TY - JOUR
T1 - Black and White Adults With CKD Hospitalized With Acute Kidney Injury
T2 - Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study
AU - CRIC Study Investigators
AU - Muiru, Anthony N.
AU - Yang, Jingrong
AU - Derebail, Vimal K.
AU - Liu, Kathleen D.
AU - Feldman, Harold I.
AU - Srivastava, Anand
AU - Bhat, Zeenat
AU - Saraf, Santosh L.
AU - Chen, Teresa K.
AU - He, Jiang
AU - Estrella, Michelle M.
AU - Go, Alan S.
AU - Hsu, Chi yuan
AU - Appel, Lawrence J.
AU - Chen, Jing
AU - Cohen, Debbie L.
AU - Lash, James P.
AU - Nelson, Robert G.
AU - Rahman, Mahboob
AU - Rao, Panduranga S.
AU - Shah, Vallabh O.
AU - Unruh, Mark L.
N1 - Funding Information:
Lawrence J. Appel, MD, MPH, Jing Chen, MD, MMSc, MSc, Debbie L Cohen, MD, James P. Lash, MD, Robert G. Nelson, MD, PhD, MS, Mahboob Rahman, MD, Panduranga S. Rao, MD, Vallabh O. Shah, PhD, MS, and Mark L. Unruh, MD, MS. Anthony N. Muiru, MD, MPH, Jingrong Yang, MA, Vimal K. Derebail, MD, MPH, Kathleen D. Liu, MD, PhD, Harold I. Feldman, MD, MSCE, Anand Srivastava, MD, MPH, Zeenat Bhat, MD, Santosh L. Saraf, MD, Teresa K. Chen, MD, MHS, Jiang He, MD, PhD, Michelle M. Estrella, MD, MHS, Alan S. Go, MD, and Chi-yuan Hsu, MD, MSc. Drs Feldman, Go, and Hsu are CRIC Study Investigators. Research idea and study design: ANM, VKD, KDL, HIF, JH, ASG, C-YH; data acquisition: HIF, ZB, SLS, JH, ASG, C-YH; data analysis/interpretation: ANM, JY, VKD, KDL, HIF, AS, ZB, SLS, TKC, JH, MME, ASG, C-YH; statistical analysis: ANM, JY, HIF, JH, ASG, C-YH; supervision or mentorship: MME, ASG, C-YH. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual's own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated, and resolved, including with documentation in the literature if appropriate. This work was supported by the University of California, San Francisco, Dean's Diversity award (Watson scholar), and R01DK114014-01A1S1 diversity supplement and K23DK119562 (to Dr Muiru); by NIH grant K23DK120811, Kidney Precision Medicine Project Opportunity Pool grant under award U2CDK114886, and core resources from the George M. O'Brien Kidney Research Center at Northwestern University (NU-GoKIDNEY) P30DK114857 (to Dr Srivastava); and by K24 DK92291 and R01 DK114014 (to Dr Hsu). Funding for the CRIC Study was obtained under a cooperative agreement from National Institute of Diabetes and Digestive and Kidney Diseases (U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, U01DK060902, and U24DK060990). In addition, this work was supported in part by the Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award NIH/NCATS UL1TR000003, Johns Hopkins University UL1 TR-000424, University of Maryland GCRC M01 RR-16500, Clinical and Translational Science Collaborative of Cleveland, UL1TR000439 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH roadmap for Medical Research, Michigan Institute for Clinical and Health Research (MICHR) UL1TR000433, University of Illinois at Chicago CTSA UL1RR029879, Tulane COBRE for Clinical and Translational Research in Cardiometabolic Diseases P20 GM109036, Kaiser Permanente NIH/NCRR UCSF-CTSI UL1 RR-024131, and Department of Internal Medicine, University of New Mexico School of Medicine Albuquerque, NM R01DK119199. The funders had no role in study design, data collection, analysis, reporting, or the decision to submit for publication. Dr Srivastava has received personal fees from Horizon Therapeutics PLC, CVS Caremark, AstraZeneca, Bayer, and Tate & Latham (medicolegal consulting). Dr Estrella has received compensation for a one-time session as a member of an advisory panel for Astra Zeneca related to APOL1. The remaining authors declare that they have no other relevant financial interests. Received October 13, 2021. Evaluated by 3 external peer reviewers and a statistician, with editorial input from an Acting Editor-in-Chief (Editorial Board Member Emmanuel Burdmann, MD, PhD). Accepted in revised form February 21, 2022. The involvement of an Acting Editor-in-Chief to handle the peer-review and decision-making processes was to comply with AJKD's procedures for potential conflicts of interest for editors, described in the Information for Authors & Journal Policies.
