006) survival. Results In dialysis patients, blacks and Hispanics had lower mortality overall than non-Hispanic whites after traditional case-mix adjustment. However, after additional control for MICS, Hispanics had mortality similar to non-Hispanic whites, and African Americans had even higher mortality. Unadjusted, case-mix, and MICS-adjusted HRs for African Americans versus whites were 0.68 (95% CI, 0.66-0.69), 0.89 (95% CI, 0.86-0.91), and 1.06 (95% CI, 1.03-1.09) in the unmatched cohort and, 0.95 (95% CI, 0.90-0.99), 0.89 (95% CI, 0.84-0.94), and 1.16 (95% CI, 1.07-1.26) in the matched cohort, and for Hispanics versus whites, 0.66 (95% CI, 0.64-0.69), 0.84 (95% CI, 0.81-0.87), and 0.97 (95% CI, 0.94-1.00) in the unmatched cohort and 0.89 (95% CI, 0.84-0.95), 0.88 (95% CI, 0.83-0.95), and 0.98 (95% CI, 0.91-1.06) in the matched cohort, respectively. Limitations Adjustment cannot be made for unmeasured confounders. Conclusions Survival advantages of African American and Hispanic hemodialysis patients may be related to differences in nutritional and inflammatory status. Further studies are required to explore these differences.

Original languageEnglish (US)
Pages (from-to)883-893
Number of pages11
JournalAmerican Journal of Kidney Diseases
Volume57
Issue number6
DOIs
StatePublished - Jun 1 2011

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Nutritional Status
Hispanic Americans
African Americans
Renal Dialysis
Inflammation
Malnutrition
Survival
Risk Adjustment
Mortality
Diagnosis-Related Groups
Ferritins
Life Expectancy
Leukocyte Count
Serum Albumin
Phosphorus
Observational Studies
Dialysis
Creatinine
Hemoglobins
Body Mass Index

All Science Journal Classification (ASJC) codes

  • Nephrology

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Role of nutritional status and inflammation in higher survival of African American and hispanic hemodialysis patients. / Streja, Elani; Kovesdy, Csaba; Molnar, Miklos Z.; Norris, Keith C.; Greenland, Sander; Nissenson, Allen R.; Kopple, Joel D.; Kalantar-Zadeh, Kamyar.

In: American Journal of Kidney Diseases, Vol. 57, No. 6, 01.06.2011, p. 883-893.

Research output: Contribution to journalArticle

Streja, Elani ; Kovesdy, Csaba ; Molnar, Miklos Z. ; Norris, Keith C. ; Greenland, Sander ; Nissenson, Allen R. ; Kopple, Joel D. ; Kalantar-Zadeh, Kamyar. / Role of nutritional status and inflammation in higher survival of African American and hispanic hemodialysis patients. In: American Journal of Kidney Diseases. 2011 ; Vol. 57, No. 6. pp. 883-893.
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abstract = "Background Observational studies indicate greater survival in African American and Hispanic maintenance hemodialysis patients compared with their non-Hispanic white counterparts, although African Americans have shorter life expectancy than whites in the general population. We hypothesized that this apparent survival advantage is due to a more favorable nutritional/inflammatory profile in minority hemodialysis patients. Study Design We examined the association between race/ethnicity and 5-year survival before and after adjustment for case-mix and surrogates of the malnutrition-inflammation complex syndrome (MICS) using Cox regression with or without matched sampling in a large cohort of adult hemodialysis patients. Setting & Participants 124,029 adult hemodialysis patients, including 16{\%} Hispanics, 49{\%} non-Hispanic whites, and 35{\%} African Americans. Predictors Race/ethnicity before and after adjustment for MICS, including values for body mass index, serum albumin, total iron-binding capacity, ferritin, creatinine, phosphorus, calcium, bicarbonate, white blood cell count, lymphocyte percentage, hemoglobin, and protein intake. Outcomes 5-year (July 2001 to June 2006) survival. Results In dialysis patients, blacks and Hispanics had lower mortality overall than non-Hispanic whites after traditional case-mix adjustment. However, after additional control for MICS, Hispanics had mortality similar to non-Hispanic whites, and African Americans had even higher mortality. Unadjusted, case-mix, and MICS-adjusted HRs for African Americans versus whites were 0.68 (95{\%} CI, 0.66-0.69), 0.89 (95{\%} CI, 0.86-0.91), and 1.06 (95{\%} CI, 1.03-1.09) in the unmatched cohort and, 0.95 (95{\%} CI, 0.90-0.99), 0.89 (95{\%} CI, 0.84-0.94), and 1.16 (95{\%} CI, 1.07-1.26) in the matched cohort, and for Hispanics versus whites, 0.66 (95{\%} CI, 0.64-0.69), 0.84 (95{\%} CI, 0.81-0.87), and 0.97 (95{\%} CI, 0.94-1.00) in the unmatched cohort and 0.89 (95{\%} CI, 0.84-0.95), 0.88 (95{\%} CI, 0.83-0.95), and 0.98 (95{\%} CI, 0.91-1.06) in the matched cohort, respectively. Limitations Adjustment cannot be made for unmeasured confounders. Conclusions Survival advantages of African American and Hispanic hemodialysis patients may be related to differences in nutritional and inflammatory status. Further studies are required to explore these differences.",
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T1 - Role of nutritional status and inflammation in higher survival of African American and hispanic hemodialysis patients

AU - Streja, Elani

AU - Kovesdy, Csaba

AU - Molnar, Miklos Z.

