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. 2009 Jul;122(7):672-8.
doi: 10.1016/j.amjmed.2008.11.021.

White/black racial differences in risk of end-stage renal disease and death

Andy I Choi  1 , Rudolph A Rodriguez, Peter Bacchetti, Daniel Bertenthal, German T Hernandez, Ann M O'Hare
Affiliations

White/black racial differences in risk of end-stage renal disease and death

Andy I Choi et al. Am J Med. 2009 Jul.

Abstract

Background: End-stage renal disease disproportionately affects black persons, but it is unknown when in the course of chronic kidney disease racial differences arise. Understanding the natural history of racial differences in kidney disease may help guide efforts to reduce disparities.

Methods: We compared white/black differences in the risk of end-stage renal disease and death by level of estimated glomerular filtration rate (eGFR) at baseline in a national sample of 2,015,891 veterans between 2001 and 2005.

Results: Rates of end-stage renal disease among black patients exceeded those among white patients at all levels of baseline eGFR. The adjusted hazard ratios for end-stage renal disease associated with black versus white race for patients with an eGFR > or = 90, 60-89, 45-59, 30-44, 15-29, and <15 mL/min/1.73 m2, respectively, were 2.14 (95% confidence interval [CI], 1.72-2.65), 2.30 (95% CI, 2.02-2.61), 3.08 (95% CI, 2.74-3.46), 2.47 (95% CI, 2.26-2.70), 1.86 (95% CI, 1.75-1.98), and 1.23 (95% CI, 1.12-1.34). We observed a similar pattern for mortality, with equal or higher rates of death among black persons at all levels of eGFR. The highest risk of mortality associated with black race also was observed among those with an eGFR 45-59 mL/min/1.73 m2 (hazard ratio 1.32, 95% CI, 1.27-1.36).

Conclusion: Racial differences in the risk of end-stage renal disease appear early in the course of kidney disease and are not explained by a survival advantage among blacks. Efforts to identify and slow progression of chronic kidney disease at earlier stages may be needed to reduce racial disparities.

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Conflict of interest statement

Potential Conflicts of Interest: GTH has received research support from the Catholic Healthcare West, Genentech, Biogen, Novartis, Roche and the National Institute of Diabetes and Digestive and Kidney Diseases; he has received honoraria from the National Institute of Environmental Health Sciences and Novartis. AMO receives royalties from UpToDate and research funding from the Centers for Disease Control. These funding sources played no role in the research presented here. The other authors declare no potential financial conflicts of interest.

Figures

Figure 1
Figure 1. Adjusted hazard ratios (HR) for end-stage renal disease (ESRD) in black versus white patients stratified by level of estimated glomerular filtration rate (GFR) at baseline
Models adjusted for all variables listed in Table 1. Estimated GFR reported in mL/min/1.73m2. Error bars indicate 95% confidence intervals.
Figure 2
Figure 2. Age-standardized incidence of death by estimated glomerular filtration rate (GFR) at baseline
Error bars indicate 95% confidence intervals.
Figure 3
Figure 3. Adjusted hazard ratios for death in black versus white patients stratified by level of estimated glomerular filtration rate (GFR) at baseline
Models adjusted for all variables listed in Table 1. Estimated GFR reported in mL/min/1.73m2. Error bars indicate 95% confidence intervals.
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