Survival Disparities within American and Israeli Dialysis Populations: Learning from Similarities and Distinctions across Race and Ethnicity

Authors

  • Kamyar Kalantar-Zadeh,

    1. Harold Simmons Center for Chronic Disease Research and Epidemiology
    2. Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California
    3. UCLA David Geffen School of Medicine
    4. Department of Family Health or Epidemiology, UCLA School of Public Health, Los Angeles, California
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  • Eliezer Golan,

    1. Department of Nephrology and Hypertension, Meir Medical Center, Kfar-Saba, Israel
    2. Israel Renal Registry
    3. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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  • Tamy Shohat,

    1. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
    2. Israel Center for Disease Control, Tel-Hashomer, Israel
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  • Elani Streja,

    1. Harold Simmons Center for Chronic Disease Research and Epidemiology
    2. Department of Family Health or Epidemiology, UCLA School of Public Health, Los Angeles, California
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  • Keith C. Norris,

    1. UCLA David Geffen School of Medicine
    2. Charles Drew University, Los Angeles, California
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  • Joel D. Kopple

    1. Harold Simmons Center for Chronic Disease Research and Epidemiology
    2. Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California
    3. UCLA David Geffen School of Medicine
    4. Department of Family Health or Epidemiology, UCLA School of Public Health, Los Angeles, California
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Address correspondence to: Kamyar Kalantar-Zadeh, MD, MPH, PhD, Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, C1-Annex, Torrance, CA 90509-2910, Tel.: 310-222-3891, Fax: 310-782-1837, or e-mail: kamkal@ucla.edu.

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.

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