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Racial and survival paradoxes in chronic kidney disease

Kamyar Kalantar-Zadeh1, Csaba P Kovesdy, Stephen F Derose

  • 1Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA. kamkal@ucla.edu

Nature Clinical Practice. Nephrology
|August 25, 2007
PubMed

Insights

Chronic kidney disease (CKD) survival shows a "reverse epidemiology," where typical risk factors predict better outcomes. Understanding these paradoxes is key to improving CKD patient survival rates.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Public Health

Background:

  • Most individuals with chronic kidney disease (CKD) in the US do not survive to dialysis; mortality rates are high for those on dialysis.
  • Conventional cardiovascular risk factors paradoxically correlate with better survival in hemodialysis patients, a phenomenon termed 'reverse epidemiology'.

Purpose of the Study:

  • To explore the 'reverse epidemiology' phenomenon in earlier stages of CKD.
  • To investigate paradoxical survival relationships concerning race and ethnicity in CKD patients.
  • To understand how these paradoxes evolve with CKD progression and their potential reversal.

Main Methods:

  • Analysis of existing data on CKD patient survival and risk factors.
  • Examination of survival rates across different racial and ethnic groups.
  • Correlation of survival paradoxes with CKD progression, malnutrition, inflammation, and wasting.

Main Results:

  • Reverse epidemiology is observed not only in dialysis populations but also in earlier CKD stages.
  • Distinct paradoxical survival patterns exist among African American, white, Hispanic, and Asian American CKD patients.
  • Kidney transplantation can reverse these survival paradoxes, highlighting the role of kidney function and nutritional status.

Conclusions:

  • CKD survival paradoxes are complex, influenced by disease progression, competing risks, and patient-specific factors like nutrition and inflammation.
  • Rethinking risk factor targets based on general populations is necessary for effective CKD management.
  • Further research into these paradoxes can lead to novel management strategies and improved survival for CKD patients.

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