期刊
AMERICAN JOURNAL OF KIDNEY DISEASES
卷 68, 期 4, 页码 545-553出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.ajkd.2016.03.429
关键词
Race; ethnicity; survival paradox; racial disparities; racial/ethnic variation; dialysis; atherosclerotic cardiovascular events; heart failure; end-stage renal disease (ESRD); Hispanic; CRIC (Chronic Renal Insufficiency Cohort); Hispanic CRIC
资金
- US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, U01DK060902]
- Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award National Institutes of Health (NIH)/National Center for Advancing Translational Sciences [UL1TR000003]
- Johns Hopkins University [UL1 TR-000424]
- University of Maryland General Clinic Research Center [M01 RR-16500]
- Clinical and Translational Science Collaborative of Cleveland from the National Center for Advancing Translational Sciences (NCATS) [UL1TR000439]
- NIH roadmap for Medical Research, Michigan Institute for Clinical and Health Research [UL1TR000433]
- University of Illinois at Chicago Clinical and Translational Science Award [UL1RR029879]
- Tulane University Translational Research in Hypertension and Renal Biology [P30GM103337]
- Kaiser Permanente Northern California NIH/National Center for Research Resources University of California San Francisco-Clinical and Translational Science Institute [UL1 RR-024131]
- NIDDK [K24DK092290, K23DK094829, K23DK091313]
- NIH [R01DK076116, R01DK081374, R01DK094796, K24DK093723, R21DK100754, U01DK099930]
- Strategically Focused Research Network Center Grant from the American Heart Association
Background: Non-Hispanic blacks and Hispanics with end-stage renal disease have a lower risk for death than non-Hispanic whites, but data for racial/ethnic variation in cardiovascular outcomes for non-dialysis-dependent chronic kidney disease are limited. Study Design: Prospective cohort. Setting & Participants: 3,785 adults with entry estimated glomerular filtration rates of 20 to 70 mL/min/1.73 m(2) enrolled in the CRIC (Chronic Renal Insufficiency Cohort) Study. Predictors: Race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic). Outcomes: Cardiovascular outcomes (atherosclerotic events [myocardial infarction, stroke, or peripheral arterial disease] and heart failure) and a composite of each cardiovascular outcome or all-cause death. Measurements: Multivariable Cox proportional hazards. Results: During a median follow-up of 6.6 years, we observed 506 atherosclerotic events, 551 heart failure events, and 692 deaths. In regression analyses, there were no significant differences in atherosclerotic events among the 3 racial/ethnic groups. In analyses stratified by clinical site, non-Hispanic blacks had a higher risk for heart failure events (HR, 1.59; 95% CI, 1.29-1.95), which became nonsignificant after adjustment for demographic factors and baseline kidney function. In contrast, Hispanics had similar risk for heart failure events as non-Hispanic whites. In analyses stratified by clinical site, compared with non-Hispanic whites, non-Hispanic blacks were at similar risk for atherosclerotic events or death. However, after further adjustment for cardiovascular risk factors, medications, and mineral metabolism markers, non-Hispanic blacks had 17% lower risk for the outcome (HR, 0.83; 95% CI, 0.69-0.99) than non-Hispanic whites, whereas there was no significant association with Hispanic ethnicity. Limitations: Hispanics were largely recruited from a single center, and the study was underpowered to evaluate the association between Hispanic ethnicity and mortality. Conclusions: There were no significant racial/ethnic differences in adjusted risk for atherosclerotic or heart failure outcomes. Future research is needed to better explain the reduced risk for atherosclerotic events or death in non-Hispanic blacks compared with non-Hispanic whites. (C) 2016 by the National Kidney Foundation, Inc.
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