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, Hai Yan Wang, Dick De Zeeuw, Brad C. Astor, Ron T. Gansevoort, Andrew S. Levey, Adeera Levin, Jackson T. Wright, Lawrence Appel, Tom Greene, John Chalmers, Stephen MacMahon, Mark WoodwardHisatomi Arima, Hiroshi Yatsuya, Kentaro Yamashita, Hideaki Toyoshima, Koji Tamakoshi, Yingying Sang, Robert C. Atkins, Kevan R. Polkinghorne, Steven Chadban, Anoop Shankar, Ronald Klein, Barbara E.K. Klein, Kristine E. Lee, Fang Wang, Luxia Zhang, Li Zuo, Lisheng Liu, Ognjenka Djurdjev, Marcello Tonelli, Frank Sacks, Gary Curhan, Michael Shlipak, Linda Fried, Hiroyasu Iso, Akihiko Kitamura, Tetsuya Ohira, Kazumasa Yamagishi, Tazeen H. Jafar, Juanita Hatcher, Neil Poulter, Nish Chaturvedi, Martin J. Landray, Jonathan Emberson, Jonathan Townend, David C. Wheeler, Dietrich Rothenbacher, Hermann Brenner, Heiko Müller, Ben Schöttker, Caroline S. Fox, Shih Jen Hwang, James B. Meigs, Robert M. Perkins, Nick Fluck, Laura Clark, Gordon J. Prescott, Angharad Marks, Corri Black, Massimo Cirillo, Stein Hallan, Knut Aasard, Cecilia M. Øien, Marie Radtke, Fujiko Irie, Toshimi Sairenchi, David H. Smith, Jessica Weiss, Eric S. Johnson, Micah L. Thorp, Allan J. Collins, Joseph A. Vassalotti, Suying Li, Shu Cheng Chen, Brian J. Lee, Jack F. Wetzels, Peter J. Blankestijn, Arjan D. Van Zuilen, Mark Sarnak, Lesley Inker, Vandana Menon, Linda F. Fried, Holly Kramer, Ian De Boer, Florian Kronenberg, Barbara Kollerits, Eberhard Ritz, Paul Roderick, Dorothea Nitsch, Astrid Fletcher, Christopher Bulpitt, Areef Ishani, James Neaton, Marc Froissart, Benedicte Stengel, Marie Metzger, Jean Philippe Haymann, Pascal Houillier, Martin Flamant, Takayoshi Ohkubo, Hirohito Metoki, Masaaki Nakayama, Masahiro Kikuya, Yutaka Imai, Robert G. Nelson, William C. Knowler, Paul E. De Jong, Bakhtawar Khan Mahmoodi, Stephan J.L. Bakker, Simerjot Kaur Jassal, Elizabeth Barrett-Connor, Jaclyn Bergstrom, Hiddo J. Lambers Heerspink, Barry Brenner, David G. Warnock, Paul Muntner, Suzanne Judd, Sun Ha Jee, Heejin Kimm, Jaeseong Jo, Yejin Mok, Eunmi Choi, Peter Rossing, Hans Henrik Parving, Navdeep Tangri, David Naimark, Sung Feng Wen, Chwen Keng Tsao, Min Kuang Tsai, Shiuan Be Wu, Johan Ärnlöv, Lars Lannfelt, Anders Larsson, Henk J. Bilo, Hanneke Joosten, Nanne Kleefstra, Klaas H. Groenier, Iefke Drion, Brenda R. Hemmelgarn, Shoshana H. Ballew, Morgan Grams, Laura Camarata, Xuan Hui, Jennifer Seltzer, Heather Winegrad

Research output: Contribution to journalArticlepeer-review

51 Scopus citations

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 (US)
Pages (from-to)819-827
Number of pages9
JournalKidney international
Volume86
Issue number4
DOIs
StatePublished - Jan 1 2014

Bibliographical note

Funding Information:
The CKD-PC Data Coordinating Center is funded in part by a program grant from the US National Kidney Foundation (NKF funding sources include Abbott) and an investigator-initiated research grant from Amgen. A variety of sources have supported enrollment and data collection, including laboratory measurements and follow-up in the collaborating cohorts of the CKD-PC. These funding sources include government agencies such as national institutes of health and medical research councils, as well as foundations and industry sponsors listed in Supplementary Appendix 3 online. The funders had no role in the design, analysis, interpretation of this study, and did not contribute to the writing of this report and the decision to submit the article for publication. The sponsors had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript. A variation of this analysis was presented at the American Society of Nephrology Kidney Week 2012 (San Diego, CA, 3 November 2012).

Keywords

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

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