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

• Published in: Kidney international Vol. 86; no. 4; pp. 819 - 827
• Main Authors: Wen, Chi Pang, Matsushita, Kunihiro, Coresh, Josef, Iseki, Kunitoshi, Islam, Muhammad, Katz, Ronit, McClellan, William, Peralta, Carmen A., Wang, HaiYan, de Zeeuw, Dick, Astor, Brad C., Gansevoort, Ron T., Levey, Andrew S., Levin, Adeera
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2014; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Albuminuria - ethnology; Asian People - statistics & numerical data; Black People - statistics & numerical data; Cardiovascular Diseases - ethnology; Cardiovascular Diseases - mortality; chronic kidney disease; Cohort Studies; Creatinine - urine; end-stage renal disease; epidemiology and outcomes; ethnicity; Female; Glomerular Filtration Rate; Humans; Kidney Failure, Chronic - ethnology; Kidney Failure, Chronic - physiopathology; Male; Middle Aged; mortality risk; Odds Ratio; Renal Insufficiency, Chronic - ethnology; Renal Insufficiency, Chronic - mortality; Renal Insufficiency, Chronic - physiopathology; Risk Factors; White People - statistics & numerical data; chronic kidney disease; epidemiology and outcomes; ethnicity; end-stage renal disease; mortality risk
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1038/ki.2013.553

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 90–104ml/min per 1.73m2 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 30–299mg/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.