Relative risks of chronic kidney disease for mortality and end-stage renal disease across races are similar

Chi Pang Wen, Kunihiro Matsushita, Josef Coresh, Kunitoshi Iseki, Muhammad Islam, Ronit Katz, William McClellan, Carmen A. Peralta, Haiyan Wang, Dick De Zeeuw, Brad C. Astor, Ron T. Gansevoort, Andrew S. Levey, Adeera Levin, Chronic Kidney Disease Prognosis Consortium, John Chalmers, Hisatomi Arima

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    51 Citations (Scopus)

    Abstract

    Some suggest race-specific cutpoints for kidney measures to define and stage chronic kidney disease (CKD), but evidence for race-specific clinical impact is limited. To address this issue, we compared hazard ratios of estimated glomerular filtration rates (eGFR) and albuminuria across races using meta-regression in 1.1 million adults (75% Asians, 21% Whites, and 4% Blacks) from 45 cohorts. Results came mainly from 25 general population cohorts comprising 0.9 million individuals. The associations of lower eGFR and higher albuminuria with mortality and end-stage renal disease (ESRD) were largely similar across races. For example, in Asians, Whites, and Blacks, the adjusted hazard ratios (95% confidence interval) for eGFR 45-59 versus 90-104 ml/min per 1.73 m 2 were 1.3 (1.2-1.3), 1.1 (1.0-1.2), and 1.3 (1.1-1.7) for all-cause mortality, 1.6 (1.5-1.7), 1.4 (1.2-1.7), and 1.4 (0.7-2.9) for cardiovascular mortality, and 27.6 (11.1-68.7), 11.2 (6.0-20.9), and 4.1 (2.2-7.5) for ESRD, respectively. The corresponding hazard ratios for urine albumin-to-creatinine ratio 30-299 mg/g or dipstick 1+ versus an albumin-to-creatinine ratio under 10 or dipstick negative were 1.6 (1.4-1.8), 1.7 (1.5-1.9), and 1.8 (1.7-2.1) for all-cause mortality, 1.7 (1.4-2.0), 1.8 (1.5-2.1), and 2.8 (2.2-3.6) for cardiovascular mortality, and 7.4 (2.0-27.6), 4.0 (2.8-5.9), and 5.6 (3.4-9.2) for ESRD, respectively. Thus, the relative mortality or ESRD risks of lower eGFR and higher albuminuria were largely similar among three major races, supporting similar clinical approach to CKD definition and staging, across races.

    Original languageEnglish
    Pages (from-to)819-827
    Number of pages9
    JournalKidney International
    Volume86
    Issue number4
    DOIs
    Publication statusPublished - Oct 2014

    Keywords

    • chronic kidney disease
    • end-stage renal disease
    • epidemiology and outcomes
    • ethnicity
    • mortality risk

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  • Cite this

    Wen, C. P., Matsushita, K., Coresh, J., Iseki, K., Islam, M., Katz, R., McClellan, W., Peralta, C. A., Wang, H., De Zeeuw, D., Astor, B. C., Gansevoort, R. T., Levey, A. S., Levin, A., Chronic Kidney Disease Prognosis Consortium, Chalmers, J., & Arima, H. (2014). Relative risks of chronic kidney disease for mortality and end-stage renal disease across races are similar. Kidney International, 86(4), 819-827. https://doi.org/10.1038/ki.2013.553