Abstract 14782: Impact of Black Race on Progression to End-Stage Renal Disease Despite Similar Outcomes for Cardiovascular Morbidity and Mortality: The TREAT Study
Introduction: The incidence of end-stage renal disease (ESRD) has been consistently shown to be higher among blacks as compared to whites in population-based studies. Residual risk factors and access to care have been suggested as explanations for some of the variance in this risk difference. In a cohort with diabetes, chronic kidney disease (CKD), and anemia, we evaluated the influence of race on a) cardiovascular (CV) outcomes (as a barometer for population differences) and b) incidence of ESRD.
Methods: TREAT (Trial to Reduce Cardiovascular Events with Aranesp Therapy) enrolled 4038 patients with anemia (hemoglobin ≤ 11 g/dL), CKD (estimated glomerular filtration rate 20-60 mL/min/1.73 m2) and type 2 diabetes. We compared self-described black patients (n=815) to non-black patients (n=3223) with regards to baseline characteristics, CV outcomes, and incident ESRD. Baseline characteristics were compared by Wilcoxon rank-sum for continuous and Chi square for categorical variables. Event rates were obtained and multivariate adjusted hazard ratios were calculated with Cox proportional hazard models adjusted for all predictive covariates developed in TREAT.
Results: Black patients were younger, more likely women, had less CV disease, and higher blood pressure (Table). During a mean follow-up of 2.4 years, the adjusted risks of all-cause death, CV death, and stroke were similar between black and non-black patients. However, black patients had a significant greater risk of ESRD than non-blacks (Table). In contrast, black patients had a significant lower risk of MI and coronary revascularization.
Conclusion: Within a well-treated population of patients with diabetes, CKD, and anemia, black patients had lower risk for MI and revascularization and similar risk for other CV outcomes compared with whites. Despite similar or lower CV event rates, the risk of ESRD was higher among blacks, who unlike non-blacks had higher rates of ESRD than death.
- © 2013 by American Heart Association, Inc.