Abstract: TH-PO558

Racial Disparities in Mortality in CKD versus ESRD: Results from the CRIC Study

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 307 CKD: Health Services, Disparities, Prevention

Authors

  • Ku, Elaine, University of California San Francisco, San Francisco, California, United States
  • Shafi, Tariq, CRIC Study, Philadelphia, Pennsylvania, United States
  • Sondheimer, James H., CRIC Study, Philadelphia, Pennsylvania, United States
  • Townsend, Raymond R., CRIC Study, Philadelphia, Pennsylvania, United States
  • Waikar, Sushrut S., CRIC Study, Philadelphia, Pennsylvania, United States
  • Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
  • Yang, Wei, CRIC Study, Philadelphia, Pennsylvania, United States
  • Go, Alan S., CRIC Study, Philadelphia, Pennsylvania, United States
  • Bansal, Nisha, CRIC Study, Philadelphia, Pennsylvania, United States
  • Feldman, Harold I., CRIC Study, Philadelphia, Pennsylvania, United States
  • He, Jiang, CRIC Study, Philadelphia, Pennsylvania, United States
  • Horwitz, Edward J., CRIC Study, Philadelphia, Pennsylvania, United States
  • Lash, James P., CRIC Study, Philadelphia, Pennsylvania, United States
  • Ricardo, Ana C., CRIC Study, Philadelphia, Pennsylvania, United States

Group or Team Name

  • CRIC Study
Background

Black individuals on maintenance dialysis have lower mortality rates than their white counterparts, but the reasons for this observation remain unexplained.

Methods

We examined risk of death among 3288 (non-Hispanic) white and black participants of a national CKD cohort, the Chronic Renal Insufficiency Cohort (CRIC) Study. We included deaths occurring before and after dialysis using Cox models. We also examined the evolution of comorbidities at baseline CRIC enrollment (prior to dialysis) vs. at dialysis initiation by race.

Results

Consistent with prior studies, risk of death was lower among blacks (Cox model HR 0.67 [95% CI 0.51- 0.88]) vs. whites when analysis began at incident dialysis. However, starting analysis at CKD/CRIC enrollment (mean eGFR 45±15 mL/min/1.73m2), risk of death was higher (HR 1.41 [95% CI 1.22-1.64]) for blacks vs. whites counting deaths both before and after ESRD [Figure]. Longitudinal analyses of the evolution of comorbidities suggest that the relative prevalence of co-morbidities at baseline vs. at incident dialysis worsens for whites vs. blacks [Table].

Conclusion

Overall, risk of death was higher for blacks vs. whites when accounting for events occurring before and after ESRD. The apparent survival advantage among blacks on dialysis may be because the subset of whites who transition from CKD to dialysis are persons with a heavier burden of co-morbidities.

Funding

  • Other NIH Support