title: Racial and ethnic differences in kidney function decline among persons without chronic kidney disease.
abstract: Whether the rate of kidney function decline before the onset of CKD differs among racial and ethnic groups remains unclear. Here, we evaluated kidney function decline and incident CKD among white, black, Hispanic, and Chinese participants in the Multi-Ethnic Study of Atherosclerosis (MESA) during 5 years of follow-up. We estimated GFR using both cystatin C (eGFRcys) and creatinine (eGFRcreat). The definition of incident CKD required eGFRcys <60 ml/min per 1.73 m(2) and a decline in eGFRcys ≥1 ml/min per year. Among participants with eGFRcreat >60 ml/min per 1.73 m(2) at baseline, blacks had a significantly higher rate of kidney function decline than whites (0.31 ml/min per 1.73 m(2)/yr faster on average, P=0.001), even after adjusting for multiple potential confounders. Among Hispanics, Dominicans and Puerto Ricans had faster rates of decline than whites (0.55 and 0.47 ml/min per 1.73 m(2)/yr faster, respectively). Mexicans, South Americans, or other Hispanics had similar rates of decline compared to whites. We did not detect significant differences in the rates of kidney function decline among Chinese and white participants. Among those with normal or near-normal kidney function at baseline, blacks and Hispanics had the highest rates of incident CKD during follow-up. Adjustment for comorbidities attenuated some of these differences. In conclusion, the average rate of kidney function decline before the onset of CKD differs among racial and ethnic groups. Traditional risk factors do not explain these differences fully, highlighting the need to explore these disparities.
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California 94121, USA. Carmenalicia.peralta@ucsf.edu
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Peralta
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.forename: Ian
authors.initials: I
authors.lastname: DeBoer
authors.forename: Joachim
authors.initials: J
authors.lastname: Ix
authors.forename: Mark
authors.initials: M
authors.lastname: Sarnak
authors.forename: Holly
authors.initials: H
authors.lastname: Kramer
authors.forename: David
authors.initials: D
authors.lastname: Siscovick
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
authors.forename: Moyses
authors.initials: M
authors.lastname: Szklo
authors.forename: Michael
authors.initials: M
authors.lastname: Shlipak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000208:ethnology*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology