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. 2019 Feb 14;20(1):55.
doi: 10.1186/s12882-019-1241-1.

Revisiting racial differences in ESRD due to ADPKD in the United States

Erin L Murphy  1 , Feng Dai  2 , Katrina Lehmann Blount  1 , Madeline L Droher  1 , Lauren Liberti  1 , Deidra C Crews  3 , Neera K Dahl  4
Affiliations

Revisiting racial differences in ESRD due to ADPKD in the United States

Erin L Murphy et al. BMC Nephrol. .

Abstract

Introduction: Autosomal dominant polycystic kidney disease (ADPKD) affects all races. Whether the progression of ADPKD varies by race remains unclear.

Methods: In this retrospective cohort study from 2004 to 2013 non-Hispanic blacks and non-Hispanic whites of all ages classified in the US Renal Data System (USRDS) with incident ESRD from ADPKD (n = 23,647), hypertension/large vessel disease (n = 296,352), or diabetes mellitus (n = 451,760) were stratified into five-year age categories ranging from < 40 to > 75 (e.g., < 40, 40-44, 45-49, …, 75+). The Cochran-Mantel-Haenszel test was used to determine the association of race and incidence of ESRD from ADPKD, diabetes, or hypertension. The difference in the proportions of ESRD in non-Hispanic black and non-Hispanic white patients at each age categorical bin was compared by two-sample proportion test. The age of ESRD onset between non-Hispanic black and non-Hispanic white patients at each year was compared using two-sample t-test with unequal variance.

Results: 1.068% of non-Hispanic blacks and 2.778% of non-Hispanic whites had ESRD attributed to ADPKD. Non-Hispanic blacks were less likely than non-Hispanic whites to have ESRD attributed to ADPKD (odds ratio (OR) (95% CI) = 0.38 (0.36-0.39), p < 0.0001). Using US Census data as the denominator to adjust for population differences non-Hispanic blacks were still slightly under-represented (OR (95% CI) 0.94 (0.91-0.96), p = 0.004). However, non-Hispanic blacks with ADPKD had a younger age of ESRD (54.4 years ±13) than non-Hispanic whites (55.9 years ±12.8) (p < 0.0001). For those < 40 years old, more non-Hispanic blacks had incident ESRD from ADPKD than non-Hispanic whites (9.49% vs. 7.68%, difference (95% CI) = 1.81% (0.87-2.84%), p < 0.001) for the combined years examined.

Conclusions: As previously shown, we find the incidence of ESRD from ADPKD in non-Hispanic blacks is lower than in non-Hispanic whites. Among the younger ADPKD population (age < 40), however, more non-Hispanic blacks initiated dialysis than non-Hispanic whites. Non-Hispanic blacks with ADPKD initiated dialysis younger than non-Hispanic whites. A potential implication of these findings may be that black race should be considered an additional risk factor for progression in ADPKD.

Keywords: Autosomal dominant polycystic kidney disease (ADPKD); End-stage renal disease (ESRD); Incidence; United States renal data system (USRDS).

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Conflict of interest statement

Ethics approval and consent to participate

Our data analysis was on aggregate, publicly available population-level data from the USRDS dataset. This type of analysis is exempt from consent as outlined in 45 CFR 46 and in guidance from the Yale Human Research Protection Policy.

Consent for publication

N/A

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Incidence of ESRD with a primary diagnosis of diabetes mellitus (DM; circles), hypertension (HTN; triangles), or ADPKD (squares) from 2004 through 2013. Non-Hispanic whites are represented by open markers and non-Hispanic blacks are represented by solid markers. Source: USRDS database
Fig. 2
Fig. 2
a Percentage of individuals with incident ESRD with a primary diagnosis of ADPKD in the USRDS database. b Incidence of ESRD due to ADPKD in the USRDS database per 100,000 people in the general United States population (Census data). The analysis included those who identified as non-Hispanic white (open squares) and non-Hispanic black (solid squares) from 2004 through 2013
Fig. 3
Fig. 3
Odds Ratio (OR) and 95% Confidence Interval (CI) for non-Hispanic blacks compared to non-Hispanic whites for incident ESRD due to hypertension (HTN), diabetes mellitus (DM), or ADPKD. Odds ratios were calculated using the number of ESRD patients in the USRDS database as the numerator and either the total USRDS database (USRDS) or the total US Census population (US) as the denominator. The point estimate is given with the CI shown in parentheses. The p value was < 0.0001 for all groups except for the analysis of ADPKD in the general US population, which had a p value of 0.004
Fig. 4
Fig. 4
a Percent of ADPKD in incident ESRD, 2004–2012. Non-Hispanic blacks, black bars; non-Hispanic whites, gray bars. The p value was ≤0.002 for all groups with an asterisk (*) and was non-significant (NS) for the 40–44 and 45–49-year age groups, which had a p value of 0.53 and 0.065, respectively. b The mean age of ESRD onset for each year with standard error shown. Non-Hispanic whites, open squares; Non-Hispanic blacks, solid squares
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