Asian Americans & chronic kidney disease in a nationally representative cohort

Merle Kataoka-Yahiro,Krupa Gandhi,Connie M Rhee,James Davis,Victoria Page

doi:10.1186/s12882-018-1145-5

Abstract

BackgroundThere is a paucity of specific data on early stages of chronic kidney disease (CKD) among Asian Americans (AAs). The objective of this study was to examine the independent association of Asian race/ethnicity and socio-demographic and co-morbidity factors with markers of early kidney damage, ascertained by ACR levels, as well as kidney dysfunction, ascertained by eGFR levels in a large cross-sectional sample of AAs enrolled in the National Health and Nutrition Examination Survey (NHANES).MethodsSecondary data analyses of the NHANES 2011–2014 data of a nationally representative sample of 5907 participants 18 years and older, US citizens, and of Asian and White race. NHANES data included race (Asian vs. White), as well as other socio-demographic information and comorbidities. Urine albumin-to-creatinine ratio (ACR) categories and estimated glomerular filtration rate (eGFR) were used as indicators for CKD. Descriptive analyses using frequencies, means (standard deviations), and chi-square tests was first conducted, then multivariable logistic regression serial adjustment models were used to examine the associations between race/ethnicity, other socio-demographic factors (age, sex, education), and co-morbidities (obesity, diabetes, hypertension) with elevated ACR levels (A2 & A3 – CKD Stages 3 and 4–5, respectively) as well as reduced eGFR (G3a-G5 and G3b –G5 - CKD Stage 3–5).ResultsAAs were more likely than White participants to have ACR levels > 300 mg/g (A3) (adjusted OR (aOR) (95% CI) 2.77 (1.55, 4.97), p = 0.001). In contrast, adjusted analyses demonstrated that AAs were less likely to have eGFR levels < 60 ml/min/1.73 m2 (G3a-G5) (aOR (95% CI) 0.50 (0.35, 0.72), p < .001).ConclusionsThis is one of the first large U.S. population-based studies of AAs that has shown a comparatively higher risk of elevated ACR > 300 mg/g levels (A3) but lower risk of having eGFR levels < 60 ml/min/1.732 m2 (G3a-G5). The findings support the need to address the gaps in knowledge regarding disparities in risk of early stage CKD among AAs.

Highlights

There is a paucity of specific data on early stages of chronic kidney disease (CKD) among Asian Americans (AAs)
We examined the independent association of Asian race/ethnicity and socio-demographic and co-morbidity factors with markers of early kidney damage, ascertained by higher albumin-to-creatinine ratio (ACR) levels, as well as kidney dysfunction, ascertained by lower estimated glomerular filtration rate (eGFR) levels
We further examined the association between socio-demographic and co-morbidity factors with these outcomes stratified by race/ethnicity

Summary

Introduction

There is a paucity of specific data on early stages of chronic kidney disease (CKD) among Asian Americans (AAs). In 2011, total Medicare spending rose 5% to $549.1 billion, while end-stage-renal disease expenditures rose 5.4% to $34.3 billion. The costs and spending will continue to increase based on the projected population growth of AAs in the U.S in the 50 years. Given these projections, disease prevention are imperative to address in the early stages of CKD among this population. While state-level data exists on end-stage renal disease and its treatment, there are no Kataoka-Yahiro et al BMC Nephrology (2019) 20:10 granular and precise data on early stages of CKD among AAs

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