Trajectories of Kidney Function Decline in Young Black and White Adults With Preserved GFR: Results From the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Open accessAbstract
Background Strong racial discrepancies in end-stage renal disease exist. Whether there are race differences in kidney function loss in younger healthy persons is not well established. Study design Longitudinal. Setting & participants 3,348 black and white adults with at least 2 measurements of cystatin C-based estimated glomerular filtration rate (eGFRcys) at scheduled Coronary Artery Risk Development in Young Adults (CARDIA) examinations (years 10, 15, and 20). Predictor Race. Outcomes & measurements We used linear mixed models to examine race differences in annualized rates of eGFRcys decline, adjusting for age, sex, lifetime exposure to systolic blood pressure >120 mm Hg, diabetes, and albumin-creatinine ratio. We used Poisson regression to compare racial differences in rapid decline (eGFRcys decline >3% per year) by study period (10-15 years after baseline examination [defining period 1] and >15-20 years after baseline examination [defining period 2]). Results Mean age was 35 ± 3.6 (SD) years, and mean eGFRcys was 110 ± 20 mL/min/1.73 m² for blacks and 104 ± 17 mL/min/1.73 m² for whites at baseline. For both blacks and whites, eGFRcys decline was minimal at younger ages (<35 years) and eGFRcys loss accelerated at older ages. However, acceleration of eGFRcys decline occurred at earlier ages for blacks than whites. Blacks had somewhat faster annualized rates of decline compared with whites, but differences were attenuated after adjustment in period 1 (0.13 mL/min/1.73 m² per year faster; P = 0.2). In contrast, during period 2, blacks had significantly faster annualized rates of decline, even after adjustment (0.32 mL/min/1.73 m² per year faster; P = 0.003). The prevalence of rapid decline was significantly higher for blacks versus whites, with prevalence rate ratios of 1.31 (95% CI, 1.04-1.63) for period 1 and 1.24 (95% CI, 1.09-1.41) for period 2. Differences were attenuated after full adjustment: adjusted prevalence rate ratios were 1.20 (95% CI, 0.95-1.49) for period 1 and 1.10 (95% CI, 0.96-1.26) for period 2. Limitations No measured GFR. Conclusions eGFRcys decline differs by race at early ages, with faster annualized rates of decline for blacks. Future studies are required to explain the observed differences.
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A published study in the non-CKD population reported that women were more likely to start a GLP-1RA than men but were less likely to start SGLT2i.
“A published study in the non-CKD population reported a similar finding that women were more likely to start a GLP-1RA than men but were less likely to start SGLT2i.25”
From Disparities in SGLT2 Inhibitor or Glucagon-Like Peptide 1 Receptor Agonist Initiation Among Medicare-Insured Adults With CKD in the United States (2023) · cites this paper as [25]
The Results (Cohort Characteristics; page unavailable) and Discussion address kidney-function decline, not initiation of diabetes medications. A search for GLP-1RA, SGLT2i, and sex differences in their initiation found no passage addressing the claim. (LLM, conf=0.78)
Experimental — accuracy not yet measuredSeveral prior studies in patients without CKD have demonstrated lower use of these agents among Black patients.
“Several prior studies in patients without CKD have demonstrated lower use of these agents among Black patients.18,24,25”
From Disparities in SGLT2 Inhibitor or Glucagon-Like Peptide 1 Receptor Agonist Initiation Among Medicare-Insured Adults With CKD in the United States (2023) · cites this paper as [25]
The Results and Discussion (pages not provided) compare kidney-function decline in Black and White adults with largely preserved kidney function, but do not report lower use of the agents among Black patients. Searches for racial differences in medication use, including ACE inhibitors and antihypertensive treatment, found no passage addressing the claim. (LLM, conf=0.75)
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Research works printed but not linked: 17
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- [8]Perkins BA Nelson RG Ostrander BE Detection of renal function decline in patients with diabetes and normal or elevated GFR by serial measurements of serum cystatin C concentration: results of a 4-year follow-up study J Am Soc Nephrol 16 1404 1412 2005 15788478 PMC2429917
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Zhao, J. Z., Weinhandl, E. D., Carlson, A. M., & St. Peter, W. L. (2023) · Kidney Medicine · doi:10.1016/j.xkme.2022.100564 · Cited by 33 · see citing works
“The Coronary Artery Risk Development in Young Adults study found that Black patients had significantly faster annualized estimated glomerular filtration rates of decline.(28) The US Renal Data System annual data reported that Black patients had the highest prevalence of end-stage kidney disease in racial and ethnic gr…”
Background
- Authors
- Peralta, C. A., Vittinghoff, E., Bansal, N., Jacobs, D., Muntner, P., Kestenbaum, B., Lewis, C., Siscovick, D., Kramer, H., Shlipak, M., & Bibbins-Domingo, K.
- Affiliations
- San Francisco VA Medical Center (US)
- University of California, San Francisco (US)
- University of Minnesota (US)
- University of Alabama at Birmingham (US)
- University of Washington (US)
- Loyola University Chicago (US)
- Corresponding author
- Peralta, Carmen A.
- ORCID
- Venue
- American Journal of Kidney Diseases
- Publisher
- Elsevier BV
- Published
- 2013-08
- Volume
- 62
- Issue
- 2
- Pages
- 261-266
- ISSN
- 0272-6386 (ISSN-L)
- PMC
- PMC3714331
- OpenAlex
- W2031772671
- Cited by
- 74
- References
- 0
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 10 · 2022: 9 · 2021: 8 · 2020: 5 · 2019: 3 · 2018: 4 · 2017: 7 · 2016: 10 · 2015: 6 · 2014: 3 · 2013: 2
- FWCI
- 5.31
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Kidney Diseases (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (1K23DK082793-01)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK078124)
- National Heart, Lung and Blood Institute (N01HC48050)
- National Institute on Minority Health and Health Disparities (1P60MD006902)
- NIDDK (P30-DK092924)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- renal function decline, racial disparities, black-white disparities, cystatin C, estimated glomerular filtration rate, rapid kidney function decline, young adults, end-stage renal disease risk, systolic blood pressure, albumin-creatinine ratio, diabetes mellitus, CARDIA study, albuminuria, chronic kidney disease progression
- MeSH terms
- Adolescent, Adult, Age Factors, Black or African American, Coronary Artery Disease, Female, Glomerular Filtration Rate, Humans, Kidney, Longitudinal Studies, Male, Prospective Studies, Risk Factors, Risk Assessment, White People, Young Adult
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