White/Black Racial Differences in Risk of End-stage Renal Disease and Death
Abstract
Background
End-stage renal disease disproportionately affects black persons, but it is unknown when in the course of chronic kidney disease racial differences arise. Understanding the natural history of racial differences in kidney disease may help guide efforts to reduce disparities.
Methods
We compared white/black differences in the risk of end-stage renal disease and death by level of estimated glomerular filtration rate (eGFR) at baseline in a national sample of 2,015,891 veterans between 2001 and 2005.
Results
Rates of end-stage renal disease among black patients exceeded those among white patients at all levels of baseline eGFR. The adjusted hazard ratios for end-stage renal disease associated with black versus white race for patients with an eGFR ≥90, 60-89, 45-59, 30-44, 15-29, and <15 mL/min/1.73m2, respectively, were 2.14 (95% confidence interval [CI], 1.72-2.65), 2.30 (95% CI, 2.02-2.61), 3.08 (95% CI, 2.74-3.46), 2.47 (95% CI, 2.26-2.70), 1.86 (95% CI, 1.75-1.98), and 1.23 (95% CI, 1.12-1.34). We observed a similar pattern for mortality, with equal or higher rates of death among black persons at all levels of eGFR. The highest risk of mortality associated with black race also was observed among those with an eGFR 45-59 mL/min/1.73m2 (hazard ratio 1.32, 95% CI, 1.27-1.36).
Conclusion
Racial differences in the risk of end-stage renal disease appear early in the course of kidney disease and are not explained by a survival advantage among blacks. Efforts to identify and slow progression of chronic kidney disease at earlier stages may be needed to reduce racial disparities.
aDepartment of Medicine, San Francisco Veterans Affairs (VA) Medical Center and University of California, San Francisco, Calif
bDepartment of Medicine, VA Puget Sound Healthcare System and University of Washington, Seattle
cDepartment of Epidemiology and Biostatistics, University of California, San Francisco, Calif
dVA Research Enhancement Award Program, San Francisco VA Medical Center, San Francisco, Calif
eDepartment of Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso
Requests for reprints should be addressed to Andy I. Choi, MD, MAS, San Francisco Veterans Affairs Medical Center, Box 111J, 4150 Clement Street, San Francisco, CA 94121
Funding: This study was supported by a fellowship grant from the National Kidney Foundation, grants from the National Institutes of Health (K23DK080645-01A1, K23AG028980-03, R01AI069952-03), W.K. Kellogg Scholars in Health Disparities Program, Paso del Norte Health Foundation's Center for Border Health Research, and the San Francisco VA Research Enhancement Award Program to Improve Care for Older Veterans. These funding sources had no involvement in the design or execution of this study.
Conflict of Interest: GTH has received research support from the Catholic Healthcare West, Genentech, Biogen, Novartis, Roche, and the National Institute of Diabetes and Digestive and Kidney Diseases; he has received honoraria from the National Institute of Environmental Health Sciences and Novartis. AMO receives royalties from UpToDate and research funding from the Centers for Disease Control. These funding sources played no role in the research presented here. The other authors declare no potential financial conflicts of interest.
Authorship: AIC, AMO, and DB had access to the data; all authors had a role in writing the manuscript.
ABSTRACT
