title: Race and ethnicity influences on cardiovascular and renal events in patients with diabetes mellitus.
abstract: BACKGROUND
  The incidence of end-stage renal disease (ESRD) has been consistently shown to be higher among blacks and Hispanics compared to whites with unmeasured risk factors and access to care as suggested explanations. In a high-risk cohort with frequent protocol-directed follow-up, we evaluated the influence of race on cardiovascular (CV) outcomes and incidence of ESRD.
  
  
  METHODS
  TREAT was a randomized, double-blind, placebo-controlled study. This secondary analysis focused on role of race on outcomes. TREAT enrolled 4,038 patients with type 2 diabetes, chronic kidney disease (estimated glomerular filtration rate 20-60 mL/min per 1.73 m(2)), and anemia (hemoglobin level ≤11 g/dL) treated with either darbepoetin alfa or placebo. We compared self-described black and Hispanic patients to white patients with regard to baseline characteristics and outcomes, including mortality, CV outcomes (myocardial infarction, stroke, heart failure, resuscitated sudden death, and coronary revascularization), and incident ESRD. Multivariate adjusted Cox models were developed for these outcomes.
  
  
  RESULTS
  Black and Hispanic patients were younger, more likely women, had less prior CV disease, and higher blood pressure. During a mean follow-up of 2.4 years with comparable access to care, blacks and Hispanics had a greater risk of ESRD but a significant lower risk of myocardial infarction and coronary revascularization than whites. After adjusting for confounders, blacks remained at significantly greater risk of ESRD than whites (hazard ratio 1.53, 95% CI 1.26-1.85, P < .001), whereas this ESRD risk did not persist among Hispanics.
  
  
  CONCLUSIONS
  Despite similar access to care and lower CV event rates, the risk of ESRD was higher among blacks and Hispanics than whites. For blacks, but not Hispanics, this increase was independent of known attributable risk factors.
authors: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Electronic address: eflewis@partners.org.
authors: Eldrin F
authors: EF
authors: Lewis
authors: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors: Brian
authors: B
authors: Claggett
authors: Division of Nephrology, Health Sciences Center, St Johns, Newfoundland and Labrador, Canada.
authors: Patrick S
authors: PS
authors: Parfrey
authors: Faculdade de Medicina de São José, do Rio Preto, Brazil.
authors: Emmanuel A
authors: EA
authors: Burdmann
authors: Western Infirmary, University of Glasgow, Scotland, UK.
authors: John J V
authors: JJ
authors: McMurray
authors: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors: Scott D
authors: SD
authors: Solomon
authors: Division of Nephrology, Tufts Medical Center, Boston, MA.
authors: Andrew S
authors: AS
authors: Levey
authors: Division of Nephrology/Hypertension, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors: Peter
authors: P
authors: Ivanovich
authors: Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Erlangen, Germany.
authors: Kai-Uwe
authors: KU
authors: Eckardt
authors: Global Clinical Development, Amgen, Thousand Oaks, CA.
authors: Reshma
authors: R
authors: Kewalramani
authors: Department of Medicine, University of Texas SW, Dallas, TX.
authors: Robert
authors: R
authors: Toto
authors: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors: Marc A
authors: MA
authors: Pfeffer
mesh_terms: D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000208:ethnology* / Q000209:etiology; D000068256:Darbepoetin alfa; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology; D004311:Double-Blind Method; D004921:Erythropoietin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005006:Ethnicity; D005500:Follow-Up Studies; D014943:Global Health; D005919:Glomerular Filtration Rate; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000208:ethnology* / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D044469:Racial Groups; D015996:Survival Rate; D013997:Time Factors
chemical_list: D006397:Hematinics; D004921:Erythropoietin; D000068256:Darbepoetin alfa