Lesley A Inker1, Tariq Shafi2, Aghogho Okparavero3, Hocine Tighiouart4, John H Eckfeldt5, Ronit Katz6, W Craig Johnson7, Norma Dermond7, Zarqa Tariq2, Imene Benayache2, Wendy S Post2, Josef Coresh2, Andrew S Levey3, Michael G Shlipak8. 1. Division of Nephrology, Tufts Medical Center, Boston, MA. Electronic address: linker@tuftsmedicalcenter.org. 2. Johns Hopkins University, Baltimore, MD. 3. Division of Nephrology, Tufts Medical Center, Boston, MA. 4. Division of Nephrology, Tufts Medical Center, Boston, MA; The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA. 5. Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN. 6. University of Washington, Kidney Research Institute, Seattle, WA. 7. Department of Biostatistics, School of Public Health and Community Medicine, University of Washington, Seattle, WA. 8. Division of Nephrology, University of California, San Francisco, CA.
Abstract
BACKGROUND: Kidney failure disproportionately affects older blacks versus whites. The reasons are unknown and may be related to lower measured glomerular filtration rate (GFR) and higher levels of albuminuria in community-based population samples. STUDY DESIGN: Cross-sectional analysis of a substudy of a prospective cohort. SETTING & PARTICIPANTS: Ancillary study following Multi-Ethnic Study of Atherosclerosis (MESA) visit 5. PREDICTOR: Age, sex, and race. OUTCOMES & MEASUREMENTS: Measured GFR using plasma clearance of iohexol and urine albumin-creatinine ratio (ACR). RESULTS: GFR was measured in 294 participants. Mean age was 71±9 (SD) years, 47% were black, 48% were women, mean GFR was 73±19mL/min/1.73m2, and median ACR was 10.0 (IQR, 5.8-20.9) mg/g. Measured GFR was on average 1.02 (95% CI, 0.79-1.24) mL/min/1.73m2 lower per year older. Mean GFR indexed for body surface area was not different between blacks versus whites (mean difference, 2.94 [95% CI, -1.37 to 7.26] mL/min/1.73m2), but was lower in women than men (mean difference, -9.34 [95% CI, -13.53 to -5.15] mL/min/1.73m2); this difference persisted and remained significant after adjustment for demographics, clinical characteristics, and measures of body size. The difference between men and women, but not between blacks and whites, was substantially greater when GFR was not indexed for body surface area. ACR was higher in older versus younger participants (mean difference, 3.2% [95% CI, 1.5%-4.8%] per year), but geometric mean ratio of ACR did not differ between blacks versus whites (mean difference, 19.7%; 95% CI, -39.1% to 6.1%) or between men versus women (mean difference, -4.4%; 95% CI, -27.7% to 26.3%). LIMITATIONS: This is a study of survivors. People who agreed to participate were younger than those who refused. CONCLUSIONS: In this first community-based study that included blacks and whites, no differences in measured GFR between races were found, suggesting that other factors must account for the disproportionately higher burden of kidney failure in older blacks versus whites.
BACKGROUND:Kidney failure disproportionately affects older blacks versus whites. The reasons are unknown and may be related to lower measured glomerular filtration rate (GFR) and higher levels of albuminuria in community-based population samples. STUDY DESIGN: Cross-sectional analysis of a substudy of a prospective cohort. SETTING & PARTICIPANTS: Ancillary study following Multi-Ethnic Study of Atherosclerosis (MESA) visit 5. PREDICTOR: Age, sex, and race. OUTCOMES & MEASUREMENTS: Measured GFR using plasma clearance of iohexol and urine albumin-creatinine ratio (ACR). RESULTS: GFR was measured in 294 participants. Mean age was 71±9 (SD) years, 47% were black, 48% were women, mean GFR was 73±19mL/min/1.73m2, and median ACR was 10.0 (IQR, 5.8-20.9) mg/g. Measured GFR was on average 1.02 (95% CI, 0.79-1.24) mL/min/1.73m2 lower per year older. Mean GFR indexed for body surface area was not different between blacks versus whites (mean difference, 2.94 [95% CI, -1.37 to 7.26] mL/min/1.73m2), but was lower in women than men (mean difference, -9.34 [95% CI, -13.53 to -5.15] mL/min/1.73m2); this difference persisted and remained significant after adjustment for demographics, clinical characteristics, and measures of body size. The difference between men and women, but not between blacks and whites, was substantially greater when GFR was not indexed for body surface area. ACR was higher in older versus younger participants (mean difference, 3.2% [95% CI, 1.5%-4.8%] per year), but geometric mean ratio of ACR did not differ between blacks versus whites (mean difference, 19.7%; 95% CI, -39.1% to 6.1%) or between men versus women (mean difference, -4.4%; 95% CI, -27.7% to 26.3%). LIMITATIONS: This is a study of survivors. People who agreed to participate were younger than those who refused. CONCLUSIONS: In this first community-based study that included blacks and whites, no differences in measured GFR between races were found, suggesting that other factors must account for the disproportionately higher burden of kidney failure in older blacks versus whites.
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Authors: Lesley A Inker; Andrew S Levey; Hocine Tighiouart; Tariq Shafi; John H Eckfeldt; Craig Johnson; Aghogho Okparavero; Wendy S Post; Josef Coresh; Michael G Shlipak Journal: Nephrol Dial Transplant Date: 2018-03-01 Impact factor: 5.992
Authors: Jovia L Nierenberg; Jiang He; Changwei Li; Xiaoying Gu; Mengyao Shi; Alexander C Razavi; Xuenan Mi; Shengxu Li; Lydia A Bazzano; Amanda H Anderson; Hua He; Wei Chen; Jason M Kinchen; Casey M Rebholz; Josef Coresh; Andrew S Levey; Lesley A Inker; Michael Shlipak; Tanika N Kelly Journal: Metabolomics Date: 2019-11-13 Impact factor: 4.290
Authors: Meredith C Foster; Andrew S Levey; Lesley A Inker; Tariq Shafi; Li Fan; Vilmundur Gudnason; Ronit Katz; Gary F Mitchell; Aghogho Okparavero; Runolfur Palsson; Wendy S Post; Michael G Shlipak Journal: Am J Kidney Dis Date: 2017-05-24 Impact factor: 8.860
Authors: Josef Coresh; Lesley A Inker; Yingying Sang; Jingsha Chen; Tariq Shafi; Wendy S Post; Michael G Shlipak; Lisa Ford; Kelli Goodman; Regis Perichon; Tom Greene; Andrew S Levey Journal: Nephrol Dial Transplant Date: 2019-05-01 Impact factor: 5.992
Authors: George J Schwartz; Hongyue Wang; Brian Erway; Gunnar Nordin; Jesse Seegmiller; John C Lieske; Sten-Erik Back; W Greg Miller; John H Eckfeldt Journal: J Appl Lab Med Date: 2018-03