AU - Norris, Keith C.

AU - Greenland, Sander

AU - Nissenson, Allen R.

AU - Kopple, Joel D.

AU - Kalantar-Zadeh, Kamyar

PY - 2011/6/1

Y1 - 2011/6/1

N2 - Background Observational studies indicate greater survival in African American and Hispanic maintenance hemodialysis patients compared with their non-Hispanic white counterparts, although African Americans have shorter life expectancy than whites in the general population. We hypothesized that this apparent survival advantage is due to a more favorable nutritional/inflammatory profile in minority hemodialysis patients. Study Design We examined the association between race/ethnicity and 5-year survival before and after adjustment for case-mix and surrogates of the malnutrition-inflammation complex syndrome (MICS) using Cox regression with or without matched sampling in a large cohort of adult hemodialysis patients. Setting & Participants 124,029 adult hemodialysis patients, including 16% Hispanics, 49% non-Hispanic whites, and 35% African Americans. Predictors Race/ethnicity before and after adjustment for MICS, including values for body mass index, serum albumin, total iron-binding capacity, ferritin, creatinine, phosphorus, calcium, bicarbonate, white blood cell count, lymphocyte percentage, hemoglobin, and protein intake. Outcomes 5-year (July 2001 to June 2006) survival. Results In dialysis patients, blacks and Hispanics had lower mortality overall than non-Hispanic whites after traditional case-mix adjustment. However, after additional control for MICS, Hispanics had mortality similar to non-Hispanic whites, and African Americans had even higher mortality. Unadjusted, case-mix, and MICS-adjusted HRs for African Americans versus whites were 0.68 (95% CI, 0.66-0.69), 0.89 (95% CI, 0.86-0.91), and 1.06 (95% CI, 1.03-1.09) in the unmatched cohort and, 0.95 (95% CI, 0.90-0.99), 0.89 (95% CI, 0.84-0.94), and 1.16 (95% CI, 1.07-1.26) in the matched cohort, and for Hispanics versus whites, 0.66 (95% CI, 0.64-0.69), 0.84 (95% CI, 0.81-0.87), and 0.97 (95% CI, 0.94-1.00) in the unmatched cohort and 0.89 (95% CI, 0.84-0.95), 0.88 (95% CI, 0.83-0.95), and 0.98 (95% CI, 0.91-1.06) in the matched cohort, respectively. Limitations Adjustment cannot be made for unmeasured confounders. Conclusions Survival advantages of African American and Hispanic hemodialysis patients may be related to differences in nutritional and inflammatory status. Further studies are required to explore these differences.

AB - Background Observational studies indicate greater survival in African American and Hispanic maintenance hemodialysis patients compared with their non-Hispanic white counterparts, although African Americans have shorter life expectancy than whites in the general population. We hypothesized that this apparent survival advantage is due to a more favorable nutritional/inflammatory profile in minority hemodialysis patients. Study Design We examined the association between race/ethnicity and 5-year survival before and after adjustment for case-mix and surrogates of the malnutrition-inflammation complex syndrome (MICS) using Cox regression with or without matched sampling in a large cohort of adult hemodialysis patients. Setting & Participants 124,029 adult hemodialysis patients, including 16% Hispanics, 49% non-Hispanic whites, and 35% African Americans. Predictors Race/ethnicity before and after adjustment for MICS, including values for body mass index, serum albumin, total iron-binding capacity, ferritin, creatinine, phosphorus, calcium, bicarbonate, white blood cell count, lymphocyte percentage, hemoglobin, and protein intake. Outcomes 5-year (July 2001 to June 2006) survival. Results In dialysis patients, blacks and Hispanics had lower mortality overall than non-Hispanic whites after traditional case-mix adjustment. However, after additional control for MICS, Hispanics had mortality similar to non-Hispanic whites, and African Americans had even higher mortality. Unadjusted, case-mix, and MICS-adjusted HRs for African Americans versus whites were 0.68 (95% CI, 0.66-0.69), 0.89 (95% CI, 0.86-0.91), and 1.06 (95% CI, 1.03-1.09) in the unmatched cohort and, 0.95 (95% CI, 0.90-0.99), 0.89 (95% CI, 0.84-0.94), and 1.16 (95% CI, 1.07-1.26) in the matched cohort, and for Hispanics versus whites, 0.66 (95% CI, 0.64-0.69), 0.84 (95% CI, 0.81-0.87), and 0.97 (95% CI, 0.94-1.00) in the unmatched cohort and 0.89 (95% CI, 0.84-0.95), 0.88 (95% CI, 0.83-0.95), and 0.98 (95% CI, 0.91-1.06) in the matched cohort, respectively. Limitations Adjustment cannot be made for unmeasured confounders. Conclusions Survival advantages of African American and Hispanic hemodialysis patients may be related to differences in nutritional and inflammatory status. Further studies are required to explore these differences.

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