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Comparative Study
. 2016 Nov;27(11):3488-3497.
doi: 10.1681/ASN.2015050570. Epub 2016 May 5.

CKD Progression and Mortality among Hispanics and Non-Hispanics

Michael J Fischer  1   2   3 , Jesse Y Hsu  4 , Claudia M Lora  5 , Ana C Ricardo  5 , Amanda H Anderson  4 , Lydia Bazzano  6 , Magdalena M Cuevas  4 , Chi-Yuan Hsu  7   8 , John W Kusek  9 , Amada Renteria  5 , Akinlolu O Ojo  10 , Dominic S Raj  11 , Sylvia E Rosas  12 , Qiang Pan  4 , Kristine Yaffe  13 , Alan S Go  8 , James P Lash  5 ; Chronic Renal Insufficiency Cohort (CRIC) Study Investigators
Collaborators, Affiliations
Comparative Study

CKD Progression and Mortality among Hispanics and Non-Hispanics

Michael J Fischer et al. J Am Soc Nephrol. 2016 Nov.

Abstract

Although recommended approaches to CKD management are achieved less often in Hispanics than in non-Hispanics, whether long-term outcomes differ between these groups is unclear. In a prospective longitudinal analysis of participants enrolled into the Chronic Renal Insufficiency Cohort (CRIC) and Hispanic-CRIC Studies, we used Cox proportional hazards models to determine the association between race/ethnicity, CKD progression (50% eGFR loss or incident ESRD), incident ESRD, and all-cause mortality, and linear mixed-effects models to assess differences in eGFR slope. Among 3785 participants, 13% were Hispanic, 43% were non-Hispanic white (NHW), and 44% were non-Hispanic black (NHB). Over a median follow-up of 5.1 years for Hispanics and 6.8 years for non-Hispanics, 27.6% of all participants had CKD progression, 21.3% reached incident ESRD, and 18.3% died. Hispanics had significantly higher rates of CKD progression, incident ESRD, and mean annual decline in eGFR than did NHW (P<0.05) but not NHB. Hispanics had a mortality rate similar to that of NHW but lower than that of NHB (P<0.05). In adjusted analyses, the risk of CKD progression did not differ between Hispanics and NHW or NHB. However, among nondiabetic participants, compared with NHB, Hispanics had a lower risk of CKD progression (hazard ratio, 0.61; 95% confidence interval, 0.39 to 0.95) and incident ESRD (hazard ratio, 0.50; 95% confidence interval, 0.30 to 0.84). At higher levels of urine protein, Hispanics had a significantly lower risk of mortality than did non-Hispanics (P<0.05). Thus, important differences in CKD progression and mortality exist between Hispanics and non-Hispanics and may be affected by proteinuria and diabetes.

Keywords: chronic kidney disease; ethnicity; mortality.

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Figures

Figure 1.
Figure 1.
Overall rates of ESRD, CKD progression and all-cause mortality by race/ethnicity.
Figure 2.
Figure 2.
Mean change in eGFR by race/ethnicity during study follow up.
Figure 3.
Figure 3.
Risk of death by race/ethnicity and urine protein.
See this image and copyright information in PMC

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