Racial and Ethnic Differences in Mortality among Individuals with Chronic Kidney Disease

Jolly, Stacey E.; Burrows, Nilka Ríos; Chen, Shu‐Cheng; Li, Suying; Jurkovitz, Claudine; Norris, Keith C.; Shlipak, Michael G.

doi:10.2215/cjn.00500111

Cited by 44 publications

(41 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We also fit similar adjusted models with patients classified into age .65 versus ,65, because prior research has shown age-related differences among the general population. 38 A separate analysis using eGFR as a continuous variable was also conducted. We tested the non-linearity of eGFR with restricted cubic splines.…”

Section: Discussionmentioning

confidence: 99%

Cause-Specific Deaths in Non–Dialysis-Dependent CKD

Navaneethan

Schold

Arrigain

et al. 2015

Journal of the American Society of Nephrology

Self Cite

View full text Add to dashboard Cite

CKD is associated with higher risk of death, but details regarding differences in cause-specific death in CKD are unclear. We examined the leading causes of death among a non-dialysis-dependent CKD population using an electronic medical record-based CKD registry in a large healthcare system and the Ohio Department of Health mortality files. We included 33,478 white and 5042 black patients with CKD who resided in Ohio between January 2005 and September 2009 and had two measurements of eGFR,60 ml/min per 1.73 m 2 obtained 90 days apart. Causes of death (before ESRD) were classified into cardiovascular, malignancy, and non-cardiovascular/non-malignancy diseases and non-disease-related causes. During a median follow-up of 2.3 years, 6661 of 38,520 patients (17%) with CKD died. Cardiovascular diseases (34.7%) and malignant neoplasms (31.8%) were the leading causes of death, with malignancy-related deaths more common among those with earlier stages of kidney disease. After adjusting for covariates, each 5 ml/min per 1.73 m 2 decline in eGFR was associated with higher risk of death due to cardiovascular disease (hazard ratio [HR], 1.10; 95% confidence interval [95% CI], 1.08 to 1.12) and non-cardiovascular/ non-malignancy diseases (HR, 1.12; 95% CI, 1.09 to 1.14) but not to malignancy. In the adjusted models, blacks had overall-mortality hazard ratios similar to those of whites but higher hazard ratios for cardiovascular deaths. Further studies to confirm these findings and explain the mechanisms for differences are warranted. In addition to lowering cardiovascular burden in CKD, efforts to target known risk factors for cancer at the population level are needed.

show abstract

Section: Discussionmentioning

confidence: 99%

Cause-Specific Deaths in Non–Dialysis-Dependent CKD

Navaneethan

Schold

Arrigain

et al. 2015

Journal of the American Society of Nephrology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Given the high prevalence of SCT in the United States and the disproportionate risk for CVD and CKD in African American patients [15,16], characterizing the potential additive risk in this population is essential for early identification and modification of cardiovascular risk factors. Herein we sought to examine the cardiovascular risk in African American CKD patients with SCT compared to African American CKD patients without SCT -with a specific focus on the interaction between SCT and sex on cardiovascular outcomes.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Outcomes in African Americans with Sickle Cell Trait and Chronic Kidney Disease

et al. 2019

View full text Add to dashboard Cite

Background: Sickle cell trait (SCT) is common among African Americans and has been historically considered to be benign. Recently, SCT has been associated with an increased risk for chronic kidney disease (CKD) and cardiovascular disease in the general population. Our understanding of SCT has been extrapolated largely from data of patients with sickle cell disease (SCD). Notably, in SCD, the outcomes differ by sex. The effect of SCT on cardiovascular risk in the African American CKD population is unknown, and the interaction between SCT and sex on cardiovascular risk has not been investigated. Methods: We performed a 2-center retrospective cohort study of all African American patients with SCT using international classification of disease diagnosis codes and CKD (using the 2012 Kidney Disease Improving Global Outcomes criteria) with at least 1 year of follow-up between January 2005 and December 2017. A reference group of African American CKD patients without SCT was used as a comparator during the same period. SCT patients and the reference patients were matched at baseline for age, sex, comorbidities, and proteinuria. Primary outcomes were incident coronary artery disease (CAD), incident stroke, and all-cause mortality. Analysis of effect modification between sex and SCT on primary outcomes was performed. Results: We identified 621 African American CKD patients, 217 SCT patients, and 404 reference patients. The mean age was 56 ± 13 years and 66% were female. The mean estimated glomerular filtration rate was 69 ± 30 mL/min. The mean follow-up time was 8 ± 4 years. There were no significant differences in the primary outcomes comparing SCT patients to matched controls. The interaction term between SCT and sex, however, was significant in the CAD model (p < 0.01). Stratification by sex showed no increased risk in females but a significantly increased risk for CAD in male SCT patients (hazard ratio [HR] 2.14; 95% CI 1.18–3.86), which persisted after multivariable analysis (HR 2.13; 95% CI 1.17–3.86). Conclusion: SCT is associated with an increased risk for CAD in African American males with CKD. The excess risk in males with SCT appears to follow the same pattern as risk in males with SCD. Larger studies are needed to confirm these findings.

show abstract

“…[1][2][3] A significant proportion of the United States adult population has CKD, 4 individuals with CKD are 16-40 times more likely to die from cardiovascular disease than to reach ESRD, 5 ESRD is responsible for the death of more Americans than breast and prostate cancer combined, 6 and blacks, Native Americans, and Latinos are at significantly greater risk for CKD, resulting in serious health disparity issues. [7][8][9] These realities have failed to sufficiently drive public awareness, industry innovation, and research funding. Additionally, Medicare costs for ESRD exceeded $34 billion in 2013, whereas patients with ESRD represent approximately 1% of the Medicare population; also, costs associated with the care of beneficiaries with ESRD constituted .6% of the Medicare budget in 2013.…”

mentioning

confidence: 99%

Overcoming Barriers in Kidney Health—Forging a Platform for Innovation

Linde

Archdeacon

Breyer

et al. 2016

JASN

View full text Add to dashboard Cite

Innovation in kidney diseases is not commensurate with the effect of these diseases on human health and mortality or innovation in other key therapeutic areas. A primary cause of the dearth in innovation is that kidney diseases disproportionately affect a demographic that is largely disenfranchised, lacking sufficient advocacy, public attention, and funding. A secondary and likely consequent cause is that the existing infrastructure supporting nephrology research pales in comparison with those for other internal medicine specialties, especially cardiology and oncology. Citing such inequities, however, is not enough. Changing the status quo will require a coordinated effort to identify and redress the existing deficits. Specifically, these deficits relate to the need to further develop and improve the following: understanding of the disease mechanisms and pathophysiology, patient engagement and activism, clinical trial infrastructure, and investigational clinical trial designs as well as coordinated efforts among critical stakeholders. This paper identifies potential solutions to these barriers, some of which are already underway through the Kidney Health Initiative. The Kidney Health Initiative is unique and will serve as a current and future platform from which to overcome these barriers to innovation in nephrology.

show abstract

Racial and Ethnic Differences in Mortality among Individuals with Chronic Kidney Disease

Cited by 44 publications

References 37 publications

Cause-Specific Deaths in Non–Dialysis-Dependent CKD

Cause-Specific Deaths in Non–Dialysis-Dependent CKD

Cardiovascular Outcomes in African Americans with Sickle Cell Trait and Chronic Kidney Disease

Overcoming Barriers in Kidney Health—Forging a Platform for Innovation

Contact Info

Product

Resources

About