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

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• 作者：James P. Lash ; MD¹ ; ^{jplash@uic.edu" class="auth_mail" title="E-mail the corresponding author} ; Ana C. Ricardo ; MD ; MPH¹ ; Jason Roy ; PhD² ; Rajat Deo ; MD² ; Michael Fischer ; MD ; MSPH¹ ; ³ ; John Flack ; MD ; MPH⁴ ; Jiang He ; MD ; PhD⁵ ; Martin Keane ; MD⁶ ; Claudia Lora ; MD ; MS¹ ; Akinlolu Ojo ; MD ; PhD⁷ ; Mahboob Rahman ; MD⁸ ; Susan Steigerwalt ; MD⁹ ; Kaixiang Tao ; PhD² ; Myles Wolf ; MD ; MMSc¹⁰ ; Jackson T. Wright Jr. ; MD ; PhD⁷ ; Alan S. Go ; MD¹¹ ; ¹² ; ¹³ ; ¹⁴ ; ¹⁵ ; on behalf of the CRIC Study Investigators^&lowast ; ; Lawrence J. Appel ; MD ; MPH ; Harold I. Feldman ; MD ; MSCE ; Alan S. Go ; MD ; Jiang He ; MD ; PhD ; John W. Kusek ; PhD ; James P. Lash ; MD ; Akinlolu Ojo ; MD ; PhD ; Mahboob Rahman ; MD ; Raymond R. Townsend ; MD
• 关键词：Race ; ethnicity ; survival paradox ; racial disparities ; racial/ethnic variation ; dialysis ; atherosclerotic cardiovascular events ; heart failure ; end-stage renal disease (ESRD) ; Hispanic ; CRIC (Chronic Renal Insufficiency Cohort) ; Hispanic CRIC
• 刊名：American Journal of Kidney Diseases
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：68
• 期：4
• 页码：545-553
• 全文大小：384 K

文摘

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 70 mL/min/1.73 m² 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.