University of California San Francisco, San Francisco, CA, USA.
Am J Kidney Dis. 2013 Aug;62(2):261-6. doi: 10.1053/j.ajkd.2013.01.012. Epub 2013 Mar 7.
Strong racial discrepancies in end-stage renal disease exist. Whether there are race differences in kidney function loss in younger healthy persons is not well established.
Longitudinal.
SETTING & PARTICIPANTS: 3,348 black and white adults with at least 2 measurements of cystatin C-based estimated glomerular filtration rate (eGFRcys) at scheduled Coronary Artery Risk Development in Young Adults (CARDIA) examinations (years 10, 15, and 20).
Race.
OUTCOMES & MEASUREMENTS: We used linear mixed models to examine race differences in annualized rates of eGFRcys decline, adjusting for age, sex, lifetime exposure to systolic blood pressure >120 mm Hg, diabetes, and albumin-creatinine ratio. We used Poisson regression to compare racial differences in rapid decline (eGFRcys decline >3% per year) by study period (10-15 years after baseline examination [defining period 1] and >15-20 years after baseline examination [defining period 2]).
Mean age was 35 ± 3.6 (SD) years, and mean eGFRcys was 110 ± 20 mL/min/1.73 m² for blacks and 104 ± 17 mL/min/1.73 m² for whites at baseline. For both blacks and whites, eGFRcys decline was minimal at younger ages (<35 years) and eGFRcys loss accelerated at older ages. However, acceleration of eGFRcys decline occurred at earlier ages for blacks than whites. Blacks had somewhat faster annualized rates of decline compared with whites, but differences were attenuated after adjustment in period 1 (0.13 mL/min/1.73 m² per year faster; P = 0.2). In contrast, during period 2, blacks had significantly faster annualized rates of decline, even after adjustment (0.32 mL/min/1.73 m² per year faster; P = 0.003). The prevalence of rapid decline was significantly higher for blacks versus whites, with prevalence rate ratios of 1.31 (95% CI, 1.04-1.63) for period 1 and 1.24 (95% CI, 1.09-1.41) for period 2. Differences were attenuated after full adjustment: adjusted prevalence rate ratios were 1.20 (95% CI, 0.95-1.49) for period 1 and 1.10 (95% CI, 0.96-1.26) for period 2.
No measured GFR.
eGFRcys decline differs by race at early ages, with faster annualized rates of decline for blacks. Future studies are required to explain the observed differences.
终末期肾病存在明显的种族差异。在年轻健康人群中，肾功能丧失是否存在种族差异尚不清楚。
纵向研究。
3348 名黑人和白人成年人，至少有 2 次半胱氨酸蛋白酶抑制剂 C 估算肾小球滤过率（eGFRcys）的测量值，这些测量值是在冠状动脉风险发展青年（CARDIA）研究的预定检查（第 10、15 和 20 年）中进行的。
种族。
我们使用线性混合模型来研究种族间 eGFRcys 年下降率的差异，调整了年龄、性别、终生暴露于收缩压>120mmHg、糖尿病和白蛋白-肌酐比值。我们使用泊松回归比较了不同研究期间（基线检查后 10-15 年[定义为第 1 期]和基线检查后 15-20 年[定义为第 2 期]）快速下降（eGFRcys 下降>3%/年）的种族差异。
平均年龄为 35±3.6（标准差）岁，黑人的基线 eGFRcys 为 110±20mL/min/1.73m²，白人的基线 eGFRcys 为 104±17mL/min/1.73m²。对于黑人和白人，在年轻年龄（<35 岁）时 eGFRcys 下降最小，随着年龄的增长，eGFRcys 损失加速。然而，黑人的 eGFRcys 下降加速发生在更早的年龄。与白人相比，黑人的 eGFRcys 年下降率略快，但在第 1 期调整后，差异减弱（每年快 0.13mL/min/1.73m²；P=0.2）。相比之下，在第 2 期，即使经过调整，黑人的 eGFRcys 年下降率也明显较快（每年快 0.32mL/min/1.73m²；P=0.003）。黑人的快速下降患病率明显高于白人，第 1 期的患病率比为 1.31（95%可信区间，1.04-1.63），第 2 期的患病率比为 1.24（95%可信区间，1.09-1.41）。在充分调整后，差异减弱：第 1 期的调整后患病率比为 1.20（95%可信区间，0.95-1.49），第 2 期的调整后患病率比为 1.10（95%可信区间，0.96-1.26）。
没有测量肾小球滤过率。
在早期，eGFRcys 下降存在种族差异，黑人的年下降率更快。需要进一步的研究来解释观察到的差异。
