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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.
Am J Kidney Dis. 2016 Oct; 68(4):545-553.AJ

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.

Authors+Show Affiliations

Department of Medicine, University of Illinois at Chicago, Chicago, IL. Electronic address: jplash@uic.edu.Department of Medicine, University of Illinois at Chicago, Chicago, IL.Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.Department of Medicine, University of Illinois at Chicago, Chicago, IL; Center of Complex Chronic Healthcare, Jesse Brown VA Medical Center, Chicago, IL.Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL.Department of Epidemiology, Tulane University, New Orleans, LA.Department of Medicine, Temple University, Philadelphia, PA.Department of Medicine, University of Illinois at Chicago, Chicago, IL.Department of Medicine, University of Michigan, Ann Arbor, MI.Department of Medicine, Case Western University, University Hospitals Case Medical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH.Renaissance Renal Research Institute, St. John's Hospital, Detroit, MI.Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.Department of Medicine, Northwestern University, Chicago, IL.Department of Medicine, University of Michigan, Ann Arbor, MI.Kaiser 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.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27209443

Citation

Lash, James P., et al. "Race/Ethnicity and Cardiovascular Outcomes in Adults With CKD: Findings From the CRIC (Chronic Renal Insufficiency Cohort) and Hispanic CRIC Studies." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 68, no. 4, 2016, pp. 545-553.
Lash JP, Ricardo AC, Roy J, et al. Race/Ethnicity and Cardiovascular Outcomes in Adults With CKD: Findings From the CRIC (Chronic Renal Insufficiency Cohort) and Hispanic CRIC Studies. Am J Kidney Dis. 2016;68(4):545-553.
Lash, J. P., Ricardo, A. C., Roy, J., Deo, R., Fischer, M., Flack, J., He, J., Keane, M., Lora, C., Ojo, A., Rahman, M., Steigerwalt, S., Tao, K., Wolf, M., Wright, J. T., & Go, A. S. (2016). Race/Ethnicity and Cardiovascular Outcomes in Adults With CKD: Findings From the CRIC (Chronic Renal Insufficiency Cohort) and Hispanic CRIC Studies. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 68(4), 545-553. https://doi.org/10.1053/j.ajkd.2016.03.429
Lash JP, et al. Race/Ethnicity and Cardiovascular Outcomes in Adults With CKD: Findings From the CRIC (Chronic Renal Insufficiency Cohort) and Hispanic CRIC Studies. Am J Kidney Dis. 2016;68(4):545-553. PubMed PMID: 27209443.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Race/Ethnicity and Cardiovascular Outcomes in Adults With CKD: Findings From the CRIC (Chronic Renal Insufficiency Cohort) and Hispanic CRIC Studies. AU - Lash,James P, AU - Ricardo,Ana C, AU - Roy,Jason, AU - Deo,Rajat, AU - Fischer,Michael, AU - Flack,John, AU - He,Jiang, AU - Keane,Martin, AU - Lora,Claudia, AU - Ojo,Akinlolu, AU - Rahman,Mahboob, AU - Steigerwalt,Susan, AU - Tao,Kaixiang, AU - Wolf,Myles, AU - Wright,Jackson T,Jr AU - Go,Alan S, AU - ,, Y1 - 2016/05/19/ PY - 2015/10/05/received PY - 2016/03/29/accepted PY - 2016/5/23/entrez PY - 2016/5/23/pubmed PY - 2017/6/1/medline KW - CRIC (Chronic Renal Insufficiency Cohort) KW - Hispanic KW - Hispanic CRIC KW - Race KW - atherosclerotic cardiovascular events KW - dialysis KW - end-stage renal disease (ESRD) KW - ethnicity KW - heart failure KW - racial disparities KW - racial/ethnic variation KW - survival paradox SP - 545 EP - 553 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 68 IS - 4 N2 - 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. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/27209443/Race/Ethnicity_and_Cardiovascular_Outcomes_in_Adults_With_CKD:_Findings_From_the_CRIC__Chronic_Renal_Insufficiency_Cohort__and_Hispanic_CRIC_Studies_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(16)30100-7 DB - PRIME DP - Unbound Medicine ER -