Funding Information:
This work was supported by the University of California, San Francisco , Dean’s Diversity award (Watson scholar), and R01DK114014-01A1S1 diversity supplement and K23DK119562 (to Dr Muiru); by NIH grant K23DK120811, Kidney Precision Medicine Project Opportunity Pool grant under award U2CDK114886, and core resources from the George M. O’Brien Kidney Research Center at Northwestern University (NU-GoKIDNEY) P30DK114857 (to Dr Srivastava); and by K24 DK92291 and R01 DK114014 (to Dr Hsu). Funding for the CRIC Study was obtained under a cooperative agreement from National Institute of Diabetes and Digestive and Kidney Diseases (U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, U01DK060902, and U24DK060990). In addition, this work was supported in part by the Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award NIH/NCATS UL1TR000003, Johns Hopkins University UL1 TR-000424, University of Maryland GCRC M01 RR-16500, Clinical and Translational Science Collaborative of Cleveland, UL1TR000439 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH roadmap for Medical Research, Michigan Institute for Clinical and Health Research (MICHR) UL1TR000433, University of Illinois at Chicago CTSA UL1RR029879, Tulane COBRE for Clinical and Translational Research in Cardiometabolic Diseases P20 GM109036, Kaiser Permanente NIH/NCRR UCSF-CTSI UL1 RR-024131, and Department of Internal Medicine, University of New Mexico School of Medicine Albuquerque, NM R01DK119199. The funders had no role in study design, data collection, analysis, reporting, or the decision to submit for publication.
Publisher Copyright:
© 2022 National Kidney Foundation, Inc.
PY - 2022/11
Y1 - 2022/11
N2 - Rationale & Objective: Few studies have investigated racial disparities in acute kidney injury (AKI), in contrast to the extensive literature on racial differences in the risk of kidney failure. We sought to study potential differences in risk in the setting of chronic kidney disease (CKD). Study Design: Prospective cohort study. Setting & Participants: We studied 2,720 self-identified Black or White participants with CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study from July 1, 2013, to December 31, 2017. Exposure: Self-reported race (Black vs White). Outcome: Hospitalized AKI (≥50% increase from nadir to peak serum creatinine). Analytical Approach: Cox regression models adjusting for demographics (age and sex), prehospitalization clinical risk factors (diabetes, blood pressure, cardiovascular disease, estimated glomerular filtration rate, proteinuria, receipt of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers), and socioeconomic status (insurance status and education level). In a subset of participants with genotype data, we adjusted for apolipoprotein L1 gene (APOL1) high-risk status and sickle cell trait. Results: Black participants (n = 1,266) were younger but had a higher burden of prehospitalization clinical risk factors. The incidence rate of first AKI hospitalization among Black participants was 6.3 (95% CI, 5.5-7.2) per 100 person-years versus 5.3 (95% CI, 4.6-6.1) per 100 person-years among White participants. In an unadjusted Cox regression model, Black participants were at a modestly increased risk of incident AKI (HR, 1.22 [95% CI, 1.01-1.48]) compared with White participants. However, this risk was attenuated and no longer significant after adjusting for prehospitalization clinical risk factors (adjusted HR, 1.02 [95% CI, 0.83-1.25]). There were only 11 AKI hospitalizations among individuals with high-risk APOL1 risk status and 14 AKI hospitalizations among individuals with sickle cell trait. Limitations: Participants were limited to research volunteers and potentially not fully representative of all CKD patients. Conclusions: In this multicenter prospective cohort of CKD patients, racial disparities in AKI incidence were modest and were explained by differences in prehospitalization clinical risk factors.
AB - Rationale & Objective: Few studies have investigated racial disparities in acute kidney injury (AKI), in contrast to the extensive literature on racial differences in the risk of kidney failure. We sought to study potential differences in risk in the setting of chronic kidney disease (CKD). Study Design: Prospective cohort study. Setting & Participants: We studied 2,720 self-identified Black or White participants with CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study from July 1, 2013, to December 31, 2017. Exposure: Self-reported race (Black vs White). Outcome: Hospitalized AKI (≥50% increase from nadir to peak serum creatinine). Analytical Approach: Cox regression models adjusting for demographics (age and sex), prehospitalization clinical risk factors (diabetes, blood pressure, cardiovascular disease, estimated glomerular filtration rate, proteinuria, receipt of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers), and socioeconomic status (insurance status and education level). In a subset of participants with genotype data, we adjusted for apolipoprotein L1 gene (APOL1) high-risk status and sickle cell trait. Results: Black participants (n = 1,266) were younger but had a higher burden of prehospitalization clinical risk factors. The incidence rate of first AKI hospitalization among Black participants was 6.3 (95% CI, 5.5-7.2) per 100 person-years versus 5.3 (95% CI, 4.6-6.1) per 100 person-years among White participants. In an unadjusted Cox regression model, Black participants were at a modestly increased risk of incident AKI (HR, 1.22 [95% CI, 1.01-1.48]) compared with White participants. However, this risk was attenuated and no longer significant after adjusting for prehospitalization clinical risk factors (adjusted HR, 1.02 [95% CI, 0.83-1.25]). There were only 11 AKI hospitalizations among individuals with high-risk APOL1 risk status and 14 AKI hospitalizations among individuals with sickle cell trait. Limitations: Participants were limited to research volunteers and potentially not fully representative of all CKD patients. Conclusions: In this multicenter prospective cohort of CKD patients, racial disparities in AKI incidence were modest and were explained by differences in prehospitalization clinical risk factors.
KW - Acute kidney injury (AKI)
KW - Black race
KW - CRIC
KW - White race
KW - chronic kidney disease (CKD)
KW - clinical risk factors
KW - health care inequity
KW - hospitalization
KW - racial disparities
KW - serum creatinine (Scr)
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U2 - 10.1053/j.ajkd.2022.02.021
DO - 10.1053/j.ajkd.2022.02.021
M3 - Article
C2 - 35405207
AN - SCOPUS:85133398971
SN - 0272-6386
VL - 80
SP - 610-618.e1
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 5
ER -