Patients with chronic kidney disease have an increased risk for progression to ESRD. The purpose of this study was to examine factors that predict increased risk for adverse renal outcomes. Cox regression was performed to assess the potential of 38 baseline risk factors to predict the clinical renal composite outcome of 50% or 25-ml/min per 1.73 m 2 GFR decline or ESRD among 1094 black patients with hypertensive nephrosclerosis (GFR 20 to 65 ml/min per 1.73 m 2 ). Patients were trial participants who had been randomly assigned to one of two BP goals and to one of three antihypertensive regimens and followed for a range of 3 to 6.4 yr. In unadjusted and adjusted analyses, baseline proteinuria was consistently associated with an increased risk for adverse renal outcomes, even at low levels of proteinuria. The relationship of proteinuria with adverse renal outcomes also was evident in analyses that were stratified by level of GFR, which itself was associated with adverse renal outcomes but only at levels <40 ml/min. Other factors that were significantly associated with increased renal events after adjustment for baseline GFR, age, and gender, both with and without adjustment for baseline proteinuria, included serum creatinine, urea nitrogen, and phosphorus. In black patients with hypertensive nephrosclerosis, increased proteinuria, reduced GFR, and elevated levels of serum creatinine, urea nitrogen and phosphorus were directly associated with adverse clinical renal events. These findings identify a subset of this high-risk population that might benefit from even more aggressive treatment.J Am Soc Nephrol 17: 2928 -2936, 2006 . doi: 10.1681 P atients with chronic kidney disease (CKD) are at increased risk for progression to ESRD and for premature cardiovascular disease (CVD) (1-4). The number of individuals who receive renal replacement therapy for ESRD continues to increase and now has reached epidemic proportions (5). Whereas the estimated prevalence of CKD is similar for black and white individuals (6), the adjusted incidence of ESRD among black individuals is the highest among racial/ ethnic subgroups of the US population and at 988 per million is nearly four times more common than their white counterparts at 254 per million (3). The magnitude of hypertension-related ESRD among black individuals is highlighted by a nearly sixfold higher incidence than in white individuals; among 20-to 44-yr-olds, the incidence of hypertension-related ESRD in black individuals is Ͼ15 times that of white individuals (3). Indeed, black race, male gender, hypertension, and hypercreatinemia have been noted as powerful predictors of development of hypertension-related ESRD (7). The level of proteinuria also has been found to be an especially strong predictor of the rate of progression in a wide range of CKD populations, including black individuals with hypertensive nephrosclerosis (8). Additional factors that contribute to the more rapid progression from CKD to ESRD among black individuals have not been defined clearly, although high...

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