BACKGROUND: Racial/ethnic disparities prevail among hemodialysis patients. We hypothesized that significant differences exist between Black and non-Hispanic and Hispanic White hemodialysis patients in nutritional status, dietary intake and inflammation, and that they account for racial survival disparities. METHODS: In a 6-year (2001-2007) cohort of 799 hemodialysis patients, we compared diet and surrogates of nutritional-inflammatory status and their mortality-predictabilities between 279 Blacks and 520 Whites using matched and regression analyses and Cox with cubic splines. RESULTS: In age-, gender- and diabetes-matched analyses, Blacks had higher lean body mass and serum prealbumin, creatinine and homocysteine levels than Whites. In case-mix-adjusted analyses, dietary intakes in Blacks versus Whites were higher in energy (+293 ± 119 cal/day) and fat (+18 ± 5 g/day), but lower in fiber (-2.9 ± 1.3 g/day) than Whites. In both races, higher serum albumin, prealbumin and creatinine were associated with greater survival, whereas CRP and IL-6, but not TNF-α, were associated with increased mortality. The highest (vs. lowest) quartile of IL-6 was associated with a 2.4-fold (95% CI: 1.3-3.8) and 4.1-fold (2.2-7.2) higher death risk in Blacks and Whites, respectively. CONCLUSIONS: Significant racial disparities exist in dietary, nutritional and inflammatory measures, which may contribute to hemodialysis outcome disparities. Testing race-specific dietary and/or anti-inflammatory interventions is indicated.
BACKGROUND: Racial/ethnic disparities prevail among hemodialysis patients. We hypothesized that significant differences exist between Black and non-Hispanic and Hispanic White hemodialysis patients in nutritional status, dietary intake and inflammation, and that they account for racial survival disparities. METHODS: In a 6-year (2001-2007) cohort of 799 hemodialysis patients, we compared diet and surrogates of nutritional-inflammatory status and their mortality-predictabilities between 279 Blacks and 520 Whites using matched and regression analyses and Cox with cubic splines. RESULTS: In age-, gender- and diabetes-matched analyses, Blacks had higher lean body mass and serum prealbumin, creatinine and homocysteine levels than Whites. In case-mix-adjusted analyses, dietary intakes in Blacks versus Whites were higher in energy (+293 ± 119 cal/day) and fat (+18 ± 5 g/day), but lower in fiber (-2.9 ± 1.3 g/day) than Whites. In both races, higher serum albumin, prealbumin and creatinine were associated with greater survival, whereas CRP and IL-6, but not TNF-α, were associated with increased mortality. The highest (vs. lowest) quartile of IL-6 was associated with a 2.4-fold (95% CI: 1.3-3.8) and 4.1-fold (2.2-7.2) higher death risk in Blacks and Whites, respectively. CONCLUSIONS: Significant racial disparities exist in dietary, nutritional and inflammatory measures, which may contribute to hemodialysis outcome disparities. Testing race-specific dietary and/or anti-inflammatory interventions is indicated.
Authors: Jessica E Miller; Csaba P Kovesdy; Keith C Norris; Rajnish Mehrotra; Allen R Nissenson; Joel D Kopple; Kamyar Kalantar-Zadeh Journal: Am J Nephrol Date: 2010-09-03 Impact factor: 3.754
Authors: Kamyar Kalantar-Zadeh; Elani Streja; Csaba P Kovesdy; Antigone Oreopoulos; Nazanin Noori; Jennie Jing; Allen R Nissenson; Mahesh Krishnan; Joel D Kopple; Rajnish Mehrotra; Stefan D Anker Journal: Mayo Clin Proc Date: 2010-11 Impact factor: 7.616
Authors: Kamyar Kalantar-Zadeh; Jessica E Miller; Csaba P Kovesdy; Rajnish Mehrotra; Lilia R Lukowsky; Elani Streja; Joni Ricks; Jennie Jing; Allen R Nissenson; Sander Greenland; Keith C Norris Journal: J Bone Miner Res Date: 2010-07-07 Impact factor: 6.741
Authors: Vanessa A Ravel; Miklos Z Molnar; Elani Streja; Jun Chul Kim; Alla Victoroff; Jennie Jing; Debbie Benner; Keith C Norris; Csaba P Kovesdy; Joel D Kopple; Kamyar Kalantar-Zadeh Journal: J Nutr Date: 2013-05-22 Impact factor: 4.798