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Kidney Week

Abstract: PO0487

Incidence of and Risk Factors for Incident eGFR <60 in the REasons for Geographic and Racial Differences in Stroke Study

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Cheung, Katharine L., The University of Vermont Larner College of Medicine, Burlington, Vermont, United States
  • Cushman, Mary, The University of Vermont Larner College of Medicine, Burlington, Vermont, United States
  • Crews, Deidra C., John Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Judd, Suzanne E., The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, United States
  • Warnock, David G., The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, United States
  • Gutierrez, Orlando M., The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, United States
Background

Few contemporary US cohorts examined the incidence of and risk factors for developing a low estimated glomerular filtration rate (eGFR) or whether these factors vary by race, sex or region of US residence.

Methods

We studied 11,814 black or white participants with an eGFR> 60 ml/min/1.73m2 at baseline and who had 10-year follow-up eGFR. Low eGFR was defined as incident eGFR<60 ml/min/1.73m2 at the second visit and ≧40% decline from baseline. Incidence rates were calculated overall and by age, sex and race groups. We used Poisson regression to calculate the risk of incident low eGFR, adjusting for demographics, socioeconomic status and clinical factors, and across race, sex and region strata.

Results

At baseline, mean age was 62 (±8.1) years, 54% were female, 36% black and 56% resided in the US stroke belt. The overall incidence of low eGFR was 9% and ranged from 4% in those aged 45-54 to 18% in those 75 years and older. Age, systolic blood pressure, diabetes, heart disease, BMI, smoking, lower income, higher education, and residence in the US stroke belt were independent risk factors for incident low eGFR. Blacks had higher risk, accounting for sociodemographic risk factors, but this was fully attenuated after adjusting for clinical factors. Low eGFR risk factors did not differ substantially by race, sex or region.

Conclusion

The higher incidence of low eGFR in black compared to white participants was accounted for by modifiable clinical risk factors. Residence in the US stroke belt was independently associated with incident low eGFR in REGARDS participants.

Risk factors for incident low eGFR (Relative risk and 95% confidence interval)
Risk factorModel 1Model 2Model 3
Age, per SD increase1.46 (1.39, 1.54)1.42 (1.33, 1.49)1.44 (1.36, 1.54)
Male sex, vs female0.87 (0.78, 0.97)0.97 (0.86, 1.09)0.88 (0.78, 1.00)
Black race, vs white1.30 (1.16, 1.46)1.22 (1.08, 1.39)0.97 (0.85, 1.10)
High school or above, vs less 0.71 (0.59, 0.85)0.82 (0.68, 0.99)
Income ≥$35,000/yr or more, vs lower 0.74 (0.65, 0.84)0.85 (0.74, 0.97)
US stroke belt, vs rest of the US 1.16 (1.03, 1.31)1.15 (1.02, 1.29)
Current smoking, vs former or never 1.19 (0.99, 1.43)1.30 (1.08, 1.50)
Systolic blood pressure, mmHg, per SD higher  1.21 (1.15, 1.28)
BMI, kg/m2, per SD higher  1.20 (1.13, 1.27)
Diabetes, vs none  2.30 (1.02, 2.63)
History of heart disease, vs none  1.33 (1.15, 1.55)

Funding

  • Other NIH Support