Racial and ethnic differences in kidney function decline among persons without chronic kidney disease

Area of Science:

• Nephrology
• Public Health
• Epidemiology

Background:

• Racial and ethnic disparities in kidney function decline and chronic kidney disease (CKD) onset are not fully understood.
• Previous studies suggest variations in CKD prevalence and progression across different demographic groups.

Purpose of the Study:

• To investigate differences in the rate of kidney function decline before the onset of CKD among various racial and ethnic groups.
• To assess the incidence of CKD across white, black, Hispanic, and Chinese participants.
• To identify factors contributing to observed disparities in kidney function decline.

Main Methods:

• Utilized data from the Multi-Ethnic Study of Atherosclerosis (MESA) with a 5-year follow-up period.
• Estimated glomerular filtration rate (GFR) using both cystatin C (eGFRcys) and creatinine (eGFRcreat).
• Defined incident CKD as eGFRcys <60 ml/min/1.73 m² and a decline in eGFRcys ≥1 ml/min/year.

Main Results:

• Black participants exhibited a significantly faster rate of kidney function decline compared to white participants, even after adjusting for confounders.
• Certain Hispanic subgroups (Dominicans, Puerto Ricans) showed accelerated kidney function decline relative to whites; Mexicans and South Americans did not.
• Black and Hispanic individuals had the highest rates of incident CKD among those with normal or near-normal baseline kidney function, with some attenuation after comorbidity adjustment.

Conclusions:

• The rate of kidney function decline preceding CKD onset differs significantly among racial and ethnic groups.
• Observed disparities in kidney function decline and CKD incidence are not entirely explained by traditional risk factors or comorbidities.
• Further research is warranted to elucidate the underlying mechanisms driving these health disparities in kidney disease.