Racial differences in estimated GFR decline, ESRD, and mortality in an integrated health system

Stephen F. Derose, Mark P. Rutkowski, Peter W. Crooks, Jiaxiao M. Shi, Jean Q. Wang, Kamyar Kalantar-Zadeh, Csaba Kovesdy, Nathan W. Levin, Steven J. Jacobsen

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background: Current evidence does not clearly identify the contribution of kidney function decline and mortality to racial disparities in end-stage renal disease (ESRD) incidence. We used observed estimated glomerular filtration rate (eGFR) to project the time of onset of kidney failure and examined mortality to better understand these racial disparities. Study Design: Retrospective cohort. Setting & Participants: Adult members of Kaiser Permanente Southern California in 2003-2009 with more than 2 serum creatinine tests and more than 180 days between tests: 526,498 whites, 350,919 Hispanics, 136,923 blacks, and 105,476 Asians. Predictor: Race/ethnicity. Outcomes: ESRD (dialysis or transplantation); mortality. Measurements: eGFR decline was modeled using linear regression. Kidney failure was projected based on predicted eGFR <15 mL/min/1.73 m 2 at specified times. Racial differences in projected kidney failure and mortality in those with projected kidney failure were estimated with adjustment for age, sex, and entry eGFR. Results: Blacks had more extreme rates of eGFR decline (1st percentile, -23.6 mL/min/1.73 m 2 per year), followed by Hispanics (-20.9 mL/min/1.73 m 2 per year), whites (-20.1 mL/min/1.73 m 2 per year), and Asians (-17.6 mL/min/1.73 m 2 per year; P < 0.001). There were 25,065 whites, 11,368 Hispanics, 6,785 blacks, and 3,176 Asians with projected kidney failure during the study period. The ORs for projected kidney failure versus whites during CKD stages 3 and 4 were 1.54 (95% CI, 1.46-1.62) in blacks, 1.49 (95% CI, 1.42-1.56) in Hispanics, and 1.41 (95% CI, 1.32-1.51) in Asians. For those with projected kidney failure, the HRs of death versus whites during CKD stages 3 and 4 were 0.82 (95% CI, 0.77-0.88) in blacks, 0.67 (95% CI, 0.63-0.72) in Hispanics, and 0.58 (95% CI, 0.52-0.65) in Asians. Limitations: Results may not generalize to the uninsured or subgroups within a race. Projected kidney failure was based on linear trends from clinically obtained eGFR. Conclusions: We found more extreme rates of eGFR decline in blacks. Projected kidney failure during CKD stages 3 and 4 was high in blacks, Hispanics, and Asians relative to whites. Mortality for those with projected kidney failure was highest in whites. Differences in eGFR decline and mortality contributed to racial disparities in ESRD incidence.

Original languageEnglish (US)
Pages (from-to)236-244
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume62
Issue number2
DOIs
StatePublished - Aug 1 2013

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Chronic Kidney Failure
Renal Insufficiency
Glomerular Filtration Rate
Hispanic Americans
Mortality
Health
Incidence
Kidney Transplantation
Renal Dialysis
Linear Models
Creatinine
Retrospective Studies
Kidney
Serum

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Derose, S. F., Rutkowski, M. P., Crooks, P. W., Shi, J. M., Wang, J. Q., Kalantar-Zadeh, K., ... Jacobsen, S. J. (2013). Racial differences in estimated GFR decline, ESRD, and mortality in an integrated health system. American Journal of Kidney Diseases, 62(2), 236-244. https://doi.org/10.1053/j.ajkd.2013.01.019

Racial differences in estimated GFR decline, ESRD, and mortality in an integrated health system. / Derose, Stephen F.; Rutkowski, Mark P.; Crooks, Peter W.; Shi, Jiaxiao M.; Wang, Jean Q.; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba; Levin, Nathan W.; Jacobsen, Steven J.

In: American Journal of Kidney Diseases, Vol. 62, No. 2, 01.08.2013, p. 236-244.

