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Race and renal impairment in heart failure: mortality in blacks versus whites.
Circulation. 2005 Mar 15; 111(10):1270-7.Circ

Abstract

BACKGROUND

Renal impairment is an emerging prognostic indicator in heart failure (HF) patients. Despite known racial differences in the progression of both HF and renal disease, it is unclear whether the prognosis for renal impairment in HF patients differs by race. We sought to determine in HF patients the 1-year mortality risks associated with elevated creatinine and impaired estimated glomerular filtration rate (eGFR) and to quantify racial differences in mortality.

METHODS AND RESULTS

We retrospectively evaluated the National Heart Care Project nationally representative cohort of 53,640 Medicare patients hospitalized with HF. Among 5669 black patients, mean creatinine was 1.6+/-0.9 mg/dL, and 54% had an eGFR < or =60, compared with creatinine 1.5+/-0.7 mg/dL and 68% eGFR < or =60 in 47,971 white patients. Higher creatinine predicted increased mortality risk, although the magnitude of risk differed by race (interaction P=0.0001). Every increase in creatinine of 0.5 mg/dL was associated with a >10% increased risk in adjusted mortality for blacks, compared with >15% increased risk in whites (interaction P=0.0001), with the most striking racial disparities at the highest levels of renal impairment. Depressed eGFR showed similar racial differences (interaction P=0.0001).

CONCLUSIONS

Impaired renal function predicts increased mortality in elderly HF patients, although risks are more pronounced in whites. Distinct morbidity and mortality burdens in black versus white patients underscore the importance of improving patient risk-stratification, defining optimal therapies, and exploring physiological underpinnings of racial differences.

Authors+Show Affiliations

Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn 06520, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15769768

Citation

Smith, Grace L., et al. "Race and Renal Impairment in Heart Failure: Mortality in Blacks Versus Whites." Circulation, vol. 111, no. 10, 2005, pp. 1270-7.
Smith GL, Shlipak MG, Havranek EP, et al. Race and renal impairment in heart failure: mortality in blacks versus whites. Circulation. 2005;111(10):1270-7.
Smith, G. L., Shlipak, M. G., Havranek, E. P., Masoudi, F. A., McClellan, W. M., Foody, J. M., Rathore, S. S., & Krumholz, H. M. (2005). Race and renal impairment in heart failure: mortality in blacks versus whites. Circulation, 111(10), 1270-7.
Smith GL, et al. Race and Renal Impairment in Heart Failure: Mortality in Blacks Versus Whites. Circulation. 2005 Mar 15;111(10):1270-7. PubMed PMID: 15769768.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Race and renal impairment in heart failure: mortality in blacks versus whites. AU - Smith,Grace L, AU - Shlipak,Michael G, AU - Havranek,Edward P, AU - Masoudi,Frederick A, AU - McClellan,William M, AU - Foody,JoAnne M, AU - Rathore,Saif S, AU - Krumholz,Harlan M, PY - 2005/3/17/pubmed PY - 2005/10/12/medline PY - 2005/3/17/entrez SP - 1270 EP - 7 JF - Circulation JO - Circulation VL - 111 IS - 10 N2 - BACKGROUND: Renal impairment is an emerging prognostic indicator in heart failure (HF) patients. Despite known racial differences in the progression of both HF and renal disease, it is unclear whether the prognosis for renal impairment in HF patients differs by race. We sought to determine in HF patients the 1-year mortality risks associated with elevated creatinine and impaired estimated glomerular filtration rate (eGFR) and to quantify racial differences in mortality. METHODS AND RESULTS: We retrospectively evaluated the National Heart Care Project nationally representative cohort of 53,640 Medicare patients hospitalized with HF. Among 5669 black patients, mean creatinine was 1.6+/-0.9 mg/dL, and 54% had an eGFR < or =60, compared with creatinine 1.5+/-0.7 mg/dL and 68% eGFR < or =60 in 47,971 white patients. Higher creatinine predicted increased mortality risk, although the magnitude of risk differed by race (interaction P=0.0001). Every increase in creatinine of 0.5 mg/dL was associated with a >10% increased risk in adjusted mortality for blacks, compared with >15% increased risk in whites (interaction P=0.0001), with the most striking racial disparities at the highest levels of renal impairment. Depressed eGFR showed similar racial differences (interaction P=0.0001). CONCLUSIONS: Impaired renal function predicts increased mortality in elderly HF patients, although risks are more pronounced in whites. Distinct morbidity and mortality burdens in black versus white patients underscore the importance of improving patient risk-stratification, defining optimal therapies, and exploring physiological underpinnings of racial differences. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/15769768/Race_and_renal_impairment_in_heart_failure:_mortality_in_blacks_versus_whites_ L2 - https://www.ahajournals.org/doi/10.1161/01.CIR.0000158131.78881.D5?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -