title: Albuminuria and racial disparities in the risk for ESRD.
abstract: The causes of the increased risk for ESRD among African Americans are not completely understood. Here, we examined whether higher levels of urinary albumin excretion among African Americans contributes to this disparity. We analyzed data from 27,911 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who had urinary albumin-to-creatinine ratio (ACR) and estimated GFR (eGFR) measured at baseline. We identified incident cases of ESRD through linkage with the United States Renal Data System. At baseline, African Americans were less likely to have an eGFR <60 ml/min per 1.73 m(2) but more likely to have an ACR ≥ 30 mg/g. The incidence rates of ESRD among African Americans and whites were 204 and 58.6 cases per 100,000 person-years, respectively. After adjustment for age and gender, African Americans had a fourfold greater risk for developing ESRD (HR 4.0; 95% CI 2.8 to 5.9) compared with whites. Additional adjustment for either eGFR or ACR reduced the risk associated with African-American race to 2.3-fold (95% CI 1.5 to 3.3) or 1.8-fold (95% CI 1.2 to 2.7), respectively. Adjustment for both ACR and eGFR reduced the race-associated risk to 1.6-fold (95% CI 1.1 to 2.4). Finally, in a model that further adjusted for both eGFR and ACR, hypertension, diabetes, family income, and educational status, African-American race associated with a nonsignificant 1.4-fold (95% CI 0.9 to 2.3) higher risk for ESRD. In conclusion, the increased prevalence of albuminuria may be an important contributor to the higher risk for ESRD experienced by African Americans.
authors.affiliation: Department of Medicine, Rollins School of Public Health, Emory University, Atlanta, GA 30220, USA. wmcclel@sph.emory.edu
authors.forename: William M
authors.initials: WM
authors.lastname: McClellan
authors.forename: David G
authors.initials: DG
authors.lastname: Warnock
authors.forename: Suzanne
authors.initials: S
authors.lastname: Judd
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.forename: Reshma
authors.initials: R
authors.lastname: Kewalramani
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.forename: Leslie A
authors.initials: LA
authors.lastname: McClure
authors.forename: Britt B
authors.initials: BB
authors.lastname: Newsome
authors.forename: George
authors.initials: G
authors.lastname: Howard
mesh_terms: D001741:Black or African American; D000368:Aged; D000419:Albuminuria / Q000208:ethnology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D015144:Southeastern United States / Q000453:epidemiology