Does racial variation in risk factors explain black-white differences in the incidence of hypertensive end-stage renal disease?

Article Abstract:

Blacks in the US have a rate of treated end-stage renal disease (ESRD; irreversible kidney failure) that is almost four times as high as the rate for whites; the racial difference is most striking for kidney failure associated with high blood pressure, or hypertension (HT-ESRD). To evaluate to what extent the association between race and HT-ESRD is independent of other risk factors for ESRD that may be more prevalent among blacks, a prospective analysis was carried out of newly identified HT-ESRD cases listed in a regional registry (in Maryland). Risk factors for the patients were calculated from population-based surveys. During the six-year study period, 534 patients with HT-ESRD were entered into the registry. In all age- and sex-specific subgroups, the incidence of the disease was higher among blacks than among whites (from 4 to 14 times higher). Overall, blacks had a sevenfold higher incidence than whites. Blacks in all subgroups also had higher incidences of hypertension than whites. Although blacks had a higher prevalence of other risk factors for HT-ESRD (hypertension, severe hypertension, diabetes, low socioeconomic level, smoking), there was considerable overlap between white and black subgroups. When the contribution of all other risk factors besides race (including hypertension) was controlled in the statistical analysis, blacks still had a risk of HT-ESRD that was four and one half times that of whites. It is possible that blacks are more susceptible to the development of kidney disease; other risk factors, including socioeconomic status, cannot account for the increased rate of disease among this group. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Demographic aspects, African Americans, Diseases, Chronic kidney failure, Blacks

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Community cholesterol screening

Article Abstract:

The effect of screening for elevated cholesterol levels and compliance with or adherence to follow-up recommendations were assessed in 375 subjects who attended a free screening program at a shopping mall walk-in clinic. Cholesterol levels were normal in 139 subjects, borderline in 135 subjects, and high in 101 subjects. Subjects with borderline and high cholesterol levels were instructed to consult with their physicians within two months to confirm their cholesterol measurements. Of 338 subjects responding to a questionnaire at three months follow-up, eight subjects with normal levels, 23 subjects with borderline levels, and 44 subjects with high levels had visited a physician for assessment of their cholesterol levels since the screening. The factors associated with visiting a physician were: category of cholesterol level at the time of screening; use of medication to lower blood pressure; history of disease of the coronary arteries, the major blood vessels supplying the heart; and history of high cholesterol levels. These findings suggest that labeling or classification of a person as being at high rather than borderline risk leads to a greater likelihood that the person will follow-up with a physician. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Evaluation, Testing, Community health services, Medical screening, Health screening, Blood cholesterol

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Kidney transplantation from living unrelated donors

Article Abstract:

Transplant survival may be approximately the same among patients transplanted with a kidney from a living unrelated donor (LUD) as among those transplanted with a kidney from a zero haplotype-matched living related donor (LRD) or from a cadaver. A zero haplotype-matched donor is one that is not genetically matched to the transplant recipient. Among 2,892 patients who underwent a kidney transplant, 165 (6%) received a kidney from a LUD, 183 (6%) from a zero haplotype-matched LRD, 1,259 (44%) from a one haplotype-matched LRD, 321 (11%) from a two haplotype-matched LRD and 964 (33%) from a cadaver. Patient survival and transplant survival were similar among individuals who were transplanted with a kidney from a LUD as among those transplanted with a kidney from zero haplotype-matched LRD or from a cadaver. Patient survival and transplant survival was higher among patients who received a kidney from a one haplotype-matched LRD or from a two haplotype-matched LRD than among the other patient groups.

Statistics, Graft rejection, Kidneys, Kidney transplantation

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