Incidence and Progression of Chronic Kidney Disease in Black and White Individuals with Type 2 Diabetes

Gerber, Claire; Cai, Xuan; Lee, Jung Hwa; Craven, Timothy E.; Scialla, Julia J.; Souma, Nao; Srivastava, Anand; Mehta, Rupal; Paluch, Amanda E.; Hodakowski, Alexander J.; Frazier, Rebecca; Carnethon, Mercedes R.; Wolf, Myles; Isakova, Tamara

doi:10.2215/cjn.11871017

Cited by 24 publications

(20 citation statements)

References 30 publications

(49 reference statements)

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“…It has been reported that racial inequity, seen especially in North Americans with diabetic nephropathy, has disappeared when Afro-Americans were subjected to the same glucose control as Caucasians. 30 The male sex is usually associated with worse renal outcomes but this was not found in this cohort, possibly due to the small number of men included. 29,31…”

Section: Discussionmentioning

confidence: 70%

Initial renal histology and early response predict outcomes of Brazilian lupus nephritis patients

Vajgel

Oliveira

Costa

et al. 2019

Lupus

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Objective We analyzed baseline and follow-up characteristics related to poorer renal outcomes in a Brazilian cohort of admixture race patients with lupus nephritis. Methods Overall, 280 outpatients with a diagnosis of systemic lupus erythematosus and previous kidney biopsy of lupus nephritis were recruited from August 2015 to December 2018 and had baseline laboratory and histologic data retrospectively analyzed; patients were then followed-up and data were recorded. The main outcome measure was the estimated glomerular filtration rate at last follow-up. Secondary analyses assessed the impact of initial kidney histology and treatment in long-term kidney survival. Results Median duration of lupus nephritis was 60 months (interquartile range: 27–120); 40 (14.3%) patients presented progressive chronic kidney disease (estimated glomerular filtration rate <30 and ≥10 ml/min/1.73 m2) or end-stage kidney disease at last visit. Adjusted logistic regression analysis showed that class IV lupus nephritis (odds ratio 14.91; 95% confidence interval 1.77–125.99; p = 0.01) and interstitial fibrosis ≥25% at initial biopsy (odds ratio 5.87; 95% confidence interval 1.32–26.16; p = 0.02), lack of complete or partial response at 12 months (odds ratio 16.3; 95% confidence interval 3.74–71.43; p < 0.001), and a second renal flare (odds ratio 4.49; 95% confidence interval 1.10–18.44; p = 0.04) were predictors of progressive chronic kidney disease. In a Kaplan-Meier survival curve we found that class IV lupus nephritis and interstitial fibrosis ≥25% were significantly associated with end-stage kidney disease throughout follow-up (hazard ratio 2.96; 95% confidence interval 1.3–7.0; p = 0.036 and hazard ratio 4.96; 95% confidence interval 1.9–12.9; p < 0.0001, respectively). Conclusion In this large cohort of admixture race patients, class IV lupus nephritis and chronic interstitial damage at initial renal biopsy together with non-response after 1 year of therapy and relapse were associated with worse long-term renal outcomes.

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Section: Discussionmentioning

confidence: 70%

Initial renal histology and early response predict outcomes of Brazilian lupus nephritis patients

Vajgel

Oliveira

Costa

et al. 2019

Lupus

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“…Whatever the reasons for this disparity, standardized interventions and improved healthcare delivery in these high‐risk individuals is required to reduce the variations in renal outcomes in these populations. In a recent post hoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial looking at the longitudinal change in eGFR, time to development of microalbuminuria, macroalbuminuria, incident CKD, and kidney failure or serum creatinine >3.3 mg/dL, it was noted that even though the mean values of systolic blood pressure, glycated haemoglobin (HbA1c) microalbuminura, macroalbuminira and serum creatinine levels were higher in black participants at baseline, black and white participants achieved similar rapid improvement of both clinical variables, which were maintained during study follow‐up. This suggests that optimization of the delivery of diabetes care prior to the development of CKD may lead to similar short‐term kidney outcomes, irrespective of race.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and progression of diabetic nephropathy in South Asian, white European and African Caribbean people with type 2 diabetes: A systematic review and meta‐analysis

Jadawji

Crasto

Gillies

et al. 2018

Diabetes Obesity Metabolism

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Aims To conduct a systematic review and meta‐analysis of published observational evidence to assess the difference in the prevalence and progression of diabetic nephropathy, and the development of end‐stage renal disease (ESRD) in people from three different ethnic groups with type 2 diabetes (T2DM). Materials and methods Relevant studies were identified in a literature search of MEDLINE, EMBASE and reference lists of relevant studies published up to May 2018. We decided a priori that there were no differences in the prevalence and progression of diabetic nephropathy, and the development of ESRD in the three ethnicities with T2DM. Pooled relative risks of microalbuminuria by ethnicity were estimated by fitting three random effects meta‐analyses models. A narrative synthesis of the nephropathy progression in the studies was carried out. The review was registered in PROSPERO (CRD42018107350). Results Thirty‐two studies with data on 153 827 unique participants were eligible for inclusion in the review. The pooled prevalence ratio of microalbuminuria in South Asian compared with white European participants was 1.14 (95% confidence interval [CI] 0.99, 1.32; P = 0.065), while for African Caribbean vs South Asian participants the pooled prevalence ratio was 1.08 (95% CI 0.93, 1.24; P = 0.327). Results for renal decline were inconsistent, with preponderance towards a high rate of disease progression in South Asian compared with white participants. The estimated pooled incidence rate ratio (IRR) for ESRD was significantly higher in African Caribbean vs white European participants: 2.75 (95% CI 2.01, 3.48; P < 0.001). Conclusion The results of this review did not show a significant link between ethnicity (South Asian, white European and African Caribbean) and the prevalence of microalbuminuria; however, the IRR for ESRD in African Caribbean compared with white European participants was significantly higher. Further research is needed to explore the potential non‐albuminuric pathways of progression to ESRD.

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“…Blacks were adequately represented, making up 19% of participants in the ACCORD trial. They had higher-risk clinical features at baseline, including higher levels of systolic BP and hemoglobin A1c as well as more frequent macro-and microalbuminuria (5). Contrary to the original study hypothesis, the rate of eGFR decline was not greater in blacks than whites starting from a normal eGFR.…”

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confidence: 58%

“…Blacks constitute 7% of overall clinical trial participants, although they make up 13% of the United States population (4). In this issue of the Clinical Journal of the American Society of Nephrology, Gerber et al (5) report a post hoc analysis of CKD risks in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) clinical trial by black versus white race (6). The ACCORD trial participants' diabetes care was standardized by the clinical trial format so that, as much as possible, they received comparable treatment consistent with clinical practice guidelines at the time, irrespective of self-identified race (6).…”

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confidence: 99%

Race in America

Tuttle

2018

CJASN

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Incidence and Progression of Chronic Kidney Disease in Black and White Individuals with Type 2 Diabetes

Abstract: Black participants enrolled in a randomized controlled trial had lower rates of incident CKD compared with white participants. Rates of eGFR decline, microalbuminuria, macroalbuminuria, and kidney failure did not vary by race.

Cited by 24 publications

References 30 publications

Initial renal histology and early response predict outcomes of Brazilian lupus nephritis patients

Initial renal histology and early response predict outcomes of Brazilian lupus nephritis patients

Prevalence and progression of diabetic nephropathy in South Asian, white European and African Caribbean people with type 2 diabetes: A systematic review and meta‐analysis

Race in America

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