Risk Factors for Rapid Kidney Function Decline Among African Americans: The Jackson Heart Study (JHS)

Bessie A. Young, Ronit Katz, Leigh Boulware, Bryan Kestenbaum, Ian H. de Boer, Wei Wang, Tibor Fülöp, Nisha Bansal, Cassianne Robinson-Cohen, Michael Griswold, Neil N. Powe, Jonathan Himmelfarb, Adolfo Correa

Research output: Contribution to journalArticle

Abstract

Background: 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. Study Design: Prospective cohort study. Setting & Participants: 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. Predictors: Demographics, socioeconomic status, lifestyle, and clinical risk factors for kidney failure. Outcomes: 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. Measurements: Clinical (systolic blood pressure and albuminuria [albumin-creatinine ratio]) and modifiable risk factors. Results: Mean age was 54±12 (SD) years, 37% were men, average body mass index was 31.8±7.1kg/m2, 19% had diabetes mellitus (DM), and mean eGFR was 96.0±20mL/min/1.73m2 with an annual rate of decline of 1.27mL/min/1.73m2. 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. Limitations: No midstudy creatinine measurement at examination 2 (2005-2008). Conclusions: Rapid decline heterogeneity exists among African Americans in JHS. Interventions targeting potentially modifiable factors may help reduce the incidence of kidney failure.

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
DOIs
StateAccepted/In press - Sep 3 2015
Externally publishedYes

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African Americans
Creatinine
Kidney
Glomerular Filtration Rate
Blood Pressure
Renal Insufficiency
Diabetes Mellitus
Albumins
Hypertension
Albuminuria
Waist Circumference
Social Class
C-Reactive Protein
Life Style
Body Mass Index
Cohort Studies
Cardiovascular Diseases
Smoking
Demography
Prospective Studies

Keywords

  • African American
  • Chronic kidney disease (CKD)
  • Disease trajectory
  • Estimated glomerular filtration rate (eGFR)
  • Ethnic differences
  • Jackson Heart Study (JHS)
  • Kidney disease progression
  • Rapid kidney function decline
  • Renal failure
  • Risk factor

ASJC Scopus subject areas

  • Nephrology

Cite this

Risk Factors for Rapid Kidney Function Decline Among African Americans : The Jackson Heart Study (JHS). / Young, Bessie A.; Katz, Ronit; Boulware, Leigh; Kestenbaum, Bryan; de Boer, Ian H.; Wang, Wei; Fülöp, Tibor; Bansal, Nisha; Robinson-Cohen, Cassianne; Griswold, Michael; Powe, Neil N.; Himmelfarb, Jonathan; Correa, Adolfo.

In: American Journal of Kidney Diseases, 03.09.2015.

Research output: Contribution to journalArticle

Young, BA, Katz, R, Boulware, L, Kestenbaum, B, de Boer, IH, Wang, W, Fülöp, T, Bansal, N, Robinson-Cohen, C, Griswold, M, Powe, NN, Himmelfarb, J & Correa, A 2015, 'Risk Factors for Rapid Kidney Function Decline Among African Americans: The Jackson Heart Study (JHS)', American Journal of Kidney Diseases. https://doi.org/10.1053/j.ajkd.2016.02.046
Young, Bessie A. ; Katz, Ronit ; Boulware, Leigh ; Kestenbaum, Bryan ; de Boer, Ian H. ; Wang, Wei ; Fülöp, Tibor ; Bansal, Nisha ; Robinson-Cohen, Cassianne ; Griswold, Michael ; Powe, Neil N. ; Himmelfarb, Jonathan ; Correa, Adolfo. / Risk Factors for Rapid Kidney Function Decline Among African Americans : The Jackson Heart Study (JHS). In: American Journal of Kidney Diseases. 2015.
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T1 - Risk Factors for Rapid Kidney Function Decline Among African Americans

T2 - The Jackson Heart Study (JHS)

AU - Young, Bessie A.

AU - Katz, Ronit

AU - Boulware, Leigh

AU - Kestenbaum, Bryan

AU - de Boer, Ian H.

AU - Wang, Wei

AU - Fülöp, Tibor

AU - Bansal, Nisha

AU - Robinson-Cohen, Cassianne

AU - Griswold, Michael

AU - Powe, Neil N.

AU - Himmelfarb, Jonathan

AU - Correa, Adolfo

PY - 2015/9/3

Y1 - 2015/9/3

N2 - Background: 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. Study Design: Prospective cohort study. Setting & Participants: 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. Predictors: Demographics, socioeconomic status, lifestyle, and clinical risk factors for kidney failure. Outcomes: 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. Measurements: Clinical (systolic blood pressure and albuminuria [albumin-creatinine ratio]) and modifiable risk factors. Results: Mean age was 54±12 (SD) years, 37% were men, average body mass index was 31.8±7.1kg/m2, 19% had diabetes mellitus (DM), and mean eGFR was 96.0±20mL/min/1.73m2 with an annual rate of decline of 1.27mL/min/1.73m2. 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. Limitations: No midstudy creatinine measurement at examination 2 (2005-2008). Conclusions: Rapid decline heterogeneity exists among African Americans in JHS. Interventions targeting potentially modifiable factors may help reduce the incidence of kidney failure.

AB - Background: 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. Study Design: Prospective cohort study. Setting & Participants: 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. Predictors: Demographics, socioeconomic status, lifestyle, and clinical risk factors for kidney failure. Outcomes: 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. Measurements: Clinical (systolic blood pressure and albuminuria [albumin-creatinine ratio]) and modifiable risk factors. Results: Mean age was 54±12 (SD) years, 37% were men, average body mass index was 31.8±7.1kg/m2, 19% had diabetes mellitus (DM), and mean eGFR was 96.0±20mL/min/1.73m2 with an annual rate of decline of 1.27mL/min/1.73m2. 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. Limitations: No midstudy creatinine measurement at examination 2 (2005-2008). Conclusions: Rapid decline heterogeneity exists among African Americans in JHS. Interventions targeting potentially modifiable factors may help reduce the incidence of kidney failure.

KW - African American

KW - Chronic kidney disease (CKD)

KW - Disease trajectory

KW - Estimated glomerular filtration rate (eGFR)

KW - Ethnic differences

KW - Jackson Heart Study (JHS)

KW - Kidney disease progression

KW - Rapid kidney function decline

KW - Renal failure

KW - Risk factor

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