Abstract: TH-OR02
Age-Dependent Racial Differences in Kidney Function Decline between Black and White Veterans after CKD Onset
Session Information
- Achieving More Equitable Kidney Care
October 24, 2024 | Location: Room 7, Convention Center
Abstract Time: 04:40 PM - 04:50 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Yan, Guofen, University of Virginia, Charlottesville, Virginia, United States
- Scialla, Julia J., University of Virginia, Charlottesville, Virginia, United States
- Hu, Nan, Florida International University, Miami, Florida, United States
- Yu, Wei, University of Virginia, Charlottesville, Virginia, United States
- Greene, Tom, University of Utah Health, Salt Lake City, Utah, United States
- Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- Heng, Fei, University of North Florida, Jacksonville, Florida, United States
- Cheung, Alfred K., University of Utah Health, 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
Recent research reveals that, when CKD onset was determined using the new race-free eGFR equation, Black adults still had a higher risk of subsequent progression to kidney failure than their White peers. We examined the extent to which rates of eGFR decline over time differ in Black and White veterans after CKD onset, and whether age modified the racial difference.
Methods
The study included 54,728 non-Hispanic Black and 256,479 non-Hispanic White veterans, aged 18-85 years, with new onset of CKD between 2005 and 2012 in the US Veterans Health Administration, and quarterly eGFR measurements for up to 6 years. eGFRs were calculated from outpatient serum creatinine measurements based on the 2021 CKD-EPI creatinine equation. We employed a linear spline mixed-effects model with random intercepts and random slopes to estimate age-specific rates of stable eGFR decline over 6 years from quarter 4 after CKD onset for each race, controlling for sex and calendar year of CKD onset.
Results
Upon CKD onset, the two race groups had similar mean eGFR levels (51 mL/min/1.73m2). The rate of eGFR decline accelerated as the age of CKD onset decreased in Black veterans; the reverse was observed in White veterans (Table). As a result, racial differences in eGFR slopes were modified by the age of CKD onset, with larger differences at younger onset of CKD. For example, at age of CKD onset of 45 years old, the rate of eGFR decline was 0.79 mL/min/1.73m2 per year faster in Black than White veterans. In distinct contrast, similar decline rates were observed in the two race groups at onset age of 85 years.
Conclusion
Racial differences in kidney function decline were larger among patients who developed CKD at a younger age, likely driven by more rapid decline in a subset of young Black patients. Delineating biological and social factors underlying the younger onset of CKD and subsequent fast progression for Black patients is warranted.
Age-specific rates of eGFR changes after CKD onset by race
| Age at CKD onset (years) | Black eGFR slope (mL/min/1.73m2 per year) | White eGFR slope (mL/min/1.73m2 per year) | Difference between Black and White (mL/min/1.73m2 per year) | P value |
| 45 | -1.35 | -0.56 | -0.79 | <0.001 |
| 55 | -1.22 | -0.64 | -0.58 | <0.001 |
| 65 | -1.09 | -0.72 | -0.37 | <0.001 |
| 75 | -0.97 | -0.81 | -0.16 | <0.001 |
| 85 | -0.85 | -0.89 | 0.04 | 0.25 |
A negative value means eGFR decline.
Funding
- NIDDK Support