Black and White Adults With CKD Hospitalized With Acute Kidney Injury: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study.
Black and White Adults With CKD Hospitalized With Acute Kidney Injury: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study.
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DOI：
10.1053/j.ajkd.2022.02.021
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发表时间：
2022-11
期刊：
影响因子：
--
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很少有研究调查了急性肾损伤（阿基）的种族差异，与此相反，大量文献研究了终末期肾病风险的黑人-白人差异。前瞻性队列研究我们研究了2013年7月1日至2017年12月31日慢性肾功能不全队列研究中2720名自认为的黑人或白色参与者。自我报告的人种（黑人vs.白色）住院阿基（血清肌酐从最低值至峰值增加≥50%）。考克斯回归模型。我们调整了人口统计学（年龄和性别）、住院前临床风险因素（糖尿病、血压、心血管疾病、估计肾小球滤过率、蛋白尿和接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂）和社会经济状况（保险状况和教育水平）。在一个有基因型数据的参与者子集中，我们调整了载脂蛋白L1基因（APOL 1）高危状态和镰状细胞性状状态。黑人参与者（N=1266）更年轻，但住院前临床风险因素负担更高。黑人受试者中首次阿基住院的发生率为6.3（95% CI：5.5-7.2）/100人-年，而白色受试者中为5.3（95% CI：4.6-6.1）/100人-年。在未校正的考克斯回归模型中，与白色受试者相比，黑人受试者发生阿基的风险适度增加（风险比[HR] 1.22; 95% CI：1.01-1.48）。然而，在调整住院前临床风险因素后，该风险降低且不再显著（调整后HR 1.02; 95% CI：0.83-1.25）。在APOL 1高危状态的个体中，只有11例阿基住院，在镰状细胞性状的个体中，只有14例阿基住院。参与者仅限于研究志愿者，并不能完全代表所有CKD患者。在这个CKD患者的多中心前瞻性队列中，阿基发生率的种族差异是适度的，并且可以通过住院前临床风险因素的差异来解释。
Few studies have investigated racial disparities in acute kidney injury (AKI), in contrast to the large literature on Black-White differences in risk of end-stage kidney disease. Prospective cohort study We studied 2720 self-identified Black or White participants in the Chronic Renal Insufficiency Cohort study from July 1, 2013-December 31, 2017. Self-reported race (Black vs. White) Hospitalized AKI (≥50% increase from nadir to peak serum creatinine). Cox regression models. We adjusted for demographics (age and sex), pre-hospitalization clinical risk factors (diabetes, blood pressure, cardiovascular disease, estimated glomerular filtration rate, proteinuria, and receipt of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers) and socioeconomic status (insurance status and education level). In a subset of participants with genotype data, we adjusted for apolipoprotein L1 gene (APOL1) high-risk status and sickle cell trait status. Black participants (N=1266) were younger but had a higher burden of pre-hospitalization clinical risk factors. Incidence rate of first AKI hospitalization among Black participants was 6.3 (95% CI: 5.5–7.2) per 100 person-years versus 5.3 (95% CI: 4.6–6.1) per 100 person-years among White participants. In an unadjusted Cox regression model, Black participants were at a modestly increased risk of incident AKI (hazard ratio [HR] 1.22; 95% CI: 1.01–1.48) compared with White participants. However, this risk was attenuated and no longer significant after adjusting for pre-hospitalization clinical risk factors (adjusted HR 1.02; 95% CI: 0.83–1.25). There were only 11 AKI hospitalizations among individuals with high-risk APOL1 risk status and 14 AKI hospitalizations among individuals with sickle cell trait. Participants are limited to research volunteers and are not fully representative of all CKD patients. In this multi-center prospective cohort of CKD patients, racial disparities in AKI incidence were modest and were explained by differences in pre-hospitalization clinical risk factors.
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DOI：
10.1053/j.ajkd.2015.02.338
发表时间：
2015-10
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
James MT;Grams ME;Woodward M;Elley CR;Green JA;Wheeler DC;de Jong P;Gansevoort RT;Levey AS;Warnock DG;Sarnak MJ;CKD Prognosis Consortium
通讯作者：
CKD Prognosis Consortium
影响因子：
9.8
作者：
Auer, Paul L.;Johnsen, Jill M.;Li, Yun
通讯作者：
Li, Yun
DOI：
10.2215/cjn.04260415
发表时间：
2015-11-01
影响因子：
9.8
作者：
Denker, Matthew;Boyle, Suzanne;Feldman, Harold I.
通讯作者：
Feldman, Harold I.
影响因子：
5.8
作者：
Duan, Qing;Liu, Eric Yi;Li, Yun
通讯作者：
Li, Yun
DOI：
10.2215/cjn.02430315
发表时间：
2015-10-01
影响因子：
9.8
作者：
Lin, Jennie;Fernandez, Hilda;Wilson, F. Perry
通讯作者：
Wilson, F. Perry