Research output: Contribution to journalArticle

Derose, SF, Rutkowski, MP, Crooks, PW, Shi, JM, Wang, JQ, Kalantar-Zadeh, K, Kovesdy, C, Levin, NW & Jacobsen, SJ 2013, 'Racial differences in estimated GFR decline, ESRD, and mortality in an integrated health system', American Journal of Kidney Diseases, vol. 62, no. 2, pp. 236-244. https://doi.org/10.1053/j.ajkd.2013.01.019
Derose, Stephen F. ; Rutkowski, Mark P. ; Crooks, Peter W. ; Shi, Jiaxiao M. ; Wang, Jean Q. ; Kalantar-Zadeh, Kamyar ; Kovesdy, Csaba ; Levin, Nathan W. ; Jacobsen, Steven J. / Racial differences in estimated GFR decline, ESRD, and mortality in an integrated health system. In: American Journal of Kidney Diseases. 2013 ; Vol. 62, No. 2. pp. 236-244.
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abstract = "Background: Current evidence does not clearly identify the contribution of kidney function decline and mortality to racial disparities in end-stage renal disease (ESRD) incidence. We used observed estimated glomerular filtration rate (eGFR) to project the time of onset of kidney failure and examined mortality to better understand these racial disparities. Study Design: Retrospective cohort. Setting & Participants: Adult members of Kaiser Permanente Southern California in 2003-2009 with more than 2 serum creatinine tests and more than 180 days between tests: 526,498 whites, 350,919 Hispanics, 136,923 blacks, and 105,476 Asians. Predictor: Race/ethnicity. Outcomes: ESRD (dialysis or transplantation); mortality. Measurements: eGFR decline was modeled using linear regression. Kidney failure was projected based on predicted eGFR <15 mL/min/1.73 m 2 at specified times. Racial differences in projected kidney failure and mortality in those with projected kidney failure were estimated with adjustment for age, sex, and entry eGFR. Results: Blacks had more extreme rates of eGFR decline (1st percentile, -23.6 mL/min/1.73 m 2 per year), followed by Hispanics (-20.9 mL/min/1.73 m 2 per year), whites (-20.1 mL/min/1.73 m 2 per year), and Asians (-17.6 mL/min/1.73 m 2 per year; P < 0.001). There were 25,065 whites, 11,368 Hispanics, 6,785 blacks, and 3,176 Asians with projected kidney failure during the study period. The ORs for projected kidney failure versus whites during CKD stages 3 and 4 were 1.54 (95{\%} CI, 1.46-1.62) in blacks, 1.49 (95{\%} CI, 1.42-1.56) in Hispanics, and 1.41 (95{\%} CI, 1.32-1.51) in Asians. For those with projected kidney failure, the HRs of death versus whites during CKD stages 3 and 4 were 0.82 (95{\%} CI, 0.77-0.88) in blacks, 0.67 (95{\%} CI, 0.63-0.72) in Hispanics, and 0.58 (95{\%} CI, 0.52-0.65) in Asians. Limitations: Results may not generalize to the uninsured or subgroups within a race. Projected kidney failure was based on linear trends from clinically obtained eGFR. Conclusions: We found more extreme rates of eGFR decline in blacks. Projected kidney failure during CKD stages 3 and 4 was high in blacks, Hispanics, and Asians relative to whites. Mortality for those with projected kidney failure was highest in whites. Differences in eGFR decline and mortality contributed to racial disparities in ESRD incidence.",
author = "Derose, {Stephen F.} and Rutkowski, {Mark P.} and Crooks, {Peter W.} and Shi, {Jiaxiao M.} and Wang, {Jean Q.} and Kamyar Kalantar-Zadeh and Csaba Kovesdy and Levin, {Nathan W.} and Jacobsen, {Steven J.}",
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T1 - Racial differences in estimated GFR decline, ESRD, and mortality in an integrated health system

AU - Derose, Stephen F.

AU - Rutkowski, Mark P.

AU - Crooks, Peter W.

AU - Shi, Jiaxiao M.

AU - Wang, Jean Q.

AU - Kalantar-Zadeh, Kamyar

AU - Kovesdy, Csaba

AU - Levin, Nathan W.

AU - Jacobsen, Steven J.

