Race/Ethnicity and Cardiovascular Outcomes in Adults With CKD: Findings From the CRIC (Chronic Renal Insufficiency Cohort) and Hispanic CRIC Studies

James P. Lash, Ana C. Ricardo, Jason Roy, Rajat Deo, Michael Fischer, John Flack, Jiang He, Martin Keane, Claudia Lora, Akinlolu Ojo, Mahboob Rahman, Susan Steigerwalt, Kaixiang Tao, Myles Wolf, Jackson T. Wright, Alan S. Go, Lawrence J. Appel, Harold I. Feldman, Alan S. Go, Jiang HeJohn W. Kusek, James P. Lash, Akinlolu Ojo, Mahboob Rahman, Raymond R. Townsend

Research output: Contribution to journalArticle

Abstract

Background Non-Hispanic blacks and Hispanics with end-stage renal disease have a lower risk for death than non-Hispanic whites, but data for racial/ethnic variation in cardiovascular outcomes for non–dialysis-dependent chronic kidney disease are limited. Study Design Prospective cohort. Setting & Participants 3,785 adults with entry estimated glomerular filtration rates of 20 to 70 mL/min/1.73 m2 enrolled in the CRIC (Chronic Renal Insufficiency Cohort) Study. Predictors Race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic). Outcomes Cardiovascular outcomes (atherosclerotic events [myocardial infarction, stroke, or peripheral arterial disease] and heart failure) and a composite of each cardiovascular outcome or all-cause death. Measurements Multivariable Cox proportional hazards. Results During a median follow-up of 6.6 years, we observed 506 atherosclerotic events, 551 heart failure events, and 692 deaths. In regression analyses, there were no significant differences in atherosclerotic events among the 3 racial/ethnic groups. In analyses stratified by clinical site, non-Hispanic blacks had a higher risk for heart failure events (HR, 1.59; 95% CI, 1.29-1.95), which became nonsignificant after adjustment for demographic factors and baseline kidney function. In contrast, Hispanics had similar risk for heart failure events as non-Hispanic whites. In analyses stratified by clinical site, compared with non-Hispanic whites, non-Hispanic blacks were at similar risk for atherosclerotic events or death. However, after further adjustment for cardiovascular risk factors, medications, and mineral metabolism markers, non-Hispanic blacks had 17% lower risk for the outcome (HR, 0.83; 95% CI, 0.69-0.99) than non-Hispanic whites, whereas there was no significant association with Hispanic ethnicity. Limitations Hispanics were largely recruited from a single center, and the study was underpowered to evaluate the association between Hispanic ethnicity and mortality. Conclusions There were no significant racial/ethnic differences in adjusted risk for atherosclerotic or heart failure outcomes. Future research is needed to better explain the reduced risk for atherosclerotic events or death in non-Hispanic blacks compared with non-Hispanic whites.

Original languageEnglish (US)
Pages (from-to)545-553
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume68
Issue number4
DOIs
StatePublished - Oct 1 2016

Keywords

  • atherosclerotic cardiovascular events
  • CRIC (Chronic Renal Insufficiency Cohort)
  • dialysis
  • end-stage renal disease (ESRD)
  • ethnicity
  • heart failure
  • Hispanic
  • Hispanic CRIC
  • Race
  • racial disparities
  • racial/ethnic variation
  • survival paradox

ASJC Scopus subject areas

  • Nephrology

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    Lash, J. P., Ricardo, A. C., Roy, J., Deo, R., Fischer, M., Flack, J., He, J., Keane, M., Lora, C., Ojo, A., Rahman, M., Steigerwalt, S., Tao, K., Wolf, M., Wright, J. T., Go, A. S., Appel, L. J., Feldman, H. I., Go, A. S., ... Townsend, R. R. (2016). Race/Ethnicity and Cardiovascular Outcomes in Adults With CKD: Findings From the CRIC (Chronic Renal Insufficiency Cohort) and Hispanic CRIC Studies. American Journal of Kidney Diseases, 68(4), 545-553. https://doi.org/10.1053/j.ajkd.2016.03.429