Kidney Week

Abstract: FR-PO495

Racial Disparities in Trajectory of eGFR Decline in Patients with or at Risk for CKD

Session Information

• CKD: Epidemiology, Outcomes - Non-Cardiovascular - I
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Chronic Kidney Disease (Non-Dialysis)

• 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular

Authors

• Nicholas, Susanne B., UCLA, Los Angeles, California, United States

Susanne B. Nicholas,

• Daratha, Kenn B., Washington State University, Spokane, Washington, United States

Kenn B. Daratha,

• Shen, Jenny I., LaBiomed at Harbor-UCLA, Torrance, California, United States

Jenny I. Shen,

• Bell, Douglas S, UCLA, Los Angeles, California, United States

Douglas S Bell,

• Alicic, Radica Z., Providence Medical Research Center, Spokane, Washington, United States

Radica Z. Alicic,

• Tuttle, Katherine R., University of Washington School of Medicine, Spokane, Washington, United States

Katherine R. Tuttle,

• Norris, Keith C., UCLA, Los Angeles, California, United States

Keith C. Norris,

Group or Team Name

• UCLA-PHS CKD Registry Study Team

Background

Blacks have a 3.5-fold greater prevalence of advanced chronic kidney disease (CKD) compared to non-Blacks. However, less is known about patterns of CKD progression in Blacks relative to non-Blacks in real world settings. UCLA and PHS have formed the largest combined electronic health record (EHR) based CKD and at-risk for CKD Registry. This study compares trajectories of estimated glomerular filtration rate (eGFR) between Blacks and non-Blacks in the UCLA dataset.

Methods

Data in the UCLA CKD and at-risk CKD Registry were analyzed from 176,406 patients who had at least two eGFR measurements from 2006-2016. Mean baseline eGFRs were compared using independent samples t-tests. Trajectories of eGFR of Blacks versus non-Blacks over the 11 years of the study were assessed using linear mixed models with random effects controlling for age and gender.

Results

Baseline characteristics of the overall cohort were: age 55±18 (mean±SD) years, CKD-EPI eGFR 90±24 mL/min/1.73m², 8% Black and 55% women. Among patients with baseline eGFR ≥60mL/min/1.73m², Blacks had higher mean baseline eGFR (103±23 versus 94±19 mL/min/1.73m², p<0.001), and higher mean difference in eGFR (6.8 mL/min/1.73m²; 95% CI=6.6-6.9; p<0.001) than non-Blacks. Among patients with baseline eGFR 30-59 mL/min/1.73m², mean baseline eGFR was similar for Blacks and non-Blacks (49±8 versus 50±8 mL/min/1.73m², p=0.004). However, Blacks appear to have steeper trajectory of eGFR decline (mean difference in eGFR 1.8 mL/min/1.73m²; 95% CI=1.4-2.3; p<0.001).

Conclusion

The trajectories of eGFR differed between Blacks and non-Blacks depending on baseline eGFR ≥60 or 30-59mL/min/1.73m², by a pattern shift from higher eGFR trajectories to lower, steeper eGFR trajectories. These data may signal critical windows for interventions to reduce disparities and improve kidney health in this high-risk group of Black patients.

Funding

• Private Foundation Support