Is peritoneal dialysis a good option for black patients?

Blacks are less likely than whites to use peritoneal dialysis (PD) as the i nitial renal replacement therapy. The reason for the underusage of PD by bl acks is unknown. In a cross-sectional multicenter trial, we studied periton eal transport character, small-molecular-weight solute clearances, and nutr itional status in 475 patients undergoing PD (168 whites, 192 blacks, and 1 15 Asians). The mean age of blacks undergoing PD was significantly younger than that of whites (47.6 +/- 14.7 v 58.2 +/- 16.7 years; P < 0.0001). Targ et Kt/V and weekly creatinine clearance (WCC) as defined by the Dialysis Ou tcome Quality Initiative Work Group was achieved by 62.5% of whites, 67.2% of blacks, and 54.8% of Asians (P = 0.05). Total protein (7.25 +/- 0.88 v 6 .55 +/- 0.73 g/dL), albumin (3.72 +/- 0.57 v 3.55 +/- 0.53 g/dL), and lean body mass (LBM; 41.7 +/- 15.6 v 33.0 +/- 11.8 kg) were lower in whites comp ared with blacks (P < 0.001). Although the normalized protein catabolic rat e (nPCR) was greater (0.82 +/- 0.24 v 0.90 +/- 0.32 g/kg/d; P = 0.04), tota l protein (6.24 +/- 0.85 g/dL) and serum albumin levels (3.36 +/- 0.52 g/dL ) and LBM (30.1 +/- 8.0 kg) were significantly lower in Asians than blacks (P < 0.0001). The favorable anabolic response in blacks may partially be ex plained by a higher calorie intake in this group of patients (29.6 +/- 10.7 Cal/kg/d) compared with whites (22.4 +/- 6.8 Cal/kg/d) and Asians (23.9 +/ - 9.8 Cal/kg/d; P = 0.03). Multiple regression analysis identified that bla ck race and weight were positively associated, whereas dialysate/plasma cre atinine ratio (D/P-Creat) and age had a negative effect on serum albumin le vel. Follow-up data indicated that the Kt/V (2.09 +/- 0.50 v 2.39 +/- 0.56; P = 0.02) and WCC (60.8 +/- 4.3 v 70.2 +/- 7.3 L/1.73 m(2); P = 0.02) incr eased significantly from baseline only in blacks. We conclude that PD is an ideal renal replacement therapy in at feast a subset of blacks with end-st age renal disease. (C) 1999 by the National Kidney Foundation, Inc.