Abstract: SA-PO027
Racial and Ethnic Differences in Incident CKD in US Veterans
Session Information
- Diversity and Equity: Other Research
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Yan, Guofen, University of Virginia School of Medicine, Charlottesville, Virginia, United States
- Scialla, Julia J., University of Virginia School of Medicine, Charlottesville, Virginia, United States
- Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- Yu, Wei, University of Virginia School of Medicine, Charlottesville, Virginia, United States
- Heng, Fei, University of North Florida, Jacksonville, Florida, United States
- Greene, Tom, University of Utah, Salt Lake City, Utah, United States
- Cheung, Alfred K., University of Utah, Salt Lake City, Utah, United States
- Norris, Keith C., University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
Background
Despite a well-documented higher incidence of end-stage kidney disease among racial and ethnic minorities compared to White adults, less is known about the incidence of earlier-stage chronic kidney disease (CKD) by race and ethnicity. We examined risks of incident CKD among veterans of various racial and ethnic groups in the US Veterans Health Administration (VHA).
Methods
The cohort included 1,883,779 veterans with the first occurrence (index date) of the estimated glomerular filtration rate (eGFR) between 60 and 100 mL/min/1.73m2 (based on the 2021 CKD-EPI equation) during 2003-2015, followed through May 2018. Veterans who had a prior eGFR <60 mL/min/1.73m2 or were in VHA for <2 years prior to the index date were excluded. The outcome was incident CKD (CKD stage G3 or higher) defined as the first time when follow-up eGFRs decreased to <60 mL/min/1.73m2 for >3 months. We examined hazard ratios (HR) of incident CKD, censoring for death, by racial and ethnic groups compared to the non-Hispanic White group.
Results
At the index date, the average age was 56 years overall, with Black veterans being the youngest (51 years) and White veterans the oldest (58 years). Average eGFR was 85 mL/min/1.73m2 for Black veterans and 87-89 mL/min/1.73m2 for other groups. Overall, after adjusting for age, sex, index year, and baseline eGFR, compared to Whites, the adjusted risk of incident CKD was 53% greater for Blacks and 3-9% greater for other race groups (Table). For subgroups of baseline eGFR 90-100 and 60-89 mL/min/1.73m2 and those with available data on urine albumin-to-creatinine ratio (UACR) ≥30 mg/g, Black veterans exhibited consistently greater risks of CKD (29% to 81% greater) while other groups varied depending on the subgroup.
Conclusion
Racial and ethnic minority veterans had a greater risk of CKD, as defined by eGFR, compared to their White peers. Enhanced screening programs for racial and ethnic minority adults to detect early stages of CKD is warranted.
Adjusted HRs (95% CIs and p values) of incident CKD by racial and ethnic groups compared to Whites
| Race and ethnicity (N in the overall cohort) | Overall cohort (n=1,883,779) | Subgroup of baseline eGFR 90-100 (n=925,980) | Subgroup of baseline eGFR 60-89 (n=957,799) | Subgroup of baseline UACR ≥30 mg/g (n=39,192) | ||||
| American Indian/Alaska Native (n=13,521) | 1.07 (1.00-1.14) | 0.059 | 0.91 (0.80-1.05) | 0.20 | 1.12 (1.04-1.22) | 0.003 | 0.85 (0.69-1.07) | 0.16 |
| Asian, Native Hawaiian/Pacific Islander (n=28,267) | 1.03 (0.98-1.08) | 0.19 | 0.98 (0.89-1.08) | 0.69 | 1.04 (0.99-1.10) | 0.094 | 1.07 (0.92-1.24) | 0.41 |
| Black (n=343,571) | 1.53 (1.51-1.55) | <0.0001 | 1.81 (1.76-1.86) | <0.0001 | 1.46 (1.44-1.48) | <0.0001 | 1.29 (1.21-1.36) | <0.0001 |
| Hispanic (n=117,279) | 1.07 (1.05-1.10) | <0.0001 | 1.02 (0.97-1.07) | 0.45 | 1.10 (1.06-1.13) | <0.0001 | 1.04 (0.96-1.12) | 0.36 |
| Multiple or other races (n=32,474) | 1.09 (1.04-1.13) | 0.0002 | 1.13 (1.05-1.23) | 0.002 | 1.07 (1.01-1.12) | 0.012 | 0.96 (0.79-1.16) | 0.65 |
| White (n=1,348,667) | Reference | Reference | Reference | Reference | ||||
Funding
- NIDDK Support