Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Vanderbilt-O'Brien Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, USA.
BMC Nephrol. 2019 Aug 7;20(1):308. doi: 10.1186/s12882-019-1502-z.
The Southern Community Cohort Study is a prospective study of low socioeconomic status (SES) blacks and whites from the southeastern US, where the burden of end-stage renal disease (ESRD) and its risk factors are high. We tested whether the 2.4-fold elevated risk of ESRD we previously observed in blacks compared to whites was explained by differences in baseline kidney function.
We conducted a case-cohort study of incident ESRD cases (n = 737) with stored blood and a probability sampled subcohort (n = 4238) and calculated estimated glomerular filtration rate (eGFR) from serum creatinine. 86% of participants were enrolled from community health centers in medically underserved areas and 14% from the general population in 12 states in the southeastern United States. Incident ESRD after entry into the cohort was ascertained by linkage of the cohort with the US Renal Data System (USRDS).
Median (25th, 75th percentile) eGFR at baseline was 63.3 (36.0, 98.2) ml/min/1.73m for ESRD cases and 103.2 (86.0, 117.9) for subcohort. Black ESRD cases had higher median (25th, 75th) eGFR [63.3 (35.9, 95.9)] compared to whites [59.1 (39.4, 99.2)]. In multivariable Cox models accounting for sampling weights, baseline eGFR was a strong predictor of ESRD risk, and an interaction with race was detected (P = 0.029). The higher ESRD risk among blacks relative to whites persisted (hazard ratio: 2.58; 95% confidence interval: 1.65, 4.03) after adjustment for eGFR.
In this predominantly lower SES cohort, the racial disparity in ESRD risk is not explained by differences in baseline kidney function.
南方社区队列研究是一项针对美国东南部低社会经济地位（SES）黑人和白人的前瞻性研究，该地区终末期肾病（ESRD）及其危险因素的负担很高。我们检测了此前观察到的黑人与白人相比，ESRD 风险高出 2.4 倍，这种风险是否由基线肾功能的差异解释。
我们对 737 例新发 ESRD 病例（病例组）和存储血液的概率抽样亚组（4238 例）进行了病例-对照研究，并根据血清肌酐计算估算肾小球滤过率（eGFR）。86%的参与者是从医疗服务不足地区的社区卫生中心招募的，14%是从美国东南部 12 个州的一般人群中招募的。队列入组后，通过将队列与美国肾脏数据系统（USRDS）进行链接，确定 ESRD 的发病情况。
ESRD 病例的基线中位（25 分位，75 分位）eGFR 为 63.3（36.0，98.2）ml/min/1.73m，亚组为 103.2（86.0，117.9）。黑人 ESRD 病例的中位（25 分位，75 分位）eGFR[63.3（35.9，95.9）]高于白人[59.1（39.4，99.2）]。在多变量 Cox 模型中，考虑到抽样权重，基线 eGFR 是 ESRD 风险的强有力预测因素，并且检测到与种族的交互作用（P=0.029）。在调整 eGFR 后，黑人相对于白人的 ESRD 风险仍然较高（危险比：2.58；95%置信区间：1.65，4.03）。
在这个以 SES 较低为主的队列中，ESRD 风险的种族差异不能用基线肾功能的差异来解释。
