Racial Disparities in CKD Kidney Failure, Death

Black adults in the United States have a higher incidence of kidney failure than White adults. To help determine to what extent this disparity is due to factors present at the time of CKD onset, Guofen Yan and other researchers analyzed racial differences in kidney failure and death from onset of CKD using the race-free 2021 CKD Epidemiology Collaboration equation.

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

The cumulative incidence of KFRT was two-and-a-half times higher for Black veterans versus White veterans. In addition, Black veterans had more than two times higher hazards of KFRT throughout follow-up (overall hazard ratio [HR], 2.38; 95% CI, 2.31-2.45) but had 17% to 48% decreased hazards of pre-KFRT death. These differences decreased after accounting for racial differences in age at CKD onset; Black veterans were an average of 7.8 years younger than their White counterparts at CKD onset.

The authors concluded that the greater cumulative incidence of kidney failure in Black adults was due to a combination of higher hazards of progression to kidney failure and lower hazards of the competing risk of death. Both can be largely explained by the younger age at CKD onset in Black adults compared with White adults.

Source: Journal of the American Society of Nephrology