TY - JOUR
T1 - Racial differences in estimated GFR decline, ESRD, and mortality in an integrated health system
AU - Derose, Stephen F.
AU - Rutkowski, Mark P.
AU - Crooks, Peter W.
AU - Shi, Jiaxiao M.
AU - Wang, Jean Q.
AU - Kalantar-Zadeh, Kamyar
AU - Kovesdy, Csaba P.
AU - Levin, Nathan W.
AU - Jacobsen, Steven J.
N1 - Funding Information:
Support: This research was supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases ( R01DK080097 to Dr Derose, and R01DK078106 to Dr Kalantar-Zadeh). Sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
PY - 2013/8
Y1 - 2013/8
N2 - Background: Current evidence does not clearly identify the contribution of kidney function decline and mortality to racial disparities in end-stage renal disease (ESRD) incidence. We used observed estimated glomerular filtration rate (eGFR) to project the time of onset of kidney failure and examined mortality to better understand these racial disparities. Study Design: Retrospective cohort. Setting & Participants: Adult members of Kaiser Permanente Southern California in 2003-2009 with more than 2 serum creatinine tests and more than 180 days between tests: 526,498 whites, 350,919 Hispanics, 136,923 blacks, and 105,476 Asians. Predictor: Race/ethnicity. Outcomes: ESRD (dialysis or transplantation); mortality. Measurements: eGFR decline was modeled using linear regression. Kidney failure was projected based on predicted eGFR <15 mL/min/1.73 m2 at specified times. Racial differences in projected kidney failure and mortality in those with projected kidney failure were estimated with adjustment for age, sex, and entry eGFR. Results: Blacks had more extreme rates of eGFR decline (1st percentile, -23.6 mL/min/1.73 m2 per year), followed by Hispanics (-20.9 mL/min/1.73 m2 per year), whites (-20.1 mL/min/1.73 m2 per year), and Asians (-17.6 mL/min/1.73 m2 per year; P < 0.001). There were 25,065 whites, 11,368 Hispanics, 6,785 blacks, and 3,176 Asians with projected kidney failure during the study period. The ORs for projected kidney failure versus whites during CKD stages 3 and 4 were 1.54 (95% CI, 1.46-1.62) in blacks, 1.49 (95% CI, 1.42-1.56) in Hispanics, and 1.41 (95% CI, 1.32-1.51) in Asians. For those with projected kidney failure, the HRs of death versus whites during CKD stages 3 and 4 were 0.82 (95% CI, 0.77-0.88) in blacks, 0.67 (95% CI, 0.63-0.72) in Hispanics, and 0.58 (95% CI, 0.52-0.65) in Asians. Limitations: Results may not generalize to the uninsured or subgroups within a race. Projected kidney failure was based on linear trends from clinically obtained eGFR. Conclusions: We found more extreme rates of eGFR decline in blacks. Projected kidney failure during CKD stages 3 and 4 was high in blacks, Hispanics, and Asians relative to whites. Mortality for those with projected kidney failure was highest in whites. Differences in eGFR decline and mortality contributed to racial disparities in ESRD incidence.
AB - Background: Current evidence does not clearly identify the contribution of kidney function decline and mortality to racial disparities in end-stage renal disease (ESRD) incidence. We used observed estimated glomerular filtration rate (eGFR) to project the time of onset of kidney failure and examined mortality to better understand these racial disparities. Study Design: Retrospective cohort. Setting & Participants: Adult members of Kaiser Permanente Southern California in 2003-2009 with more than 2 serum creatinine tests and more than 180 days between tests: 526,498 whites, 350,919 Hispanics, 136,923 blacks, and 105,476 Asians. Predictor: Race/ethnicity. Outcomes: ESRD (dialysis or transplantation); mortality. Measurements: eGFR decline was modeled using linear regression. Kidney failure was projected based on predicted eGFR <15 mL/min/1.73 m2 at specified times. Racial differences in projected kidney failure and mortality in those with projected kidney failure were estimated with adjustment for age, sex, and entry eGFR. Results: Blacks had more extreme rates of eGFR decline (1st percentile, -23.6 mL/min/1.73 m2 per year), followed by Hispanics (-20.9 mL/min/1.73 m2 per year), whites (-20.1 mL/min/1.73 m2 per year), and Asians (-17.6 mL/min/1.73 m2 per year; P < 0.001). There were 25,065 whites, 11,368 Hispanics, 6,785 blacks, and 3,176 Asians with projected kidney failure during the study period. The ORs for projected kidney failure versus whites during CKD stages 3 and 4 were 1.54 (95% CI, 1.46-1.62) in blacks, 1.49 (95% CI, 1.42-1.56) in Hispanics, and 1.41 (95% CI, 1.32-1.51) in Asians. For those with projected kidney failure, the HRs of death versus whites during CKD stages 3 and 4 were 0.82 (95% CI, 0.77-0.88) in blacks, 0.67 (95% CI, 0.63-0.72) in Hispanics, and 0.58 (95% CI, 0.52-0.65) in Asians. Limitations: Results may not generalize to the uninsured or subgroups within a race. Projected kidney failure was based on linear trends from clinically obtained eGFR. Conclusions: We found more extreme rates of eGFR decline in blacks. Projected kidney failure during CKD stages 3 and 4 was high in blacks, Hispanics, and Asians relative to whites. Mortality for those with projected kidney failure was highest in whites. Differences in eGFR decline and mortality contributed to racial disparities in ESRD incidence.
KW - Chronic kidney disease
KW - epidemiology
KW - health disparities
UR - http://www.scopus.com/inward/record.url?scp=84880594839&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2013.01.019
DO - 10.1053/j.ajkd.2013.01.019
M3 - Article
C2 - 23499049
AN - SCOPUS:84880594839
SN - 0272-6386
VL - 62
SP - 236
EP - 244
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -