Abstract
IntroductionThe Southern Community Cohort Study is a prospective study of low socioeconomic status (SES) blacks and whites from the southeastern US, where the burden of end-stage renal disease (ESRD) and its risk factors are high. We tested whether the 2.4-fold elevated risk of ESRD we previously observed in blacks compared to whites was explained by differences in baseline kidney function.MethodsWe conducted a case-cohort study of incident ESRD cases (n = 737) with stored blood and a probability sampled subcohort (n = 4238) and calculated estimated glomerular filtration rate (eGFR) from serum creatinine. 86% of participants were enrolled from community health centers in medically underserved areas and 14% from the general population in 12 states in the southeastern United States. Incident ESRD after entry into the cohort was ascertained by linkage of the cohort with the US Renal Data System (USRDS).ResultsMedian (25th, 75th percentile) eGFR at baseline was 63.3 (36.0, 98.2) ml/min/1.73m2 for ESRD cases and 103.2 (86.0, 117.9) for subcohort. Black ESRD cases had higher median (25th, 75th) eGFR [63.3 (35.9, 95.9)] compared to whites [59.1 (39.4, 99.2)]. In multivariable Cox models accounting for sampling weights, baseline eGFR was a strong predictor of ESRD risk, and an interaction with race was detected (P = 0.029). The higher ESRD risk among blacks relative to whites persisted (hazard ratio: 2.58; 95% confidence interval: 1.65, 4.03) after adjustment for eGFR.ConclusionIn this predominantly lower SES cohort, the racial disparity in ESRD risk is not explained by differences in baseline kidney function.
Highlights
The Southern Community Cohort Study is a prospective study of low socioeconomic status (SES) blacks and whites from the southeastern US, where the burden of end-stage renal disease (ESRD) and its risk factors are high
We modeled time to ESRD as a function of race, demographic, socioeconomic, and clinical variables, including baseline estimated glomerular filtration rate (eGFR), body mass index (BMI, kg/m2), history of smoking, and history of diabetes, stroke, myocardial infarction, and hypertension, in a series of Cox regression models that accounted for the case-cohort study design and the weighted sample [16]
While the Chronic Renal Insufficiency Cohort (CRIC) study demonstrated an increased ESRD risks of blacks compared to whites (HR 1.55, 95% confidence interval (CI) 1.29–1.86) after adjusting for baseline eGFR, we demonstrate that the difference in ESRD risk may diminish at an eGFR of less than 40
Summary
The Southern Community Cohort Study is a prospective study of low socioeconomic status (SES) blacks and whites from the southeastern US, where the burden of end-stage renal disease (ESRD) and its risk factors are high. The Southern Community Cohort Study (SCCS) is a large ongoing, prospective study of black and white participants residing in the southeastern United States, where rates of ESRD are among the highest in the nation due to reasons that remain to be fully elucidated [3]. After adjustment for these known risk factors, the risk of ESRD remained more than twofold higher for blacks [hazard ratio (HR): 2.4, 95% confidence interval (CI): 1.9, 3.0] These analyses lacked data on baseline kidney function. We used a case-cohort design, measured baseline serum creatinine to characterize kidney function, and evaluated associations with ESRD risk among black and white participants of the SCCS
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