TY - JOUR
T1 - Race and Mortality in CKD and Dialysis
T2 - Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study
AU - CRIC Study Investigators
AU - Ku, Elaine
AU - Yang, Wei
AU - McCulloch, Charles E.
AU - Feldman, Harold I.
AU - Go, Alan S.
AU - Lash, James
AU - Bansal, Nisha
AU - He, Jiang
AU - Horwitz, Ed
AU - Ricardo, Ana C.
AU - Shafi, Tariq
AU - Sondheimer, James
AU - Townsend, Raymond R.
AU - Waikar, Sushrut S.
AU - Hsu, Chi yuan
AU - Appel, Lawrence J.
AU - Kusek, John W.
AU - Rao, Panduranga S.
AU - Rahman, Mahboob
N1 - Publisher Copyright:
© 2019 National Kidney Foundation, Inc.
PY - 2020/3
Y1 - 2020/3
N2 - Rationale & Objectives: Few studies have investigated racial disparities in survival among dialysis patients in a manner that considers risk factors and mortality during the phase of kidney disease before maintenance dialysis. Our objective was to explore racial variations in survival among dialysis patients and relate them to racial differences in comorbid conditions and rates of death in the setting of kidney disease not yet requiring dialysis therapy. Study Design: Retrospective cohort study. Settings & Participants: 3,288 black and white participants in the Chronic Renal Insufficiency Cohort (CRIC), none of whom were receiving dialysis at enrollment. Exposure: Race. Outcome: Mortality. Analytic Approach: Cox proportional hazards regression was used to examine the association between race and mortality starting at: (1) time of dialysis initiation and (2) entry into the CRIC. Results: During 7.1 years of median follow-up, 678 CRIC participants started dialysis. Starting from the time of dialysis initiation, blacks had lower risk for death (unadjusted HR, 0.67; 95% CI, 0.51-0.87) compared with whites. Starting from baseline CRIC enrollment, the strength of the association between some risk factors and dialysis was notably stronger for whites than blacks. For example, the HR for dialysis onset in the presence (vs absence) of heart failure at CRIC enrollment was 1.30 (95% CI, 1.01-1.68) for blacks versus 2.78 (95% CI, 1.90-4.50) for whites, suggesting differential severity of these risk factors by race. When we included deaths occurring both before and after dialysis, risk for death was higher among blacks (vs whites) starting from CRIC enrollment (HR, 1.41; 95% CI, 1.22-1.64), but this finding was attenuated in adjusted models (HR, 1.08; 95% CI, 0.91-1.28). Limitations: Residual confounding. Conclusions: The apparent survival advantage among blacks over whites treated with dialysis may be attributed to selected transition of a subset of whites with more severe comorbid conditions onto dialysis.
AB - Rationale & Objectives: Few studies have investigated racial disparities in survival among dialysis patients in a manner that considers risk factors and mortality during the phase of kidney disease before maintenance dialysis. Our objective was to explore racial variations in survival among dialysis patients and relate them to racial differences in comorbid conditions and rates of death in the setting of kidney disease not yet requiring dialysis therapy. Study Design: Retrospective cohort study. Settings & Participants: 3,288 black and white participants in the Chronic Renal Insufficiency Cohort (CRIC), none of whom were receiving dialysis at enrollment. Exposure: Race. Outcome: Mortality. Analytic Approach: Cox proportional hazards regression was used to examine the association between race and mortality starting at: (1) time of dialysis initiation and (2) entry into the CRIC. Results: During 7.1 years of median follow-up, 678 CRIC participants started dialysis. Starting from the time of dialysis initiation, blacks had lower risk for death (unadjusted HR, 0.67; 95% CI, 0.51-0.87) compared with whites. Starting from baseline CRIC enrollment, the strength of the association between some risk factors and dialysis was notably stronger for whites than blacks. For example, the HR for dialysis onset in the presence (vs absence) of heart failure at CRIC enrollment was 1.30 (95% CI, 1.01-1.68) for blacks versus 2.78 (95% CI, 1.90-4.50) for whites, suggesting differential severity of these risk factors by race. When we included deaths occurring both before and after dialysis, risk for death was higher among blacks (vs whites) starting from CRIC enrollment (HR, 1.41; 95% CI, 1.22-1.64), but this finding was attenuated in adjusted models (HR, 1.08; 95% CI, 0.91-1.28). Limitations: Residual confounding. Conclusions: The apparent survival advantage among blacks over whites treated with dialysis may be attributed to selected transition of a subset of whites with more severe comorbid conditions onto dialysis.
KW - Chronic Renal Insufficiency Cohort (CRIC)
KW - Mortality
KW - cardiovascular disease
KW - chronic kidney disease (CKD)
KW - comorbid conditions
KW - dialysis
KW - end-stage renal disease (ESRD)
KW - non–dialysis-dependent CKD (NDD-CKD)
KW - race
KW - racial disparities
KW - survival analysis
KW - survival paradox
KW - transition to dialysis
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U2 - 10.1053/j.ajkd.2019.08.011
DO - 10.1053/j.ajkd.2019.08.011
M3 - Article
C2 - 31732235
AN - SCOPUS:85075346978
SN - 0272-6386
VL - 75
SP - 394
EP - 403
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 3
ER -