This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Smith, G. L. Articles by Krumholz, H. M. Search for Related Content PubMed PubMed Citation Articles by Smith, G. L. Articles by Krumholz, H. M. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Heart Failure Kidney Diseases Related Collections Cardio-renal physiology/pathophysiology Congestive Epidemiology

(Circulation. 2005;111:1270-1277.)
© 2005 American Heart Association, Inc.

Heart Failure

Race and Renal Impairment in Heart Failure

Mortality in Blacks Versus Whites

Grace L. Smith, MPH; Michael G. Shlipak, MD, MPH; Edward P. Havranek, MD; Frederick A. Masoudi, MD, MSPH; William M. McClellan, MD; JoAnne M. Foody, MD; Saif S. Rathore, MPH; Harlan M. Krumholz, MD, MS

From the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn (G.L.S., J.M.F., S.S.R., H.M.K.); General Internal Medicine Section, Medical Service, San Francisco Veterans Affairs Medical Center, San Francisco, Calif (M.G.S.); Department of Medicine, University of California, San Francisco, Calif (M.G.S.); Division of Cardiology, Denver Health Medical Center, Denver, Colo (E.P.H., F.A.M.); Division of Cardiology, University of Colorado Health Sciences Center, Denver, Colo (E.P.H., F.A.M.); Division of Geriatric Medicine, University of Colorado Health Sciences Center, Denver, Colo (E.P.H., F.A.M.); Colorado Foundation for Medical Care, Aurora, Colo (F.A.M.); Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Ga (W.M.M.); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn (J.M.F., H.M.K.); Robert Wood Johnson Clinical Scholars Program, New Haven, Conn (H.M.K.); Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn (H.M.K.).

Correspondence to Dr Harlan Krumholz, Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, Sterling Hall of Medicine (SHM), I-Wing, Suite 456, 333 Cedar St, New Haven, CT 06520. E-mail harlan.krumholz{at}yale.edu

Received October 1, 2004; revision received January 24, 2005; accepted January 26, 2005.

Background— Renal impairment is an emerging prognostic indicator in heart failure (HF) patients. Despite known racial differences in the progression of both HF and renal disease, it is unclear whether the prognosis for renal impairment in HF patients differs by race. We sought to determine in HF patients the 1-year mortality risks associated with elevated creatinine and impaired estimated glomerular filtration rate (eGFR) and to quantify racial differences in mortality.

Methods and Results— We retrospectively evaluated the National Heart Care Project nationally representative cohort of 53 640 Medicare patients hospitalized with HF. Among 5669 black patients, mean creatinine was 1.6±0.9 mg/dL, and 54% had an eGFR 60, compared with creatinine 1.5±0.7 mg/dL and 68% eGFR 60 in 47 971 white patients. Higher creatinine predicted increased mortality risk, although the magnitude of risk differed by race (interaction P=0.0001). Every increase in creatinine of 0.5 mg/dL was associated with a >10% increased risk in adjusted mortality for blacks, compared with >15% increased risk in whites (interaction P=0.0001), with the most striking racial disparities at the highest levels of renal impairment. Depressed eGFR showed similar racial differences (interaction P=0.0001).

Conclusions— Impaired renal function predicts increased mortality in elderly HF patients, although risks are more pronounced in whites. Distinct morbidity and mortality burdens in black versus white patients underscore the importance of improving patient risk-stratification, defining optimal therapies, and exploring physiological underpinnings of racial differences.

Key Words: ethnic groups • kidney • heart failure • mortality

This article has been cited by other articles:

				A. P. Kalogeropoulos, V. V. Georgiopoulou, G. Giamouzis, A. L. Smith, S. A. Agha, S. Waheed, S. Laskar, J. Puskas, S. Dunbar, D. Vega, et al. Utility of the Seattle heart failure model in patients with advanced heart failure. J. Am. Coll. Cardiol., January 27, 2009; 53(4): 334 - 342. [Abstract] [Full Text] [PDF]

				R. C. Campbell, X. Sui, G. Filippatos, T. E. Love, C. Wahle, P. W. Sanders, and A. Ahmed Association of chronic kidney disease with outcomes in chronic heart failure: a propensity-matched study Nephrol. Dial. Transplant., January 1, 2009; 24(1): 186 - 193. [Abstract] [Full Text] [PDF]

				R. Mehrotra, D. Kermah, L. Fried, S. Adler, and K. Norris Racial Differences in Mortality Among Those with CKD J. Am. Soc. Nephrol., July 1, 2008; 19(7): 1403 - 1410. [Full Text] [PDF]

				G. L. Smith, F. A. Masoudi, M. G. Shlipak, H. M. Krumholz, and C. R. Parikh Renal Impairment Predicts Long-Term Mortality Risk after Acute Myocardial Infarction J. Am. Soc. Nephrol., January 1, 2008; 19(1): 141 - 150. [Abstract] [Full Text] [PDF]

				S. S. Waikar, G. C. Curhan, J. Z. Ayanian, and G. M. Chertow Race and Mortality after Acute Renal Failure J. Am. Soc. Nephrol., October 1, 2007; 18(10): 2740 - 2748. [Abstract] [Full Text] [PDF]

				B. B. Newsome, W. M. McClellan, C. S. Coffey, J. J. Allison, C. I. Kiefe, and D. G. Warnock Survival Advantage of Black Patients with Kidney Disease after Acute Myocardial Infarction Clin. J. Am. Soc. Nephrol., September 1, 2006; 1(5): 993 - 999. [Abstract] [Full Text] [PDF]

				N. R. Powe Reverse Race and Ethnic Disparities in Survival Increase with Severity of Chronic Kidney Disease: What Does This Mean? Clin. J. Am. Soc. Nephrol., September 1, 2006; 1(5): 905 - 906. [Full Text] [PDF]

				N. Volkova, W. McClellan, J. M. Soucie, and A. Schoolwerth Racial disparities in the prevalence of cardiovascular disease among incident end-stage renal disease patients Nephrol. Dial. Transplant., August 1, 2006; 21(8): 2202 - 2209. [Abstract] [Full Text] [PDF]

				M. Tonelli, N. Wiebe, B. Culleton, A. House, C. Rabbat, M. Fok, F. McAlister, and A. X. Garg Chronic Kidney Disease and Mortality Risk: A Systematic Review J. Am. Soc. Nephrol., July 1, 2006; 17(7): 2034 - 2047. [Abstract] [Full Text] [PDF]

				W. McClellan, D. G. Warnock, L. McClure, R. C. Campbell, B. B. Newsome, V. Howard, M. Cushman, and G. Howard Racial Differences in the Prevalence of Chronic Kidney Disease among Participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort Study J. Am. Soc. Nephrol., June 1, 2006; 17(6): 1710 - 1715. [Abstract] [Full Text] [PDF]

				G. L. Smith, M. G. Shlipak, E. P. Havranek, J. M. Foody, F. A. Masoudi, S. S. Rathore, and H. M. Krumholz Serum urea nitrogen, creatinine, and estimators of renal function: mortality in older patients with cardiovascular disease. Arch Intern Med, May 22, 2006; 166(10): 1134 - 1142. [Abstract] [Full Text] [PDF]

				G. L. Smith, J. H. Lichtman, M. B. Bracken, M. G. Shlipak, C. O. Phillips, P. DiCapua, and H. M. Krumholz Renal Impairment and Outcomes in Heart Failure: Systematic Review and Meta-Analysis J. Am. Coll. Cardiol., May 16, 2006; 47(10): 1987 - 1996. [Abstract] [Full Text] [PDF]