Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Suite 230J, Birmingham, AL 35294, USA.
Clin J Am Soc Nephrol. 2012 Jan;7(1):101-7. doi: 10.2215/CJN.06450611. Epub 2011 Nov 10.
The incidence of ESRD is higher in African Americans than in whites, despite reports of a similar or lower prevalence of CKD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study compared the incidence of CKD among young African-American and white adults over 20 years of follow-up in the community-based Coronary Artery Risk Development in Young Adults study. Participants included 4119 adults, 18-30 years of age, with an estimated GFR (eGFR) ≥60 ml/min per 1.73 m(2) at baseline. Incident CKD was defined as an eGFR <60 ml/min per 1.73 m(2) and a ≥25% decline in eGFR at study visits conducted 10, 15, and 20 years after baseline.
At baseline, the mean age of African Americans and whites was 24 and 26 years, respectively (P<0.001), and 56% and 53% of participants, respectively, were women (P=0.06). There were 43 incident cases of CKD during follow-up, 29 (1.4%) among African Americans and 14 (0.7%) among whites (P=0.02). The age- and sex-adjusted hazard ratio (HR) for incident CKD comparing African Americans to whites was 2.56 (95% confidence interval [95% CI], 1.35-5.05). After further adjustment for body mass index, systolic BP, fasting plasma glucose, and HDL cholesterol, the HR was 2.51 (95% CI, 1.25-5.05). After multivariable adjustment including albuminuria at year 10, the HR for CKD at year 15 or 20 was 1.12 (95% CI, 0.52-2.41).
In this study, the 20-year CKD incidence was higher among African Americans than whites, a difference that is explained in part by albuminuria.
尽管慢性肾脏病（CKD）的报告发病率相似或更低，但非洲裔美国人的终末期肾病（ESRD）发病率高于白人。
设计、设置、参与者和测量：本研究比较了在社区为基础的年轻人冠状动脉风险发展研究中，超过 20 年随访期间年轻的非裔美国人和白人成年人 CKD 的发病率。参与者包括 4119 名成年人，年龄在 18-30 岁之间，基线时估计肾小球滤过率（eGFR）≥60ml/min/1.73m2。新发 CKD 的定义为 eGFR<60ml/min/1.73m2 以及 eGFR 在基线后 10、15 和 20 年的研究访问中下降≥25%。
在基线时，非裔美国人和白人的平均年龄分别为 24 岁和 26 岁（P<0.001），分别有 56%和 53%的参与者为女性（P=0.06）。在随访期间，共发生 43 例 CKD 事件，其中 29 例（1.4%）发生在非裔美国人中，14 例（0.7%）发生在白人中（P=0.02）。比较非裔美国人和白人的年龄和性别调整后发生 CKD 的风险比（HR）为 2.56（95%置信区间[95%CI]，1.35-5.05）。进一步调整体重指数、收缩压、空腹血糖和高密度脂蛋白胆固醇后，HR 为 2.51（95%CI，1.25-5.05）。在包括第 10 年白蛋白尿的多变量调整后，第 15 年或第 20 年 CKD 的 HR 为 1.12（95%CI，0.52-2.41）。
在这项研究中，非裔美国人的 20 年 CKD 发病率高于白人，这种差异部分可以用白蛋白尿来解释。
