Race and ethnicity influences on cardiovascular and renal events in patients with diabetes mellitus

Background The incidence of end-stage renal disease (ESRD) has been consistently shown to be higher among blacks and Hispanics compared to whites with unmeasured risk factors and access to care as suggested explanations. In a high-risk cohort with frequent protocol-directed follow-up, we evaluated t...

Full description

Saved in:

Bibliographic Details
Published in:	The American heart journal 2015-08, Vol.170 (2), p.322-329.e4
Main Authors:	Lewis, Eldrin F., MD, MPH, Claggett, Brian, PhD, Parfrey, Patrick S., MD, Burdmann, Emmanuel A., MD, PhD, McMurray, John J.V., MD, Solomon, Scott D., MD, Levey, Andrew S., MD, Ivanovich, Peter, MD, Eckardt, Kai-Uwe, MD, Kewalramani, Reshma, MD, Toto, Robert, MD, Pfeffer, Marc A., MD, PhD
Format:	Article
Language:	eng
Subjects:	African Americans Blood pressure Body mass index Cardiovascular Cardiovascular disease Cardiovascular Diseases - drug therapy Cardiovascular Diseases - ethnology Cardiovascular Diseases - etiology Continental Population Groups Darbepoetin alfa Diabetes Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - drug therapy Diabetes Mellitus, Type 2 - ethnology Double-Blind Method Erythropoietin - analogs & derivatives Erythropoietin - therapeutic use Ethnic Groups Ethnicity Follow-Up Studies Global Health Glomerular Filtration Rate Health care access Heart failure Hematinics - therapeutic use Hemodialysis Hispanic Americans Humans Incidence Kidney diseases Kidney Failure, Chronic - drug therapy Kidney Failure, Chronic - ethnology Kidney Failure, Chronic - etiology Prognosis Prospective Studies Race Sensitivity analysis Survival Rate Time Factors Transplants & implants Urine Variables White people
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Background The incidence of end-stage renal disease (ESRD) has been consistently shown to be higher among blacks and Hispanics compared to whites with unmeasured risk factors and access to care as suggested explanations. In a high-risk cohort with frequent protocol-directed follow-up, we evaluated the influence of race on cardiovascular (CV) outcomes and incidence of ESRD. Methods TREAT was a randomized, double-blind, placebo-controlled study. This secondary analysis focused on role of race on outcomes. TREAT enrolled 4,038 patients with type 2 diabetes, chronic kidney disease (estimated glomerular filtration rate 20-60 mL/min per 1.73 m2 ), and anemia (hemoglobin level ≤11 g/dL) treated with either darbepoetin alfa or placebo. We compared self-described black and Hispanic patients to white patients with regard to baseline characteristics and outcomes, including mortality, CV outcomes (myocardial infarction, stroke, heart failure, resuscitated sudden death, and coronary revascularization), and incident ESRD. Multivariate adjusted Cox models were developed for these outcomes. Results Black and Hispanic patients were younger, more likely women, had less prior CV disease, and higher blood pressure. During a mean follow-up of 2.4 years with comparable access to care, blacks and Hispanics had a greater risk of ESRD but a significant lower risk of myocardial infarction and coronary revascularization than whites. After adjusting for confounders, blacks remained at significantly greater risk of ESRD than whites (hazard ratio 1.53, 95% CI 1.26-1.85, P < .001), whereas this ESRD risk did not persist among Hispanics. Conclusion Despite similar access to care and lower CV event rates, the risk of ESRD was higher among blacks and Hispanics than whites. For blacks, but not Hispanics, this increase was independent of known attributable risk factors.
ISSN:	0002-8703 1097-6744