Abstract
BackgroundPrior evidence suggests that longer duration of residence in the southeastern United States is associated with higher prevalence of diabetes and hypertension. We postulated that a similar association would exist for chronic kidney disease (CKD).MethodsIn a national population-based cohort study that enrolled 30,239 men and women ≥ 45 years old (42% black/58% white; 56% residing in the Southeast) between 2003 and 2007, lifetime southeastern residence duration was calculated and categorized [none (0%), less than half (>0-< 50%), half or more (≥50-< 100%), and all (100%)]. Prevalent albuminuria (single spot urinary albumin:creatinine ratio of ≥30 mg/g) and reduced kidney function (estimated glomerular filtration rate <60 ml/min/1.73 m2) were defined at enrollment. Incident end-stage renal disease (ESRD) during follow-up was identified through linkage to United States Renal Data System.ResultsWhite and black participants most often reported living their entire lives outside (35.7% and 27.0%, respectively) or inside (27.9% and 33.8%, respectively) the southeastern United States. The prevalence of neither albuminuria nor reduced kidney function was statistically significantly associated with southeastern residence duration, in either race. ESRD incidence was not statistically significantly associated with all vs. none southeastern residence duration (HR = 0.50, 95% CI, 0.22-1.14) among whites, whereas blacks with all vs. none exposure showed increased risk of ESRD (HR = 1.63, 95% CI, 1.02-2.63; PraceXduration = 0.011).ConclusionsThese data suggest that blacks but not whites who lived in the Southeast their entire lives were at increased risk of ESRD, but we found no clear geographic pattern for earlier-stage CKD.
Highlights
Chronic kidney disease (CKD), defined by albuminuria or reduced estimated glomerular filtration rate, is common among adults in the United States [1], and, in 2009, more than 600,000 individuals with chronic kidney disease (CKD) were treated for end-stage renal disease (ESRD) [2], requiring dialysis or kidney transplantation to sustain life
In this national cohort, we found that higher prevalence of albuminuria and reduced kidney function was not associated with longer duration of Southeastern residence among either whites or blacks
We found no association of southeastern residence duration with either albuminuria or reduced kidney function, regardless of race
Summary
Chronic kidney disease (CKD), defined by albuminuria or reduced estimated glomerular filtration rate (eGFR), is common among adults in the United States (estimated prevalence >10%) [1], and, in 2009, more than 600,000 individuals with CKD were treated for end-stage renal disease (ESRD) [2], requiring dialysis or kidney transplantation to sustain life. Substantial geographic variation exists in the age-, race- and sex-adjusted incidence of ESRD in the United States, and many of the southeastern states (which overlay the so-called “stroke belt” [3]) have higher incidence than many other U.S regions [2]. Both diabetes [4] and hypertension [5], which are strong risk factors for CKD, have been shown to be more prevalent in the southeastern United States, compared to the rest of the country. We postulated that a similar association would exist for chronic kidney disease (CKD)
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