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.
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.
Authors: Daniel E Weiner; Hocine Tighiouart; Manish G Amin; Paul C Stark; Bonnie MacLeod; John L Griffith; Deeb N Salem; Andrew S Levey; Mark J Sarnak Journal: J Am Soc Nephrol Date: 2004-05 Impact factor: 10.121
Authors: L G Hunsicker; S Adler; A Caggiula; B K England; T Greene; J W Kusek; N L Rogers; P E Teschan Journal: Kidney Int Date: 1997-06 Impact factor: 10.612
Authors: William McClellan; David G Warnock; Leslie McClure; Ruth C Campbell; Britt B Newsome; Virginia Howard; Mary Cushman; George Howard Journal: J Am Soc Nephrol Date: 2006-04-26 Impact factor: 10.121
Authors: Kunihiro Matsushita; Bakhtawar K Mahmoodi; Mark Woodward; Jonathan R Emberson; Tazeen H Jafar; Sun Ha Jee; Kevan R Polkinghorne; Anoop Shankar; David H Smith; Marcello Tonelli; David G Warnock; Chi-Pang Wen; Josef Coresh; Ron T Gansevoort; Brenda R Hemmelgarn; Andrew S Levey Journal: JAMA Date: 2012-05-09 Impact factor: 56.272
Authors: Afshin Parsa; W H Linda Kao; Dawei Xie; Brad C Astor; Man Li; Chi-yuan Hsu; Harold I Feldman; Rulan S Parekh; John W Kusek; Tom H Greene; Jeffrey C Fink; Amanda H Anderson; Michael J Choi; Jackson T Wright; James P Lash; Barry I Freedman; Akinlolu Ojo; Cheryl A Winkler; Dominic S Raj; Jeffrey B Kopp; Jiang He; Nancy G Jensvold; Kaixiang Tao; Michael S Lipkowitz; Lawrence J Appel Journal: N Engl J Med Date: 2013-11-09 Impact factor: 91.245
Authors: Kara L Watts; Abhishek Srivastava; Wilson Lin; Daniel Schoenfeld; Matthew Abramowitz; Joshua M Stern Journal: Urolithiasis Date: 2019-02-12 Impact factor: 3.436
Authors: Kamyar Kalantar-Zadeh; Csaba P Kovesdy; Elani Streja; Connie M Rhee; Melissa Soohoo; Joline L T Chen; Miklos Z Molnar; Yoshitsugu Obi; Daniel Gillen; Danh V Nguyen; Keith C Norris; John J Sim; Steve S Jacobsen Journal: Nephrol Dial Transplant Date: 2017-04-01 Impact factor: 5.992
Authors: Jayme E Locke; Haiyan Qu; Richard Shewchuk; Roslyn B Mannon; Robert Gaston; Dorry L Segev; Elinor C Mannon; Michelle Y Martin Journal: Clin J Am Soc Nephrol Date: 2015-01-29 Impact factor: 8.237
Authors: Michael J Fischer; Jesse Y Hsu; Claudia M Lora; Ana C Ricardo; Amanda H Anderson; Lydia Bazzano; Magdalena M Cuevas; Chi-Yuan Hsu; John W Kusek; Amada Renteria; Akinlolu O Ojo; Dominic S Raj; Sylvia E Rosas; Qiang Pan; Kristine Yaffe; Alan S Go; James P Lash Journal: J Am Soc Nephrol Date: 2016-05-05 Impact factor: 10.121
Authors: Jenna M Norton; Marva M Moxey-Mims; Paul W Eggers; Andrew S Narva; Robert A Star; Paul L Kimmel; Griffin P Rodgers Journal: J Am Soc Nephrol Date: 2016-05-13 Impact factor: 10.121
Authors: Csaba P Kovesdy; Josef Coresh; Shoshana H Ballew; Mark Woodward; Adeera Levin; David M J Naimark; Joseph Nally; Dietrich Rothenbacher; Benedicte Stengel; Kunitoshi Iseki; Kunihiro Matsushita; Andrew S Levey Journal: J Am Soc Nephrol Date: 2015-12-11 Impact factor: 10.121
Authors: Caren E Smith; Stephanie M Fullerton; Keith A Dookeran; Heather Hampel; Adrienne Tin; Nisa M Maruthur; Jonathan C Schisler; Jeffrey A Henderson; Katherine L Tucker; José M Ordovás Journal: Health Aff (Millwood) Date: 2016-08-01 Impact factor: 6.301