Causes of death in dialysis patients: racial and gender differences.

The risk of death in the dialysis population is high and has previously been shown to be accentuated in male (versus female) and white (versus black) subgroups. To better understand the difference in mortality among these subgroups, the causes of death between males and females as well as between whites and blacks adjusting for age, cause of ESRD (diabetic versus nondiabetic), dialysis modality, and time on dialysis (< 1 yr versus > 1 yr) were compared, with national data obtained from the U.S. Renal Data System. A total of 42,372 deaths occurring over 170,700 patient years at risk were analyzed. Males had a 22% higher risk of death than females (P < 0.001), attributable to a higher risk of death due to acute myocardial infarction (relative death rate ratio (RR) = 1.48; P = 0.001), all other cardiac causes (RR = 1.3; P = 0.001), and malignancy (RR = 1.59; P < 0.001). Whites had a 29% higher risk of death than blacks (P < 0.001), accounted for by an increased risk of death due to acute myocardial infarction (RR = 1.34), all other cardiac causes (RR = 1.30), withdrawal from dialysis (RR = 2.72) (all P < 0.001), and infection (RR = 1.09; P = 0.005). This analysis expands the knowledge and understanding of the excess mortality seen in male and white subgroups, which is a necessary step in designing strategies to reduce the high mortality in dialysis patients.