Racial Differences in the Incidence of Treatment for End-Stage Renal Disease

Rostand, Stephen G.; Kirk, Katharine A.; Rutsky, Edwin A.; Pate, Brenda A.

doi:10.1056/nejm198205273062106

Cited by 364 publications

(151 citation statements)

References 5 publications

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“…The unexpected reversal of prevalence of CKD among black individuals compared with the white population and the failure of multiple risk factors to explain the observed disparities in ESRD incidence are consistent with observations that black people with the same degree of impaired kidney function are at increased risk of progressive kidney failure [62][63][64][65][66][67][68][69]. Hsu et al recently examined this possibility in an ecologic analysis of NHANES III and USRDS data [70,71].…”

Section: Part 1 Epidemiology Of Kidney Diseasementioning

confidence: 81%

Epidemiology of Chronic Kidney Disease

McClellan

Port

2008

Evidence‐Based Nephrology

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Section: Part 1 Epidemiology Of Kidney Diseasementioning

confidence: 81%

Epidemiology of Chronic Kidney Disease

McClellan

Port

2008

Evidence‐Based Nephrology

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“…Conceivably, a higher arterial pressure during a period when vasculature may be at a more formative stage could have permanent injurious effects. The higher prevalence and the earlier onset of arterial disease resulting in kidney failure 27 and stroke 28 in blacks might stem in part from exposure to higher levels of blood pressure early in life.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal assessment of blood pressures in black and white children.

1993

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The prevalence of hypertension is greater for blacks than whites. Whether black children have higher blood pressure than white children is less clear. We investigated this issue through a prospective longitudinal assessment of blood pressure in 345 white children and 164 black children. Each child had his or her blood pressure measured every 6 months for 2 to 5.5 years. The means for systolic and diastolic blood pressures for each individual were calculated, and the rate of change in blood pressure over time for each subject was estimated. The mean blood pressure and the mean rate were compared between gender-specific black and white groups. For both boys and girls, the mean systolic blood pressure was 2 mm Hg higher in black children than white children (/*=.0008). Boys had a higher systolic blood pressure than girls (P=.OO48). The mean diastolic blood pressure was 1.5 mm Hg higher in black children than in white children (P=.O27O); no significant gender difference in diastolic blood pressure was observed. Age, weight, height, and body mass index were highly correlated with blood pressure. When accounting for these variables, for girls the racial difference in systolic blood pressure remained significant, whereas the difference in diastolic blood pressure in boys and girls was no longer significant. The rate of increase in blood pressure over time was significantly greater in blacks than whites: for systolic blood pressure, P=.0002, and for diastolic blood pressure, P=.OO9. There was no sex difference in rate of change in systolic blood pressure, whereas girls showed a greater increase in diastolic blood pressure over time than boys (P=.O131). In summary, the average blood pressure for black children was higher than in white children, and the blood pressure increased at a faster rate in blacks compared with whites. The findings suggest that mechanisms that predispose blacks to hypertension may be functioning in childhood. (Hypertension 1993;22:84-89) KEY WORDS • blacks • blood pressure • hypertension, essential • child H ypertension is more common in blacks than in whites. 1 -2 It remains uncertain, however, whether blood pressure is higher in blacks than in whites before hypertension begins. Some crosssectional studies found slightly higher blood pressure in black children, 35 whereas others described inconclusive findings or found blood pressure to be lower in whites than in blacks.6 ' 9 In one study of adolescents, blood pressure at night was higher in blacks than in whites. 10 An increased level of arterial pressure in black children compared with white children would suggest that factors involved in the development of hypertension in blacks are functioning early in life. If the pathophysiology of the hypertension is indeed present in childhood, then studies that include young, normotensive individuals might provide useful information to an understanding of the etiology of hypertension.We describe here a prospective, longitudinal study of blood pressure in black and white children. Blood pressure was me...

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“…5,6 A common mechanism linking these 2 diseases is the overproduction of reactive oxygen species (ROS), particularly in the renal medulla. Mechanisms that decrease blood flow to this area of the kidney result in long-term alterations in arterial blood pressure 7 as are seen with local increases of O 2 ⅐Ϫ and H 2 O 2 in the renal medulla of Sprague Dawley rats, which causes hypertension.…”

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confidence: 99%

NADPH Oxidase in the Renal Medulla Causes Oxidative Stress and Contributes to Salt-Sensitive Hypertension in Dahl S Rats

et al. 2006

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Abstract-Dahl salt-sensitive (SS) rats exhibit increased renal medullary oxidative stress and blood pressure salt-sensitivity compared with consomic, salt-resistant SS-13 BN rats, despite highly similar genetic backgrounds. The present study examined potential sources of renal medullary superoxide in prehypertensive SS rats fed a 0.4% NaCl diet by assessing activity and protein levels of superoxide producing and scavenging enzymes. Superoxide production was nearly doubled in SS rats compared with SS-13 BN rats as determined by urinary 8-isoprostane excretion and renal medullary oxy-ethidium microdialysate levels. Medullary superoxide production in tissue homogenates was greater in SS rats, and the NADPH oxidase inhibitor diphenylene iodonium preferentially reduced SS levels to those found in SS-13 BN rats. Dinitrophenol, a mitochondrial uncoupler, eliminated the remaining superoxide production in both strains, whereas inhibition of xanthine oxidase, NO synthase, and cycloxygenase had no effect. L-arginine, NO synthase, superoxide dismutase, catalase, and glutathione peroxidase activities between SS and SS-13 BN rats did not differ. Chronic blood pressure responses to a 4% NaCl diet were then determined in the presence or absence of the NADPH oxidase inhibitor apocynin (3.5 g/kg per minute), chronically delivered directly into the renal medulla. Apocynin infusion reduced renal medullary interstitial superoxide from 1059Ϯ130 to 422Ϯ80 (oxyethidium fluorescence units) and mean arterial pressure from 175Ϯ4 to 157Ϯ6 mm Hg in SS rats, whereas no effects on either were observed in the SS-13 BN . We conclude that excess renal medullary superoxide production in SS rats contributes to salt-induced hypertension, and NADPH oxidase is the major source of the excess superoxide.

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Racial Differences in the Incidence of Treatment for End-Stage Renal Disease

Cited by 364 publications

References 5 publications

Epidemiology of Chronic Kidney Disease

Epidemiology of Chronic Kidney Disease

Longitudinal assessment of blood pressures in black and white children.

NADPH Oxidase in the Renal Medulla Causes Oxidative Stress and Contributes to Salt-Sensitive Hypertension in Dahl S Rats

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