Age, Competing Risk of Death, and Racial Disparities in Kidney Failure

Black adults have a much higher incidence of kidney failure than White adults, but the reason for this is uncertain. Using the race-free 2021 CKD Epidemiology Collaboration equation, researchers, including Guofen Yan, PhD, examined racial differences in kidney failure and death from the onset of CKD and the extent to which those differences could be attributed to factors present at the time of CKD onset.

The study cohort included 547,188 US veterans (103,821 non-Hispanic Black and 443,367 non-Hispanic White) aged 18 to 85 years. All participants had new-onset CKD between 2005 and 2016 and were tracked for incident kidney failure with replacement therapy (KFRT) and pre-KFRT death through 10 years or until May 2018.

Black veterans were on average 7.8 years younger than their White counterparts at the onset of CKD. The cumulative incidence of KFRT was 2.5 times higher for Black individuals than White individuals at any point in time from CKD onset. Black veterans also had hazards of KFRT that were more than twice as high during follow-up (HR [95% CI], 2.38 [2.31-2.45]); they had 17% to 48% decreased hazards of pre-KFRT death. Differences decreased after adjusting for the racial difference in age at CKD onset.

In conclusion, the higher cumulative incidence of kidney failure in Black veterans was attributable to a combination of higher hazards of progression to kidney failure and lower hazards of competing risk of death. Both factors are likely due largely to Black veterans’ younger age at CKD onset compared with White veterans.

Source: Journal of the American Society of Nephrology