Abstract
Introduction: Non-white minorities are at higher risk for chronic kidney disease than non-Hispanic whites. Better cardiorespiratory fitness is associated with slower declines in estimated glomerular filtration rate and a lower incidence of chronic kidney disease. Little is known regarding associations of fitness with racial disparities in chronic kidney disease. Methods: A prospective cohort of 3,842 young adults without chronic kidney disease completed a maximal treadmill test at baseline in 1985–1986. Chronic kidney disease status was defined as estimated glomerular filtration rate of <60 mL/min/1.73 m2 during 10-, 15-, 20-, 25-, and 30-year follow-up assessments (through 2006). Analyses were completed in 2019. Multivariable Cox models were used to determine hazard ratios and 95% CI for incidence of chronic kidney disease. Multivariable models included race, gender, age, field center, education, baseline estimated glomerular filtration rate, and time-varying covariates of healthy diet index, smoking status, alcohol intake, BMI, systolic blood pressure, and fasting glucose. Percent attenuation quantified the association of fitness to racial disparities in chronic kidney disease. Results: Chronic kidney disease incidence was higher among blacks (n=83/1,941, 1.61 per 1,000 person years) than whites (43/1,901, 0.82 per 1,000 person years). Every 1-minute shorter treadmill duration was associated with 1.14 (95% CI=1.04, 1.25) times higher risk of chronic kidney disease. Blacks were 1.72 (95% CI=1.13, 2.63) times more likely to develop chronic kidney disease compared with whites. The risk was reduced to 1.54 (95% CI=1.01, 2.39) with fitness added. This suggests that fitness is associated with 20.4% (95% CI=5.8, 43.0%) of the excess risk of chronic kidney disease attributable to race. Conclusions: Low fitness is a modifiable factor that may contribute to the racial disparity in chronic kidney disease.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 68-76 |
| Number of pages | 9 |
| Journal | American journal of preventive medicine |
| Volume | 57 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jul 2019 |
Bibliographical note
Funding Information:The CARDIA study is supported by contracts HHSN268201800003I, HHSN268201800004I, HHSN268201800005I, HHSN268201800006I, and HHSN268201800007I from the National Heart, Lung, and Blood Institute .
Funding Information:
This research was supported, in part, by a grant from the American Heart Association (15SFDRN25080331).
Funding Information:
The authors would like to thank the participants, staff, and investigators of the Coronary Artery Risk Development in Young Adults (CARDIA) study. The CARDIA study is supported by contracts HHSN268201800003I, HHSN268201800004I, HHSN268201800005I, HHSN268201800006I, and HHSN268201800007I from the National Heart, Lung, and Blood Institute. This research was supported, in part, by a grant from the American Heart Association (15SFDRN25080331). The sponsors had no role in the study design; collection, analysis, and interpretation of the data; writing the report; or the decision to submit the report for publication. The research reported here does not represent the official views of the funding sources. AEP and MRC worked on study conception and interpreting data. AEP and LRP analyzed the data. AEP drafted the manuscript. AEP, LRP, MW, TI, CEL, RM, PJS, SS, and MRC worked on critical revisions of the manuscript and approved the final version. Preliminary analyses of article contents were presented at the American Heart Association Epidemiology and Prevention Lifestyle Scientific Sessions in March 2018. RM has interest in Abbott Laboratories, AbbVie, Inc. and Teva Pharmaceuticals Industries Ltd. No other financial disclosures were reported.
Publisher Copyright:
© 2019 American Journal of Preventive Medicine