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N2 - Background: Current evidence does not clearly identify the contribution of kidney function decline and mortality to racial disparities in end-stage renal disease (ESRD) incidence. We used observed estimated glomerular filtration rate (eGFR) to project the time of onset of kidney failure and examined mortality to better understand these racial disparities. Study Design: Retrospective cohort. Setting & Participants: Adult members of Kaiser Permanente Southern California in 2003-2009 with more than 2 serum creatinine tests and more than 180 days between tests: 526,498 whites, 350,919 Hispanics, 136,923 blacks, and 105,476 Asians. Predictor: Race/ethnicity. Outcomes: ESRD (dialysis or transplantation); mortality. Measurements: eGFR decline was modeled using linear regression. Kidney failure was projected based on predicted eGFR <15 mL/min/1.73 m 2 at specified times. Racial differences in projected kidney failure and mortality in those with projected kidney failure were estimated with adjustment for age, sex, and entry eGFR. Results: Blacks had more extreme rates of eGFR decline (1st percentile, -23.6 mL/min/1.73 m 2 per year), followed by Hispanics (-20.9 mL/min/1.73 m 2 per year), whites (-20.1 mL/min/1.73 m 2 per year), and Asians (-17.6 mL/min/1.73 m 2 per year; P < 0.001). There were 25,065 whites, 11,368 Hispanics, 6,785 blacks, and 3,176 Asians with projected kidney failure during the study period. The ORs for projected kidney failure versus whites during CKD stages 3 and 4 were 1.54 (95% CI, 1.46-1.62) in blacks, 1.49 (95% CI, 1.42-1.56) in Hispanics, and 1.41 (95% CI, 1.32-1.51) in Asians. For those with projected kidney failure, the HRs of death versus whites during CKD stages 3 and 4 were 0.82 (95% CI, 0.77-0.88) in blacks, 0.67 (95% CI, 0.63-0.72) in Hispanics, and 0.58 (95% CI, 0.52-0.65) in Asians. Limitations: Results may not generalize to the uninsured or subgroups within a race. Projected kidney failure was based on linear trends from clinically obtained eGFR. Conclusions: We found more extreme rates of eGFR decline in blacks. Projected kidney failure during CKD stages 3 and 4 was high in blacks, Hispanics, and Asians relative to whites. Mortality for those with projected kidney failure was highest in whites. Differences in eGFR decline and mortality contributed to racial disparities in ESRD incidence.

AB - Background: Current evidence does not clearly identify the contribution of kidney function decline and mortality to racial disparities in end-stage renal disease (ESRD) incidence. We used observed estimated glomerular filtration rate (eGFR) to project the time of onset of kidney failure and examined mortality to better understand these racial disparities. Study Design: Retrospective cohort. Setting & Participants: Adult members of Kaiser Permanente Southern California in 2003-2009 with more than 2 serum creatinine tests and more than 180 days between tests: 526,498 whites, 350,919 Hispanics, 136,923 blacks, and 105,476 Asians. Predictor: Race/ethnicity. Outcomes: ESRD (dialysis or transplantation); mortality. Measurements: eGFR decline was modeled using linear regression. Kidney failure was projected based on predicted eGFR <15 mL/min/1.73 m 2 at specified times. Racial differences in projected kidney failure and mortality in those with projected kidney failure were estimated with adjustment for age, sex, and entry eGFR. Results: Blacks had more extreme rates of eGFR decline (1st percentile, -23.6 mL/min/1.73 m 2 per year), followed by Hispanics (-20.9 mL/min/1.73 m 2 per year), whites (-20.1 mL/min/1.73 m 2 per year), and Asians (-17.6 mL/min/1.73 m 2 per year; P < 0.001). There were 25,065 whites, 11,368 Hispanics, 6,785 blacks, and 3,176 Asians with projected kidney failure during the study period. The ORs for projected kidney failure versus whites during CKD stages 3 and 4 were 1.54 (95% CI, 1.46-1.62) in blacks, 1.49 (95% CI, 1.42-1.56) in Hispanics, and 1.41 (95% CI, 1.32-1.51) in Asians. For those with projected kidney failure, the HRs of death versus whites during CKD stages 3 and 4 were 0.82 (95% CI, 0.77-0.88) in blacks, 0.67 (95% CI, 0.63-0.72) in Hispanics, and 0.58 (95% CI, 0.52-0.65) in Asians. Limitations: Results may not generalize to the uninsured or subgroups within a race. Projected kidney failure was based on linear trends from clinically obtained eGFR. Conclusions: We found more extreme rates of eGFR decline in blacks. Projected kidney failure during CKD stages 3 and 4 was high in blacks, Hispanics, and Asians relative to whites. Mortality for those with projected kidney failure was highest in whites. Differences in eGFR decline and mortality contributed to racial disparities in ESRD incidence.

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