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Am J Kidney Dis. 2016 Oct;68(4):545-53. doi: 10.1053/j.ajkd.2016.03.429. Epub 2016 May 19.

Race/Ethnicity and Cardiovascular Outcomes in Adults With CKD: Findings From the CRIC (Chronic Renal Insufficiency Cohort) and Hispanic CRIC Studies.

Author information

  • 1Department of Medicine, University of Illinois at Chicago, Chicago, IL. Electronic address: jplash@uic.edu.
  • 2Department of Medicine, University of Illinois at Chicago, Chicago, IL.
  • 3Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
  • 4Department of Medicine, University of Illinois at Chicago, Chicago, IL; Center of Complex Chronic Healthcare, Jesse Brown VA Medical Center, Chicago, IL.
  • 5Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL.
  • 6Department of Epidemiology, Tulane University, New Orleans, LA.
  • 7Department of Medicine, Temple University, Philadelphia, PA.
  • 8Department of Medicine, University of Michigan, Ann Arbor, MI.
  • 9Department of Medicine, Case Western University, University Hospitals Case Medical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH.
  • 10Renaissance Renal Research Institute, St. John's Hospital, Detroit, MI.
  • 11Department of Medicine, Northwestern University, Chicago, IL.
  • 12Kaiser Permanente Northern California Division of Research, Oakland, CA; Department of Epidemiology, University of California, San Francisco, San Francisco, CA; Department of Biostatistics, University of California, San Francisco, San Francisco, CA; Department of Medicine, University of California, San Francisco, San Francisco, CA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA.

Abstract

BACKGROUND:

Non-Hispanic blacks and Hispanics with end-stage renal disease have a lower risk for death than non-Hispanic whites, but data for racial/ethnic variation in cardiovascular outcomes for non-dialysis-dependent chronic kidney disease are limited.

STUDY DESIGN:

Prospective cohort.

SETTING & PARTICIPANTS:

3,785 adults with entry estimated glomerular filtration rates of 20 to 70mL/min/1.73m(2) enrolled in the CRIC (Chronic Renal Insufficiency Cohort) Study.

PREDICTORS:

Race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic).

OUTCOMES:

Cardiovascular outcomes (atherosclerotic events [myocardial infarction, stroke, or peripheral arterial disease] and heart failure) and a composite of each cardiovascular outcome or all-cause death.

MEASUREMENTS:

Multivariable Cox proportional hazards.

RESULTS:

During a median follow-up of 6.6 years, we observed 506 atherosclerotic events, 551 heart failure events, and 692 deaths. In regression analyses, there were no significant differences in atherosclerotic events among the 3 racial/ethnic groups. In analyses stratified by clinical site, non-Hispanic blacks had a higher risk for heart failure events (HR, 1.59; 95% CI, 1.29-1.95), which became nonsignificant after adjustment for demographic factors and baseline kidney function. In contrast, Hispanics had similar risk for heart failure events as non-Hispanic whites. In analyses stratified by clinical site, compared with non-Hispanic whites, non-Hispanic blacks were at similar risk for atherosclerotic events or death. However, after further adjustment for cardiovascular risk factors, medications, and mineral metabolism markers, non-Hispanic blacks had 17% lower risk for the outcome (HR, 0.83; 95% CI, 0.69-0.99) than non-Hispanic whites, whereas there was no significant association with Hispanic ethnicity.

LIMITATIONS:

Hispanics were largely recruited from a single center, and the study was underpowered to evaluate the association between Hispanic ethnicity and mortality.

CONCLUSIONS:

There were no significant racial/ethnic differences in adjusted risk for atherosclerotic or heart failure outcomes. Future research is needed to better explain the reduced risk for atherosclerotic events or death in non-Hispanic blacks compared with non-Hispanic whites.

KEYWORDS:

CRIC (Chronic Renal Insufficiency Cohort); Hispanic; Hispanic CRIC; Race; atherosclerotic cardiovascular events; dialysis; end-stage renal disease (ESRD); ethnicity; heart failure; racial disparities; racial/ethnic variation; survival paradox

PMID:
27209443
PMCID:
PMC5295809
[Available on 2017-10-01]
DOI:
10.1053/j.ajkd.2016.03.429
[PubMed - in process]
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