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Abstract: TH-PO631

Race-Free KDIGO Risk Categories and CVD Mortality Among Black US Adults, 1999-2019

Session Information

Category: Hypertension and CVD

  • 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials

Authors

  • Rodriguez, Juanly N., University of Miami School of Medicine, Miami, Florida, United States
  • Drexler, Yelena, University of Miami School of Medicine, Miami, Florida, United States
  • Barrios, Richard, University of Miami School of Medicine, Miami, Florida, United States
  • Shahoori, Neda, University of Miami School of Medicine, Miami, Florida, United States
  • Isaac, Farid, University of Miami School of Medicine, Miami, Florida, United States
  • Contreras, Gabriel, University of Miami School of Medicine, Miami, Florida, United States
  • Elfassy, Tali, University of Miami School of Medicine, Miami, Florida, United States

Group or Team Name

  • Filtering 305
Background

Mortality from cardiovascular disease (CVD) is high among those with CKD. Remarkable racial disparities in CVD risk and progression to ESKD exist between Black and non-Black adults. Elimination of the race coefficient to estimate GFR, while helping to mitigate these disparities, results in higher prevalence estimates for CKD among Blacks. In this study, we describe CVD mortality rates among Black US adults by KDIGO risk category using a race-free eGFR equation.

Methods

The National Health and Nutrition Examination Survey is a representative sample of US adults. We included 10,658 Black adult participants (1999-2018) with mortality data through 2019 linked from the National Death Index. Using serum creatinine, eGFR was calculated using the 2009 CKD-EPI and 2021 race-free CKD-EPI equations. Albumin-to-creatinine ratio (ACR in mg/g) was measured from spot urine samples. Participants were classified into four KDIGO risk categories (low, intermediate, high, or very high risk) based on ACR and eGFR. CVD mortality (CVD-M) was defined through ICD-10 codes as diseases of the heart or cerebrovascular disease. We used age adjusted Poisson regression models to estimate incidence densities (ID) per 1,000 person years (PY) and ID ratios (IDRs) for CVD-M.

Results

The population was comprised of 55.6% women with a mean age of 43 years. After an average follow-up of 9.9 years, 1,348 (11.5%) died of any cause and 438 (3.8%) died of CVD. Rates of CVD-M were not significantly different when using the 2009 CKD-EPI or 2021 race-free CKD-EPI equation to classify KDIGO risk. After removing the race coefficient, compared to the lowest KDIGO risk (ID: 2.3/1,000PY, 95% CI: 1.9, 2.8), CVD-M was 115% greater (IDR: 2.15, 95% CI: 1.69, 2.73) with intermediate KDIGO risk (ID: 5.0/1,000 PY, 95% CI: 4.2, 6.1), 200% greater (IDR: 3.00, 95% CI: 2.20, 4.09) with high KDIGO risk (ID: 7.0/1,000PY, 95% CI: 5.4, 9.1), and 428% greater (IDR: 5.28, 95% CI: 3.59, 7.78) with very high KDIGO risk (ID: 12.4/1,000PY, 95% CI: 9.3, 16.5).

Conclusion

Among Black US adults, CVD-M rates were similar using the 2009 CKD-EPI or 2021 race-free CKD-EPI equation. CVD-M rates were substantially higher with greater KDIGO risk, independently of the use of a race coefficient.

Funding

  • Private Foundation Support