Mortal risk and URR: Differences among demographic groups.
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:207A 1997
The analysis of mortality vs. URR and albumin published by Owen and Lowrie and their coworkers in the N Engl J Med was an impetus to establish quality assurance guidelines and DOQI guidelines for a minimum dialysis standard, presently URR > 65% and single-pool Kt/V > 1.2. This has given rise to a URR-mania in the United States, and has involved HCFA and other regulatory agencies. However, the problems with cross-sectional studies remain. There is perhaps a reason why a given patient is being dialyzed to a given URR or Kt/V. For technical reasons, the amount of dialysis given, or K x t, is often fixed (maximum tolerated blood flow rate, use of large dialyzer). Thus, one major determinant of the Kt/V is the patient's V. Very large patients tend to have low values for V, and high values for V may be found in small, but also in cachectic patients. However, large patients are known to have a good, and not a poor survival if they are on dialysis.
In this abstract, Lowrie and the Fresenius Medical Care group now repeat their analysis on a new dataset, but also break the data down by race and gender. Their results were somewhat surprising. Whereas the previously reported relationship between URR and mortality continued to be found in whites, and especially in white females, it was nearly absent in blacks, and especially in black males.
Comment: What does this mean? That one doesn't need to worry about dialysis adequacy in blacks? There are several possibilities. The simplest that comes to mind is, that the data were not controlled for body size and especially serum creatinine. Perhaps the preponderance of low Kt/V treatments given to black males was to those with large values for V, which conferred a survival advantage. See also their related abstract that does address the body size issue somewhat, but in which the data are not broken down by race. (John T. Daugirdas, M.D., University of Illinois at Chicago)
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ASN 30th Annual Meeting, San Antonio
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