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Kidney Week

Abstract: SA-PO439

Ethnic Differences in Mortality among Veterans with Kidney Disease: A 13-Year National Longitudinal Cohort Study

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular

Authors

  • Ozieh, Mukoso N., Medical College of Wisconsin, Milwaukee, Wisconsin, United States
  • Gebregziabher, Mulugeta, Medical University of South Carolina, Charleston, South Carolina, United States
  • Ward, Ralph, Ralph H. Johnson VAMC, Charleston, Wisconsin, United States
  • Taber, David J., Medical University of South Carolina, Charleston, South Carolina, United States
  • Egede, Leonard, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Background

To assess the association between ethnic differences and mortality among Veterans with chronic kidney disease (CKD) over a 13-year period.

Methods

We examined all-cause mortality among Veterans with CKD from Jan 2000 to Dec 2012, including 3,015,318 Veterans using a unique algorithm to identify CKD; which was defined as estimated glomerular filtration rate (eGFR) of >60ml/min/1.73m2 and presence of proteinuria for >3 months for stage 1 and 2 CKD or eGFR <60 ml/min/1.73m2 for >3 months for stage 3 CKD or higher. Cox proportional hazards models were used to assess the relationship between mortality and racial/ethnic groups, and the models were developed in a sequential fashion. Hazard ratios (HR) and corresponding 95% CI were reported overall. All analyses were performed in SAS 9.4.

Results

The mean age for the cohort was 76.7 ± 11 years, which varied by ethnicity: 70.8 ± 12 years in Non-Hispanic blacks (NHB); 74.5 ± 11.7 years in Hispanics and 78.0 ± 10.3 years in non-Hispanic whites (NHW)]. The unadjusted all-cause mortality rate was 52.0% in NHW, 42.7% in NHB and 41.3% in Hispanics. After adjusting for demographic variables, NHBs and Hispanics had statistically significant lower CKD mortality risk relative to NHW (HR 0.92; 95% CI, 0.91 - 0.92) and (HR: 0.73, 95% CI, 0.72 - 0.74) respectively. In the fully adjusted model (adjusting for CKD stage and comorbidities in addition to other relevant covariates), NHB and Hispanics maintained this survival advantage compared to NHW, [NHB (HR: 0.85, 95% CI, 0.84 - 0.85) and Hispanic (HR: 0.74, 95% CI, 0.73 - 0.74)].

Conclusion

This is the first national longitudinal cohort study among Veterans which uses a robust algorithm to identify CKD. Non-Hispanic blacks and Hispanic Veterans with CKD have a survival advantage relative to NHW after adjusting for demographics, CKD stage and comorbidities.