ESRD More Likely Than Early Death for Black Kidney Patients

End-stage renal disease more likely for African-Americans with hypertensive nephrosclerosis

FRIDAY, July 23 (HealthDay News) -- African-Americans with hypertensive nephrosclerosis are more likely to reach end-stage renal disease (ESRD) than to die prematurely, according to a study published online July 22 in the Journal of the American Society of Nephrology.

Tahira P. Alves, M.D., of the University of Texas Health Science Center at San Antonio, and colleagues evaluated participants with hypertensive nephrosclerosis from the African American Study of Kidney Disease and Hypertension (AASK) trial (1996 to 2001) and cohort (2002 to 2007) phases to compare incident ESRD rates with rates of total mortality, cardiovascular disease (CVD) death, and a CVD composite (CVD mortality and CVD hospitalization). AASK included 1,094 participants, with 764 participants completing the trial phase without an event and 691 of those participants later enrolled in the cohort phase.

The researchers found that the rate of ESRD (3.9 per 100 patient-years) was significantly higher than the rates of total mortality (2.2 per 100 patient-years), CVD mortality (0.8 per 100 patient-years), and the CVD composite (3.2 per 100 patient-years). Across most of the subgroups defined by age, gender, income, education, previous CVD, baseline urine protein excretion, and baseline estimated glomerular filtration rate, the rate of ESRD was consistently higher than mortality rates.

"This study remains novel in that it is the only study to analyze cardiovascular and renal outcomes in an exclusively African-American cohort with chronic kidney disease and well-controlled blood pressure during an 11-year follow-up period. Furthermore, we demonstrated the risk for total mortality and CVD death is not uniform in all chronic kidney disease populations. More research is needed to determine the specific reasons, including possible genetic or socioeconomic factors, that may explain the observed lower cardiovascular mortality in this high-risk minority population," the authors conclude.

King Pharmaceuticals provided monetary support to each clinical center involved in the study. In addition, King Pharmaceuticals, Pfizer Inc., AstraZeneca Pharmaceuticals, GlaxoSmithKline, Forest Laboratories, Pharmacia, and Upjohn donated antihypertensive medications. Several authors disclosed financial ties to these and other pharmaceutical and/or medical device companies.

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