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Outcomes Associated with Race in Males with Nondialysis-Dependent Chronic Kidney Disease

Csaba P. Kovesdy^*,, John E. Anderson, Stephen F. Derose, and Kamyar Kalantar-Zadeh^||,¶

^* Division of Nephrology, Salem Veterans Affairs Medical Center, Salem, Virginia; Department of Medicine, University of Virginia, Charlottesville, Virginia; Department of Nephrology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Kaiser Permanente Research, Pasadena, California; ^¶ Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; ^|| David Geffen School of Medicine at UCLA, Los Angeles, California

Correspondence: Dr. Csaba P. Kovesdy, Division of Nephrology, Salem VA Medical Center, 1970 Roanoke Boulevard, Salem, VA 24153; Phone: 540-982-2463; Fax: 540-224-1963; E-mail: csaba.kovesdy{at}va.gov

Background and objectives: Blacks are over-represented among dialysis patients, but they have better survival rates than whites. It is unclear if the over-representation of blacks on dialysis is due to faster loss of kidney function or greater survival (or both) in predialysis stages of chronic kidney disease (CKD).

Design, setting, participants & measurements: We compared predialysis mortality, incidence of end stage renal disease (ESRD), and slopes of estimated GFR (eGFR) in 298 black versus 945 white male patients with moderate and advanced nondialysis-dependent CKD (NDD-CKD) from a single medical center. Mortality and ESRD incidence were compared in parametric survival models, and slopes of eGFR were assessed in mixed-effects models.

Results: Blacks had lower crude mortality and higher crude ESRD incidence. The lower mortality in blacks was explained by differences in case mix, especially a lower prevalence of cardiovascular disease, and the higher incidence of ESRD was explained by differences in case mix and baseline kidney function. The slopes of eGFR were similar in blacks and whites.

Conclusions: Lower mortality in black versus white patients is also observed in NDD-CKD and can be accounted for by differences in clinical characteristics. Higher mortality of black patients in earlier stages of CKD may result in the selection of a subgroup with fewer comorbidities and better survival in later stages of CKD. The higher crude ESRD rate in blacks appears to result from lower mortality in late stages of CKD, not faster progression of CKD.