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

Authors :
James P. Lash
Ana C. Ricardo
Jason Roy
Rajat Deo
Michael Fischer
John Flack
Jiang He
Martin Keane
Claudia Lora
Akinlolu Ojo
Mahboob Rahman
Susan Steigerwalt
Kaixiang Tao
Myles Wolf
Jackson T. Wright
Alan S. Go
Lawrence J. Appel
Harold I. Feldman
John W. Kusek
Raymond R. Townsend
Source :
American Journal of Kidney Diseases. 68:545-553
Publication Year :
2016
Publisher :
Elsevier BV, 2016.

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.

Details

ISSN :
02726386
Volume :
68
Database :
OpenAIRE
Journal :
American Journal of Kidney Diseases
Accession number :
edsair.doi.dedup.....d4e3ebdfad1d351a86627366ea7d7657