title: Racial differences in mortality among those with CKD.
abstract: Compared with white individuals, black individuals have a significantly higher risk for death in the general population but seem to have a survival advantage in the ESRD population. Data on the relationship of race to survival in early stages of chronic kidney disease (CKD) are inconsistent. This study evaluated racial differences in mortality among the adult participants of the Third National Health and Nutrition Examination Survey, a population-based survey of community-dwelling individuals. CKD was defined either by an estimated GFR < 60 ml/min per 1.73 m2 or by the presence of albuminuria, and this status was determined for 14,611 individuals, 2892 of whom were found to have CKD. Adjusting for age,gender, and race, risk for all-cause mortality among individuals with CKD was more than double that of individuals with normal renal function. In the subgroup with CKD, adjusting for age and gender,black individuals had a significantly higher risk for death, and this risk was modified by age;specifically, black individuals who were younger than 65 yr were 78% more likely to die than white individuals, whereas no significant differences in mortality were observed among individuals who were > or = 65 yr of age. Further adjustment for cardiovascular risk factors and CKD stage did not materially change the results, but the hazard ratios were significantly attenuated after adjustment for socioeconomic factors. In conclusion, these data demonstrate racial/ethnic disparities in mortality among individuals with CKD. This higher risk for death in early stages of CKD may explain the apparent survival advantage observed among black individuals who live long enough to reach stage 5 CKD.
authors.affiliation: Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA. rmehrotra@labiomed.org
authors.forename: Rajnish
authors.initials: R
authors.lastname: Mehrotra
authors.forename: Dulcie
authors.initials: D
authors.lastname: Kermah
authors.forename: Linda
authors.initials: L
authors.lastname: Fried
authors.forename: Sharon
authors.initials: S
authors.lastname: Adler
authors.forename: Keith
authors.initials: K
authors.lastname: Norris
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000401:mortality*; D008297:Male; D017058:Mexican Americans / Q000706:statistics & numerical data*; D008875:Middle Aged; D009749:Nutrition Surveys; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*