DIAGNOSIS OF HYPERTENSIVE END-STAGE RENAL-DISEASE - EFFECT OF PATIENTS RACE

The authors conducted a simulation study to examine whether the race o f a patient with end-stage renal disease (ESRD) influences the diagnos is of underlying kidney disease made by the nephrologist, The hypothes is was that ESRD may be more readily ascribed to hypertension in black s than in whites. Nephrologists practicing in Maryland during 1991 wer e sent written case histories based on the presentation of seven patie nts with ESRD. For each case history, the patient's race was randomly assigned to be ''black'' or ''white.'' The nephrologist's diagnosis of underlying renal disease was recorded as ''hypertensive'' or ''other. '' Analysis of 197 case histories from 58 physicians (81% of those eli gible) was performed using logistic regression. The distribution of un derlying causes of ESRD in the case histories was similar to national statistics: hypertensive ESRD, 34%; diabetic ESRD, 30%; glomerulonephr itis, 11%; other, 16%; unknown, 10%. Case histories that identified th e patient's race as black were more likely (odds ratio = 1.97; 95% con fidence interval 1.05-3.68) to result in a diagnosis of hypertensive E SRD than case histories in which the patient's race was said to be whi te, after adjustment for case history. Analyses that accounted for the physicians' individual tendencies to diagnose hypertensive ESRD yield ed similar results. These findings suggest that black ESRD patients ma y be more likely to be labeled as having hypertensive kidney disease t han white ESRD patients with similar clinical histories. Using race as a criterion to establish diagnoses of kidney disease may obscure the interpretation of incidence statistics, affect the management of indiv idual patients, and hinder epidemiologic studies of risk factors for k idney failure. Definition of clear diagnostic criteria for the underly ing cause of kidney failure is highly desirable.