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Author Interview: Silas P. Norman, MD, MPH

University of Michigan
3914 Taubman Center

Ann Arbor, MI 48109


Publication:

Increased Risk of Death in Young African American Dialysis Patients

Silas P. Norman, MD, MPH 

Arch Surg. 2012;147(2):111-112. doi:10.1001/archsurg.2011.1625

Commentary on:
JAMA 2011;306(6):620-626
Association of Race and Age With Survival Among Patients Undergoing Dialysis

Lauren M. Kucirka, ScM; Morgan E. Grams, MD, MHS; Justin Lessler, PhD; Erin Carlyle Hall, MD, MPH; Nathan James, ScM; Allan B. Massie, MHS; Robert A. Montgomery, MD, DPhil;
Dorry L. Segev, MD, PhD


What are the main findings of the study?

The manuscript highlights the increased mortality risk of young African American patients on dialysis relative to their White counterparts.

Were any of the findings unexpected?

Yes. Conventional wisdom has been that African Americans have a relative survival advantage on dialysis compared to Whites.

As a consequence, some African Americans have not been referred for transplant evaluation in a timely manner as providers were under the impression that dialysis provided an equivalent therapy. 

As the manuscript makes clear, there is an increased risk of death in young African American dialysis patients.

What should clinicians and patients take away from this study?

The concept of African American survival advantage on dialysis is a myth. Young African Americans have an increased mortality on dialysis compared to Whites.

Waiting for patients who are “doing well” on dialysis to deteriorate prior to transplant referral is counterintuitive and harmful to patients. 

Each patient should be referred for a transplant evaluation as early as possible to optimize the chances for kidney transplant and maximum improvement in survival.

What recommendations do you have for future studies as a result of your study?

End-stage kidney disease and dialysis confer an increased risk of death to patients, including African Americans. 

As kidney transplant is the standard of care renal replacement therapy, providers should refer their ESRD patients for kidney transplantation evaluation as rapidly as possible.

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