Division of Nephrology, Department of Medicine, University of California, San Francisco, California.
Division of Research, Kaiser Permanente Northern California, Oakland, California.
Am J Kidney Dis. 2022 Nov;80(5):610-618.e1. doi: 10.1053/j.ajkd.2022.02.021. Epub 2022 Apr 8.
RATIONALE & OBJECTIVE: Few studies have investigated racial disparities in acute kidney injury (AKI), in contrast to the extensive literature on racial differences in the risk of kidney failure. We sought to study potential differences in risk in the setting of chronic kidney disease (CKD).
Prospective cohort study.
SETTING & PARTICIPANTS: We studied 2,720 self-identified Black or White participants with CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study from July 1, 2013, to December 31, 2017.
Self-reported race (Black vs White).
Hospitalized AKI (≥50% increase from nadir to peak serum creatinine).
Cox regression models adjusting for demographics (age and sex), prehospitalization clinical risk factors (diabetes, blood pressure, cardiovascular disease, estimated glomerular filtration rate, proteinuria, receipt of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers), and socioeconomic status (insurance status and education level). In a subset of participants with genotype data, we adjusted for apolipoprotein L1 gene (APOL1) high-risk status and sickle cell trait.
Black participants (n = 1,266) were younger but had a higher burden of prehospitalization clinical risk factors. The incidence rate of first AKI hospitalization among Black participants was 6.3 (95% CI, 5.5-7.2) per 100 person-years versus 5.3 (95% CI, 4.6-6.1) per 100 person-years among White participants. In an unadjusted Cox regression model, Black participants were at a modestly increased risk of incident AKI (HR, 1.22 [95% CI, 1.01-1.48]) compared with White participants. However, this risk was attenuated and no longer significant after adjusting for prehospitalization clinical risk factors (adjusted HR, 1.02 [95% CI, 0.83-1.25]). There were only 11 AKI hospitalizations among individuals with high-risk APOL1 risk status and 14 AKI hospitalizations among individuals with sickle cell trait.
Participants were limited to research volunteers and potentially not fully representative of all CKD patients.
In this multicenter prospective cohort of CKD patients, racial disparities in AKI incidence were modest and were explained by differences in prehospitalization clinical risk factors.
相较于大量关于肾功能衰竭风险的种族差异的文献，鲜有研究调查急性肾损伤（AKI）中的种族差异。我们试图在慢性肾脏病（CKD）背景下研究风险方面的潜在差异。
前瞻性队列研究。
我们研究了 2720 名自认为是黑人或白人的 CKD 患者，这些患者于 2013 年 7 月 1 日至 2017 年 12 月 31 日期间参加了慢性肾损伤队列（CRIC）研究。
自我报告的种族（黑人与白人）。
住院 AKI（血清肌酐从最低点到最高点升高≥50%）。
Cox 回归模型调整了人口统计学因素（年龄和性别）、住院前临床危险因素（糖尿病、血压、心血管疾病、估算肾小球滤过率、蛋白尿、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的使用）和社会经济地位（保险状况和教育水平）。在有基因型数据的参与者亚组中，我们还调整了载脂蛋白 L1 基因（APOL1）高危状态和镰状细胞特征。
黑人参与者（n=1266）年龄较小，但住院前临床危险因素负担更高。黑人参与者首次 AKI 住院的发生率为每 100 人年 6.3（95%CI，5.5-7.2），而白人参与者为每 100 人年 5.3（95%CI，4.6-6.1）。在未经调整的 Cox 回归模型中，与白人参与者相比，黑人参与者 AKI 发病风险略有增加（HR，1.22[95%CI，1.01-1.48]）。然而，在校正住院前临床危险因素后，这种风险减弱且不再显著（校正 HR，1.02[95%CI，0.83-1.25]）。只有 11 例 AKI 住院患者存在高危 APOL1 风险状态，14 例 AKI 住院患者存在镰状细胞特征。
参与者仅限于研究志愿者，可能不能完全代表所有 CKD 患者。
在这项针对 CKD 患者的多中心前瞻性队列研究中，AKI 发病率的种族差异较小，且可由住院前临床危险因素的差异来解释。
