Racial Differences and Contributory Cardiovascular and Non-Cardiovascular Risk Factors Towards Chronic Kidney Disease Progression.
Racial Differences and Contributory Cardiovascular and Non-Cardiovascular Risk Factors Towards Chronic Kidney Disease Progression.
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DOI：
10.2147/vhrm.s416395
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发表时间：
2023
影响因子：
2.9
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中科院分区：
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晚期慢性肾脏疾病（CKD）的患病率黑人高于白人美国人。我们评估了黑人和白人参与者的CKD进展以及生物危险因素的贡献。我们纳入了肺功能的研究（通过用力肺活量[FVC]测量），这是CKD进展中与肾脏器官间串扰的新概念的一部分。这项纵向研究包括2175名黑人和2207名白人成人冠状动脉风险发展（CARDIA）参与者。在研究第10年（27 - 41岁）测量肾小球滤过率（eGFR）和尿白蛋白与肌酐比值（UACR），每5年测量一次，持续20年。结果是基于eGFR和UACR组合的无CKD、低、中、高或非常高风险类别的CKD进展。在多变量调整的Cox模型中评估种族与CKD进展之间的关系以及危险因素对种族差异的贡献。在研究的20年期间，黑人参与者比白人参与者有更高的CKD转换概率和更普遍的风险因素。黑人参与者（相对于白人参与者）CKD转变的风险比从无CKD到≥低风险为1.38，从≤低风险到≥中等风险为2.25，从≤中等风险到≥高风险为4.49。CKD从无CKD进展到≥低危的种族差异主要由FVC（54.8%）、高血压（30.9%）和肥胖（20.8%）解释。相比之下，种族差异在更严重的转变中解释得较少。黑人参与者CKD进展的风险更高，这种差异可能部分由FVC和传统风险因素解释。
The prevalence of advanced chronic kidney disease (CKD) is higher in Black than in White Americans. We evaluated CKD progression in Black and White participants and the contribution of biological risk factors. We included the study of lung function (measured by forced vital capacity [FVC]), which is part of the emerging notion of interorgan cross-talk with the kidneys to racial differences in CKD progression. This longitudinal study included 2175 Black and 2207 White adult Coronary Artery Risk Development in Young Adults (CARDIA) participants. Estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) were measured at study year 10 (age 27–41y) and every five years for 20 years. The outcome was CKD progression through no CKD, low, moderate, high, or very high-risk categories based on eGFR and UACR in combination. The association between race and CKD progression as well as the contribution of risk factors to racial differences were assessed in multivariable-adjusted Cox models. Black participants had higher CKD transition probabilities than White participants and more prevalent risk factors during the 20-year period studied. Hazard ratios for CKD transition for Black (vs White participants) were 1.38 from No CKD into ≥ low risk, 2.25 from ≤ low risk into ≥ moderate risk, and 4.49 from ≤ moderate risk into ≥ high risk. Racial differences in CKD progression from No CKD into ≥ low risk were primarily explained by FVC (54.8%), hypertension (30.9%), and obesity (20.8%). In contrast, racial differences were less explained in more severe transitions. Black participants had a higher risk of CKD progression, and this discrepancy may be partly explained by FVC and conventional risk factors.