Division of Nephrology, Childrens' National Hospital, Washington DC.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Am J Kidney Dis. 2021 Jul;78(1):66-74. doi: 10.1053/j.ajkd.2020.11.013. Epub 2021 Jan 5.
RATIONALE & OBJECTIVE: To identify differences in socioeconomic factors (SES) and subclinical cardiovascular disease (CVD) markers by race among Chronic Kidney Disease in Children (CKiD) participants and determine whether differences in CVD markers persist after adjusting for SES.
Analysis of 3,103 visits with repeated measures from 628 children (497 White participants; 131 African American participants) enrolled in the CKiD study.
SETTING & PARTICIPANTS: Children with mild-moderate CKD with at least 1 cardiovascular (CV) parameter (ambulatory blood pressure, left ventricular mass index [LVMI], or lipid profile) measured.
African American race.
Ambulatory hypertension, LVMI, triglycerides, high-density lipoprotein cholesterol.
Due to increased CV risks of glomerular disease, the analysis was stratified by CKD cause. Inverse probability weighting was used to adjust for SES (health insurance, household income, maternal education, food insecurity, abnormal birth history). Linear and logistic regression were used to evaluate association of race with CV markers.
African American children were disproportionately affected by adverse SES. African Americans with nonglomerular CKD had more instances of ambulatory hypertension and higher LVMI but more favorable lipid profiles. After adjustment for SES, age, and sex, the magnitude of differences in these CV markers was attenuated but remained statistically significant. Only LVMI differed by race in the glomerular CKD group, despite adjustment for SES.
Study design limits causal inference.
African American children with CKD are disproportionately affected by socioeconomic disadvantages compared with White children. The degree to which CV markers differ by race is influenced by disease etiology. African Americans with nonglomerular CKD have increased LVMI, more ambulatory hypertension, and favorable lipid profile, but attenuation in magnitude after adjustment for SES was observed. African Americans with glomerular CKD had increased LVMI, which persisted after SES adjustment. As many social determinants of health were not captured, future research should examine effects of systemic racism on CV health in this population.
本研究旨在比较慢性肾脏病儿童（CKiD）患者种族间社会经济因素（SES）和亚临床心血管疾病（CVD）标志物的差异，并确定在调整 SES 后 CVD 标志物的差异是否仍然存在。
对 628 名儿童（497 名白人参与者，131 名非裔美国参与者）的 3103 次随访进行分析，这些参与者参加了 CKiD 研究。
患有轻度至中度 CKD 的儿童，至少有 1 项心血管（CV）参数（动态血压、左心室质量指数[LVMI]或血脂谱）。
非裔美国人种族。
非裔美国人儿童的 SES 不良情况更为严重。非裔美国人非肾小球性 CKD 患者的动态高血压和 LVMI 更高，但血脂谱更理想。在调整 SES、年龄和性别后，种族与 CV 标志物之间的关联强度减弱，但仍具有统计学意义。在肾小球性 CKD 组中，只有 LVMI 存在种族差异，尽管调整了 SES。
研究设计限制了因果推断。
与白人儿童相比，非裔美国 CKiD 儿童受社会经济劣势的影响更为严重。种族间 CV 标志物差异的程度受疾病病因的影响。非裔美国人非肾小球性 CKD 患者的 LVMI 更高，动态高血压更多，血脂谱更理想，但在调整 SES 后，其程度有所减弱。患有肾小球性 CKD 的非裔美国人的 LVMI 更高，在调整 SES 后仍然存在。由于许多健康的社会决定因素未被捕获，未来的研究应在该人群中研究系统性种族主义对 CV 健康的影响。
