Association of decreased glomerular filtration rate with racial differences in survival after acute myocardial infarction

Ethnic minority disparities in progression and mortality of pre-dialysis chronic kidney disease: a systematic scoping review

Background

There are a growing number of studies on ethnic differences in progression and mortality for pre-dialysis chronic kidney disease (CKD), but this literature has yet to be synthesised, particularly for studies on mortality.

Methods

This scoping review synthesized existing literature on ethnic differences in progression and mortality for adults with pre-dialysis CKD, explored factors contributing to these differences, and identified gaps in the literature. A comprehensive search strategy using search terms for ethnicity and CKD was taken to identify potentially relevant studies. Nine databases were searched from 1992 to June 2017, with an updated search in February 2020.

Results

8059 articles were identified and screened. Fifty-five studies (2 systematic review, 7 non-systematic reviews, and 46 individual studies) were included in this review. Most were US studies and compared African-American/Afro-Caribbean and Caucasian populations, and fewer studies assessed outcomes for Hispanics and Asians. Most studies reported higher risk of CKD progression in Afro-Caribbean/African-Americans, Hispanics, and Asians, lower risk of mortality for Asians, and mixed findings on risk of mortality for Afro-Caribbean/African-Americans and Hispanics, compared to Caucasians. Biological factors such as hypertension, diabetes, and cardiovascular disease contributed to increased risk of progression for ethnic minorities but did not increase risk of mortality in these groups.

Conclusions

Higher rates of renal replacement therapy among ethnic minorities may be partly due to increased risk of progression and reduced mortality in these groups. The review identifies gaps in the literature and highlights a need for a more structured approach by researchers that would allow higher confidence in single studies and better harmonization of data across studies to advance our understanding of CKD progression and mortality.

Contribution of glomerular filtration rate to 10-year cardiovascular and mortality risk among hypertensive adults: Tehran lipid and glucose study

The authors tested the hypotheses that (1) estimated glomerular filtration rate (eGFR) predicts cardiovascular disease (CVD) or mortality risk among hypertensive patients, (2) associations are curvilinear, and (3) diabetes modifies these associations. Data from a 10-year follow-up of 3179 hypertensive patients 18 years and older were analyzed. Measurements included eGFR and CVD risk factors, and outcomes were CVD and mortality. Cox models were developed to estimate the hazard ratios (HRs) for different endpoints for a 1-standard deviation (SD) increment in eGFR. The nonlinearity in associations was examined by cubic spline method. Mean (SD) age of the participants (59.0% women) was 56.3 (12.3) years. During follow-up (10-year), 629 incident cases of CVD (296 women) and 320 deaths (130 women) were documented. The incidence rate of different outcomes decreased across increasing eGFR quintiles. Among men, irrespective of their diabetes status, eGFR was inversely associated with risk of mortality. Among women, irrespective of their diabetes status, eGFR did not predict mortality. Neither among men nor among women did eGFR predict CVD or coronary heart disease. No evidence was found for nonlinearity in these associations. eGFR was independently associated with mortality among hypertensive men with or without diabetes. When information on traditional CVD risk factors was available, eGFR provided no additional predictive value for CVD.

Chronic kidney disease at presentation is not an independent risk factor for AIDS-defining events or death in HIV-infected persons

Studies have documented an association between chronic kidney disease (CKD) and increased risk of end stage renal disease, death and comorbidities, including cardiovascular disease and metabolic syndrome, in the general population. However, there is little data on the relationship between CKD and ADE (AIDS defining event), and to our knowledge, no studies have analyzed death as a competing risk for ADE among HIV-infected persons. An observational cohort study was performed to determine the incidence and risks for developing an ADE or death among HIV-infected persons with and without CKD from 1998 - 2005. CKD was defined as an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2 using the CKDEpidemiology Collaboration (CKD-EPI) equation. Log rank test and Cox regression which determined time to development of ADE and/or death as combined and separate outcomes, and competing risk models for ADE versus mortality, were performed. Among the 2,127 persons that contributed to the 5,824 person years of follow-up: 22% were female, 34% African American, 38% on HAART, and 3% had CKD at baseline. ADE occurred in 227 (11%) persons and there were 80 (4%) deaths. CKD was not significantly associated with ADE/death (HR 1.3, 95% CIs: 0.5, 3.2), ADE (HR 1.0, 95% CIs: 0.4, 3.1), or death (HR 1.6, 95% CIs: 0.4, 3.1). Competing risk analyses confirmed no statistically significant associations between CKD and these outcomes. CKD was uncommon in HIV-infected persons presenting for care in this racially diverse cohort, and was not independently associated with risk of developing an ADE or dying during follow-up.