Survival on dialysis among American Indians and Alaska natives with diabetes in the United States, 1995 - 2010

• Main Authors: Burrows, N.R., Cho, P., Bullard, K.M., Narva, A.S., Eggers, P.W.
• Format: Article in Journal/Newspaper
• Language: unknown
• Subjects: Indian; Meier; inuit; inuits; Alaska
• Online Access: http://hdl.handle.net/10.2105/AJPH.2014.301942

Objectives. We assessed survival in American Indians and Alaska Natives (AI/ANs) with end-stage renal disease attributed to diabetes who initiated hemodialysis between 1995 and 2009. Methods. Follow-up extended from the first date of dialysis in the United States Renal Data System until December 31, 2010, kidney transplantation, or death. We used the Kaplan-Meier method to compute survival on dialysis by age and race/ethnicity and Cox regression analysis to compute adjusted hazard ratios (HRs). Results. Our study included 510 666 persons48% Whites, 2% AI/AN persons, and 50% others. Median follow-up was 2.2 years (interquartile range = 1.1û4.1 years). At any age, AI/AN persons survived longer on hemodialysis than Whites; this finding persisted after adjusting for baseline differences. Among AI/AN individuals, those with full Indian blood ancestry had the lowest adjusted risk of death compared with Whites (HR = 0.58; 95% confidence interval = 0.55, 0.61). The risk increased with declining proportion of AI/AN ancestry. Conclusions. Survival on dialysis was better among AI/AN than White persons with diabetes. Among AI/AN persons, the inverse relationship between risk of death and level of AI/AN ancestry suggested that cultural or hereditary factors played a role in survival. American Indian; article; Caucasian; chronic kidney failure; diabetic nephropathy; ethnology; female; health survey; human; Inuit; male; middle aged; mortality; renal replacement therapy; statistics; survival; United States, Alaska; Diabetic Nephropathies; European Continental Ancestry Group; Female; Humans; Indians, North American; Inuits; Kidney Failure, Chronic; Male; Middle Aged; Population Surveillance; Renal Dialysis; Survival Analysis; United States