Charlottesville, VA — The younger age of chronic kidney disease (CKD) in Black patients can help explain some of the differences and disparities compared to white patients with CKD, according to a new study.
The study, led by the University of Virginia School of Medicine in Charlottesville and including participation from the Walter Reed National Military Medical Center in Bethesda, MD, pointed out that the Black adult population is understood to have higher incidence of kidney failure compared with the white population. Why that has occurred remained unclear, however.
The study team assessed the racial differences in kidney failure and death from onset of CKD on the basis of the race-free 2021 CKD Epidemiology Collaboration equation and examined how much of the difference could be explained by factors at the time of CKD onset. The results were published in the Journal of the American Society of Nephrology.1
For the study, the researchers analyzed a national cohort consisting of 547,188 U.S. veterans—103,821 non-Hispanic Black and 443,367 non-Hispanic white—aged 18-85 years, with new-onset CKD between 2005 and 2016. The patients were followed through 10 years or May 2018 for incident kidney failure with replacement therapy (KFRT) and pre-KFRT death.
“At CKD onset, Black veterans were, on average, 7.8 years younger than white veterans,” the authors advised.
Results indicated that, in any time period from CKD onset, the cumulative incidence of KFRT was 2.5-fold higher for Black vs. white veterans. Black veterans also had a persistently greater than twofold higher hazards of KFRT throughout follow-up (overall hazard ratio [95% confidence interval], 2.38 [2.31 to 2.45]), while also having a 17%-48% decreased hazards of pre-KFRT death.
The researchers noted that the differences were reduced after accounting for the racial difference in age at CKD onset.
“The 2.5-fold higher cumulative incidence of kidney failure in Black adults resulted from a combination of higher hazards of progression to kidney failure and lower hazards of the competing risk of death, both of which can be largely explained by the younger age at CKD onset in Black compared with white adults,” the study concluded.
- Yan G, Nee R, Scialla JJ, Greene T, Yu W, Heng F, Cheung AK, Norris KC. Role of Age and Competing Risk of Death in the Racial Disparity of Kidney Failure Incidence after Onset of CKD. J Am Soc Nephrol. 2024 Jan 23. doi: 10.1681/ASN.0000000000000300. Epub ahead of print. PMID: 38254260.
