Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 May;4(5):973-8.
doi: 10.2215/CJN.06031108. Epub 2009 Apr 15.

Outcomes associated with race in males with nondialysis-dependent chronic kidney disease

Csaba P Kovesdy  1 , John E Anderson, Stephen F Derose, Kamyar Kalantar-Zadeh
Affiliations

Outcomes associated with race in males with nondialysis-dependent chronic kidney disease

Csaba P Kovesdy et al. Clin J Am Soc Nephrol. 2009 May.

Abstract

Background and objectives: Blacks are over-represented among dialysis patients, but they have better survival rates than whites. It is unclear if the over-representation of blacks on dialysis is due to faster loss of kidney function or greater survival (or both) in predialysis stages of chronic kidney disease (CKD).

Design, setting, participants & measurements: We compared predialysis mortality, incidence of end stage renal disease (ESRD), and slopes of estimated GFR (eGFR) in 298 black versus 945 white male patients with moderate and advanced nondialysis-dependent CKD (NDD-CKD) from a single medical center. Mortality and ESRD incidence were compared in parametric survival models, and slopes of eGFR were assessed in mixed-effects models.

Results: Blacks had lower crude mortality and higher crude ESRD incidence. The lower mortality in blacks was explained by differences in case mix, especially a lower prevalence of cardiovascular disease, and the higher incidence of ESRD was explained by differences in case mix and baseline kidney function. The slopes of eGFR were similar in blacks and whites.

Conclusions: Lower mortality in black versus white patients is also observed in NDD-CKD and can be accounted for by differences in clinical characteristics. Higher mortality of black patients in earlier stages of CKD may result in the selection of a subgroup with fewer comorbidities and better survival in later stages of CKD. The higher crude ESRD rate in blacks appears to result from lower mortality in late stages of CKD, not faster progression of CKD.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Multivariable adjusted hazard ratios of all-cause mortality in patients categorized by mutually exclusive race and cardiovascular disease status in parametric survival models, unadjusted and adjusted for age; diabetes mellitus; cardiovascular disease; systolic and diastolic BP; smoking status; estimated GFR; serum albumin; bicarbonate; blood hemoglobin; white blood cell count; % lymphocytes in white blood cell count; and 24 h urine protein and use of calcitriol, phosphate binders, and statin medications. The group of white patients with cardiovascular disease served as referent. *P < 0.01, **P < 0.001
Figure 2.
Figure 2.
Predicted slopes of estimated GFR in groups of patients divided by race in an unadjusted multilevel mixed-effect model.
See this image and copyright information in PMC

References

    1. Easterling RE: Racial factors in the incidence and causation of end-stage renal disease (ESRD). Trans Am Soc Artif Intern Organs 23: 28–33, 1977 - PubMed
    1. Rostand SG, Kirk KA, Rutsky EA, Pate BA: Racial differences in the incidence of treatment for end-stage renal disease. N Engl J Med 306: 1276–1279, 1982 - PubMed
    1. Krop JS, Coresh J, Chambless LE, Shahar E, Watson RL, Szklo M, Brancati FL: A community-based study of explanatory factors for the excess risk for early renal function decline in blacks vs. whites with diabetes: The Atherosclerosis Risk in Communities Study. Arch Intern Med 159: 1777–1783, 1999 - PubMed
    1. Hsu CY, Lin F, Vittinghoff E, Shlipak MG: Racial differences in the progression from chronic renal insufficiency to end-stage renal disease in the United States. J Am Soc Nephrol 14: 2902–2907, 2003 - PubMed
    1. Bleyer AJ, Tell GS, Evans GW, Ettinger WH, Jr., Burkart JM: Survival of patients undergoing renal replacement therapy in one center with special emphasis on racial differences. Am J Kidney Dis 28: 72–81, 1996 - PubMed

Publication types