This study examined racial differences in health status, primary renal disease, form of renal replacement therapy, and survival among a large cohort of dialysis patients. Data were collected from the Piedmont Dialysis Center of Bowman Gray School of Medicine in Winston-Salem, North Carolina. Five hundred fifty patients who started dialysis during the period from 1990 through 1993 were included in this study and followed through 1994.

The proportion of African American and white patients suffering from end-stage diabetic nephropathy and end-stage glomerulonephritis was remarkably similar. However, more of the African-Americans were diagnosed with hypertensive nephrosclerosis. White patients were older (58.2 years versus 55.6 years), had a higher mean serum albumin level, and were more likely to choose peritoneal dialysis as their first form of renal replacement therapy compared with African American patients.

The proportion of patients changing treatment modality was substantially higher among white patients compared with African-American patients. However, voluntary withdrawal from dialysis was equal for the two racial groups and was not a determinant of survival differences. In the early part of the study, a small group of patients was placed on IPD, with dialysis taking place less than 7 days per week (1.3% of the African Americans and 5.7% of the white patients). The survival of these patients was worse than that of those on hemodialysis and other peritoneal dialysis patients.

White patients were much more likely than African-American patients to receive a transplant (27.6% versus 9.3%). White patients received more cadaveric renal transplants (18% versus 7%), more living-related transplants (7.7% versus 2.3%), and more living non-related transplants (1.92% versus 0). Patients who were transplanted had an 18-fold improved survival.

Over the 5-year follow-up period, 40% of the white patients and 31% of the African-American patients died. Excluding patients with IPD, a survival model showed that age, race, an age-race interaction, serum albumin, activity level, and presence of cancer and congestive heart failure had significant effects on survival. The age-race interaction revealed that, for African-Americans, the risk of death remained relatively stable and did not increase as patients aged. For white patients, the relative risk of death increased as age increased. Thus, in the younger group, African Americans had a significantly higher mortality risk, and, in the older group, African Americans had a significantly lower risk. The authors state that the cause of this pattern is unclear but may be related to variation in the prevalence of IHD, which may be occult at the time of presentation.