MINORITY ADVANTAGE IN DIABETIC END-STAGE RENAL-DISEASE SURVIVAL ON HEMODIALYSIS - DUE TO DIFFERENT PROPORTIONS OF DIABETIC TYPE

The objectives of this study were to identify predictors of survival o n hemodialysis in patients with diabetic end-stage renal disease (ESRD ) and to explain ethnic differences in survival among non-Hispanic whi tes, African-Americans, and Mexican-Americans. The study design was a survival analysis of an inception cohort and was conducted in dialysis centers in two urban counties in Texas. A population-based, tri-ethni c cohort of 638 adult patients with diabetic ESRD were studied. Follow -up was completed in 96% of the cohort, with a median length of follow -up of 3.8 years. Survival length on center hemodialysis was the main outcome measure. In a combined model of types I and II diabetes, Mexic an-Americans (relative hazard [RH], 0.666; 95% confidence interval [CI ], 0.457 to 0.944) and African-Americans (RH, 0.598; 95% CI, 0.414 to 0.864) showed a better survival than non-Hispanic whites. Other predic tors independently associated with survival were age (RH, 1.015 per 10 years of age; 95% CI, 1.001 to 1.028), high self-reported physical di sability (RH, 1.770; 95% CI, 1.213 to 2.583), coronary artery disease (RH, 1.445; 95% CI, 1.044 to 2.012), lower extremity amputations (RH, 2.049; 95% CI, 1.438 to 2.920), and average blood glucose levels prior to ESRD (RH, 1.002 per 1 mg/dL increment; 95% OI, 1.003 to 1.004). No n-Hispanic whites had a significantly higher rate of type I diabetes, but did not have a greater burden of any of the other predictors, In s eparate type I and II models, ethnicity was still a significant predic tor of survival among type I but not among type II. In conclusion, we have reconfirmed the survival advantage on dialysis of African-America ns and Mexican-Americans over non-Hispanic whites with diabetic ESRD. However, among type II patients, this minority survival advantage disa ppears. Self-reported physical disability is an important predictor of survival among both diabetes types. Functional status at baseline is an important predictor of survival and should be assessed as an adjunc t to measurement of co-morbidities. Macrovascular disease is important for type II, while educational status is important for type I. While amputation may be a marker for the severity of systemic illness, it co uld be a marker for quality of primary care provided to diabetic patie nts, since a majority of diabetic lower extremity amputations are thou ght to be preventable. (C) 1996 by the National Kidney Foundation, Inc .