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Original ArticlesDiabetes and The Kidney
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Incidence and Progression of Chronic Kidney Disease in Black and White Individuals with Type 2 Diabetes

Claire Gerber, Xuan Cai, Jungwha Lee, Timothy Craven, Julia Scialla, Nao Souma, Anand Srivastava, Rupal Mehta, Amanda Paluch, Alexander Hodakowski, Rebecca Frazier, Mercedes R. Carnethon, Myles Selig Wolf and Tamara Isakova
CJASN June 2018, 13 (6) 884-892; DOI: https://doi.org/10.2215/CJN.11871017
Claire Gerber
Center for Translational Metabolism and Health, Institute for Public Health and Medicine,Division of Nephrology and Hypertension, Department of Medicine, and
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Xuan Cai
Center for Translational Metabolism and Health, Institute for Public Health and Medicine,
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Jungwha Lee
Center for Translational Metabolism and Health, Institute for Public Health and Medicine,
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Timothy Craven
Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina; and
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Julia Scialla
Division of Nephrology, Department of Medicine, Duke University Medical Center, Duke University, Durham, North Carolina
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  • ORCID record for Julia Scialla
Nao Souma
Center for Translational Metabolism and Health, Institute for Public Health and Medicine,
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Anand Srivastava
Center for Translational Metabolism and Health, Institute for Public Health and Medicine,Division of Nephrology and Hypertension, Department of Medicine, and
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Rupal Mehta
Center for Translational Metabolism and Health, Institute for Public Health and Medicine,Division of Nephrology and Hypertension, Department of Medicine, and
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Amanda Paluch
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
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Alexander Hodakowski
Center for Translational Metabolism and Health, Institute for Public Health and Medicine,
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Rebecca Frazier
Division of Nephrology and Hypertension, Department of Medicine, and
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Mercedes R. Carnethon
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
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Myles Selig Wolf
Division of Nephrology, Department of Medicine, Duke University Medical Center, Duke University, Durham, North Carolina
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Tamara Isakova
Center for Translational Metabolism and Health, Institute for Public Health and Medicine,Division of Nephrology and Hypertension, Department of Medicine, and
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Abstract

Background and objectives Type 2 diabetes and associated CKD disproportionately affect blacks. It is uncertain if racial disparities in type 2 diabetes-associated CKD are driven by biologic factors that influence propensity to CKD or by differences in type 2 diabetes care.

Design, setting, participants, & measurements We conducted a post hoc analysis of 1937 black and 6372 white participants of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial to examine associations of black race with change in eGFR and risks of developing microalbuminuria, macroalbuminuria, incident CKD (eGFR<60 ml/min per 1.73m2, ≥25% decrease from baseline eGFR, and eGFR slope <−1.6 ml/min per 1.73 m2 per year), and kidney failure or serum creatinine >3.3 mg/dl.

Results During a median follow-up that ranged between 4.4 and 4.7 years, 278 black participants (58 per 1000 person-years) and 981 white participants (55 per 1000 person-years) developed microalbuminuria, 122 black participants (16 per 1000 person-years) and 374 white participants (14 per 1000 person-years) developed macroalbuminuria, 111 black participants (21 per 1000 person-years) and 499 white participants (28 per 1000 person-years) developed incident CKD, and 59 black participants (seven per 1000 person-years) and 178 white participants (six per 1000 person-years) developed kidney failure or serum creatinine >3.3 mg/dl. Compared with white participants, black participants had lower risks of incident CKD (hazard ratio, 0.73; 95% confidence intervals, 0.57 to 0.92). There were no significant differences by race in eGFR decline or in risks of microalbuminuria, macroalbuminuria, and kidney failure or of serum creatinine >3.3 mg/dl.

Conclusions Black participants enrolled in a randomized controlled trial had lower rates of incident CKD compared with white participants. Rates of eGFR decline, microalbuminuria, macroalbuminuria, and kidney failure did not vary by race.

  • Biological Factors
  • Cardiovascular Diseases
  • chronic kidney disease
  • Confidence Intervals
  • creatinine
  • diabetes
  • Diabetes Mellitus, Type 2
  • Disease Progression
  • Follow-up Studies
  • glomerular filtration rate
  • Humans
  • Incidence
  • Renal Insufficiency
  • Renal Insufficiency, Chronic
  • risk factors
  • Received October 20, 2017.
  • Accepted March 1, 2018.
  • Copyright © 2018 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 13 (6)
Clinical Journal of the American Society of Nephrology
Vol. 13, Issue 6
June 07, 2018
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Incidence and Progression of Chronic Kidney Disease in Black and White Individuals with Type 2 Diabetes
Claire Gerber, Xuan Cai, Jungwha Lee, Timothy Craven, Julia Scialla, Nao Souma, Anand Srivastava, Rupal Mehta, Amanda Paluch, Alexander Hodakowski, Rebecca Frazier, Mercedes R. Carnethon, Myles Selig Wolf, Tamara Isakova
CJASN Jun 2018, 13 (6) 884-892; DOI: 10.2215/CJN.11871017

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Incidence and Progression of Chronic Kidney Disease in Black and White Individuals with Type 2 Diabetes
Claire Gerber, Xuan Cai, Jungwha Lee, Timothy Craven, Julia Scialla, Nao Souma, Anand Srivastava, Rupal Mehta, Amanda Paluch, Alexander Hodakowski, Rebecca Frazier, Mercedes R. Carnethon, Myles Selig Wolf, Tamara Isakova
CJASN Jun 2018, 13 (6) 884-892; DOI: 10.2215/CJN.11871017
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Keywords

  • Biological Factors
  • Cardiovascular Diseases
  • chronic kidney disease
  • Confidence Intervals
  • creatinine
  • diabetes
  • Diabetes Mellitus, Type 2
  • Disease Progression
  • Follow-Up Studies
  • glomerular filtration rate
  • Humans
  • Incidence
  • Renal Insufficiency
  • Renal Insufficiency, Chronic
  • risk factors

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