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In Reply. — We welcome Bleyer's letter as it gives us the opportunity to correct the error in our original editorial.1Black Americans undergoing dialysis do have a better survival rate than white patients. The error was due to misinterpretation of the text and tables in reference 23 in our editorial.2We do not believe that the error in any way detracts from the message that we wished to convey in the editorial, ie, that black patients suffer more from end-stage renal disease even after correcting for clinical, demographic, and socioeconomic variables. Like Bleyer, we have also speculated on why black patients undergoing dialysis would have better survival rates. Bleyer argues that it is unlikely that this better outcome is due to better care for black patients than for white patients and he offers clinical reasons why blacks survive longer. He postulates that blacks undergoing dialysis are less

As early as 1977, studies of patients undergoing dialysis in the United States showed that blacks were overrepresented relative to their proportion of the national population. 1 However, it was unclear whether this disparity indicated some particular vulnerability of the kidneys of black Americans or was due instead to the well-recognized increased prevalence in blacks of diseases that cause renal insufficiency, such as hypertension 2 and type II diabetes mellitus. 3 Subsequent epidemiologic investigations that controlled for hypertension, diabetes, their degree of control, and other clinical factors demonstrated that black patients still had two to four times the risk of developing renal insufficiency compared with white patients. 4,5 However, each of these studies, including our own, 5 was incomplete because (1) they involved patients receiving care in particular settings rather than investigating the population at large and (2) they did not control for socioeconomic status. In this issue of the