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NDT Advance Access published online on July 21, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp348
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© The Author [2009].
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org


Survival of patients from South Asian and Black populations starting renal replacement therapy in England and Wales

Paul Roderick1, Catherine Byrne2, Anna Casula3, Retha Steenkamp3, David Ansell3, Richard Burden2, Dorothea Nitsch4 and Terry Feest3

1 Public Health Sciences and Medical Statistics, University of Southampton, C floor, South Academic Block, Southampton General Hospital, Southampton SO166YD 2 Renal Unit, Nottingham City Hospital, Hucknall Road, Nottingham, NG51PB 3 Renal Association UK Renal Registry, Southmead Hospital, Southmead Road, Bristol BS10 5NB 4 Non-communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK

Correspondence and offprint requests to: Paul Roderick; E-mail: pjr{at}soton.ac.uk



  Abstract

Background. South Asian and Black ethnic minorities in the UK have higher rates of acceptance onto renal replacement therapy (RRT) than Caucasians. Registry studies in the USA and Canada show better survival; there are few data in the UK.

Methods. Renal Association UK Renal Registry data were used to compare the characteristics and survival of patients starting RRT from both groups with those of Caucasians, using incident cases accepted between 1997 and 2006. Survival was analysed by multivariate Cox's proportional hazards regression split by haemodialysis and peritoneal dialysis (PD) due to non-proportionality, and without censoring at transplantation.

Results. A total of 2495 (8.2%) were South Asian and 1218 (4.0%) were Black. They were younger and had more diabetic nephropathy. The age-adjusted prevalence of vascular co-morbidity was higher in South Asians and lower in Blacks; other co-morbidities were generally common in Caucasians. Late referral did not differ. They were less likely to receive a transplant or to start PD. South Asians and Blacks had significantly better survival than Caucasians both from RRT start to Day 90 and after Day 90, and for those on HD or PD at Day 90. Fully adjusted hazard ratios after Day 90 on haemodialysis were 0.70 (0.55–0.89) for South Asians and 0.56 (0.41–0.75) for Blacks.

Conclusion. South Asian and Black minorities have better survival on dialysis. An understanding of the mechanisms may provide general insights for all patients on RRT.

Keywords: ethnic minorities; haemodialysis; peritoneal dialysis; survival

Received for publication: 13.11.08
Accepted in revised form: 23. 6.09


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