title: CKD Progression and Mortality among Hispanics and Non-Hispanics.
abstract: Although recommended approaches to CKD management are achieved less often in Hispanics than in non-Hispanics, whether long-term outcomes differ between these groups is unclear. In a prospective longitudinal analysis of participants enrolled into the Chronic Renal Insufficiency Cohort (CRIC) and Hispanic-CRIC Studies, we used Cox proportional hazards models to determine the association between race/ethnicity, CKD progression (50% eGFR loss or incident ESRD), incident ESRD, and all-cause mortality, and linear mixed-effects models to assess differences in eGFR slope. Among 3785 participants, 13% were Hispanic, 43% were non-Hispanic white (NHW), and 44% were non-Hispanic black (NHB). Over a median follow-up of 5.1 years for Hispanics and 6.8 years for non-Hispanics, 27.6% of all participants had CKD progression, 21.3% reached incident ESRD, and 18.3% died. Hispanics had significantly higher rates of CKD progression, incident ESRD, and mean annual decline in eGFR than did NHW (P<0.05) but not NHB. Hispanics had a mortality rate similar to that of NHW but lower than that of NHB (P<0.05). In adjusted analyses, the risk of CKD progression did not differ between Hispanics and NHW or NHB. However, among nondiabetic participants, compared with NHB, Hispanics had a lower risk of CKD progression (hazard ratio, 0.61; 95% confidence interval, 0.39 to 0.95) and incident ESRD (hazard ratio, 0.50; 95% confidence interval, 0.30 to 0.84). At higher levels of urine protein, Hispanics had a significantly lower risk of mortality than did non-Hispanics (P<0.05). Thus, important differences in CKD progression and mortality exist between Hispanics and non-Hispanics and may be affected by proteinuria and diabetes.
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; fischerm@uic.edu.|Medical Service, Jesse Brown VA Medical Center, Chicago, Illinois.|Research Service, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr., VA Hospital, Hines, Illinois.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fischer
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jesse Y
authors.initials: JY
authors.lastname: Hsu
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Lora
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Ricardo
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Amanda H
authors.initials: AH
authors.lastname: Anderson
authors.affiliation: Department of Epidemiology, Tulane University, New Orleans, Louisiana.
authors.forename: Lydia
authors.initials: L
authors.lastname: Bazzano
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Magdalena M
authors.initials: MM
authors.lastname: Cuevas
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, California.|Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Chi-Yuan
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Amada
authors.initials: A
authors.lastname: Renteria
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Akinlolu O
authors.initials: AO
authors.lastname: Ojo
authors.affiliation: Department of Medicine, The George Washington University, Washington, DC.
authors.forename: Dominic S
authors.initials: DS
authors.lastname: Raj
authors.affiliation: Kidney and Hypertension Unit, Joslin Diabetes Center and Nephrology Section, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Sylvia E
authors.initials: SE
authors.lastname: Rosas
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Pan
authors.affiliation: Departments of Psychiatry, Neurology and Epidemiology, University of California San Francisco and San Francisco VA Medical Center, San Francisco, California.
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: James P
authors.initials: JP
authors.lastname: Lash
mesh_terms: D001741:Black or African American; D018450:Disease Progression; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality*; D044465:White People
keywords: chronic kidney disease; ethnicity; mortality