title: Risk Factors for Rapid Kidney Function Decline Among African Americans: The Jackson Heart Study (JHS).
abstract: Racial differences in rapid kidney function decline exist, but less is known regarding factors associated with rapid decline among African Americans. Greater understanding of potentially modifiable risk factors for early kidney function loss may help reduce the burden of kidney failure in this high-risk population.
  
  
  
  Prospective cohort study.
  
  
  
  3,653 African American participants enrolled in the Jackson Heart Study (JHS) with kidney function data from 2 of 3 examinations (2000-2004 and 2009-2013). Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine using the CKD-EPI creatinine equation.
  
  
  
  Demographics, socioeconomic status, lifestyle, and clinical risk factors for kidney failure.
  
  
  
  Rapid decline was defined as a ≥30% decline in eGFR during follow-up. We quantified the association of risk factors with rapid decline in multivariable models.
  
  
  
  Clinical (systolic blood pressure and albuminuria [albumin-creatinine ratio]) and modifiable risk factors.
  
  
  
  Mean age was 54±12 (SD) years, 37% were men, average body mass index was 31.8±7.1kg/m(2), 19% had diabetes mellitus (DM), and mean eGFR was 96.0±20mL/min/1.73m(2) with an annual rate of decline of 1.27mL/min/1.73m(2). Those with rapid decline (11.5%) were older, were more likely to be of low/middle income, and had higher systolic blood pressures and greater DM than those with nonrapid decline. Factors associated with ≥30% decline were older age (adjusted OR per 10 years older, 1.51; 95% CI, 1.34-1.71), cardiovascular disease (adjusted OR, 1.53; 95% CI, 1.12-2.10), higher systolic blood pressure (adjusted OR per 17mmHg greater, 1.22; 95% CI, 1.06-1.41), DM (adjusted OR, 2.63; 95% CI, 2.02-3.41), smoking (adjusted OR, 1.60; 95% CI, 1.10-2.31), and albumin-creatinine ratio > 30mg/g (adjusted OR, 1.55; 95% CI, 1.08-1.21). Conversely, results did not support associations of waist circumference, C-reactive protein level, and physical activity with rapid decline.
  
  
  
  No midstudy creatinine measurement at examination 2 (2005-2008).
  
  
  
  Rapid decline heterogeneity exists among African Americans in JHS. Interventions targeting potentially modifiable factors may help reduce the incidence of kidney failure.
authors.affiliation: Center of Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, WA; Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA; Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA. Electronic address: youngb@uw.edu.
authors.forename: Bessie A
authors.initials: BA
authors.lastname: Young
authors.affiliation: Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA.
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.affiliation: Department of Medicine, Duke University, Durham, NC.
authors.forename: L Ebony
authors.initials: LE
authors.lastname: Boulware
authors.affiliation: Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Kestenbaum
authors.affiliation: Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA; Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA.
authors.forename: Ian H
authors.initials: IH
authors.lastname: de Boer
authors.affiliation: Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
authors.forename: Tibor
authors.initials: T
authors.lastname: Fülöp
authors.affiliation: Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA.
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.affiliation: Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA.
authors.forename: Cassianne
authors.initials: C
authors.lastname: Robinson-Cohen
authors.affiliation: Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS.
authors.forename: Michael
authors.initials: M
authors.lastname: Griswold
authors.affiliation: Department of Medicine, University of California, San Francisco, San Francisco, CA.
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.affiliation: Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, WA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Himmelfarb
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Correa
mesh_terms: D001741:Black or African American; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000453:epidemiology*; D012307:Risk Factors; D013997:Time Factors
keywords: African American; Chronic kidney disease (CKD); Jackson Heart Study (JHS); disease trajectory; estimated glomerular filtration rate (eGFR); ethnic differences; kidney disease progression; rapid kidney function decline; renal failure; risk factor