Emory University Study Examines Racial Disparity in Kidney Disease

William M. McClellan et al., JASN, September 1, 2011

[Editor’s Note: Kidney failure is four times as likely among blacks than whites. Researchers at Emory University in Atlanta did a study of 27,911 subjects and found that blacks are more likely than whites to excrete large amounts of protein in their urine. This can contribute to kidney disease and failure.

ESRD stands for “end-stage renal disease.”

The study was published in the Journal of the American Society of Nephrology.]

Abstract:

The causes of the increased risk for ESRD among African Americans are not completely understood. Here, we examined whether higher levels of urinary albumin excretion among African Americans contributes to this disparity. We analyzed data from 27,911 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who had urinary albumin-to-creatinine ratio (ACR) and estimated GFR (eGFR) measured at baseline. We identified incident cases of ESRD through linkage with the United States Renal Data System. At baseline, African Americans were less likely to have an eGFR <60 ml/min per 1.73 m2 but more likely to have an ACR ≥30 mg/g. The incidence rates of ESRD among African Americans and whites were 204 and 58.6 cases per 100,000 person-years, respectively. After adjustment for age and gender, African Americans had a fourfold greater risk for developing ESRD (HR 4.0; 95% CI 2.8 to 5.9) compared with whites. Additional adjustment for either eGFR or ACR reduced the risk associated with African-American race to 2.3-fold (95% CI 1.5 to 3.3) or 1.8-fold (95% CI 1.2 to 2.7), respectively. Adjustment for both ACR and eGFR reduced the race-associated risk to 1.6-fold (95% CI 1.1 to 2.4). Finally, in a model that further adjusted for both eGFR and ACR, hypertension, diabetes, family income, and educational status, African-American race associated with a nonsignificant 1.4-fold (95% CI 0.9 to 2.3) higher risk for ESRD. In conclusion, the increased prevalence of albuminuria may be an important contributor to the higher risk for ESRD experienced by African Americans.

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  • Southron

    Gosh, does this mean that kidneys aren’t a social construct?

  • Ben

    I wonder why they would would adjust for hypertension? How do you know that African Americans have the same levels of hypertension (quality and quantity) and it can just be mitigated? They would need to factor any difference for any factors that also lead up to renal failure as well (to get a better idea of what is going on).

    Hypertension = higher amount of blood pressure = more protein in blood can be absorbed in the juxtaglomerular apparatus = finding itself in the calyx = death from protein lost.

    http://goo.gl/cHKoY

  • Anonymous

    The (Black/White) differential statistics about major mental disorders would be interesting.

  • Salt

    #3 They would indeed, except that blacks by & large avoid dealings with the mental health industry if they can. For the most part blacks turn to: religious organizations, alcohol, drugs, and friends to cope with their mental health issues.

    The exceptions I see for this are those that enter the prison system where sometimes they get adequate mental health care (usually not), drug rehabilitation centers, and for those few that are so messed up that society has to force them into it. Asians are also extremely unlike to show up for counseling, or any other mental health treatment as it is a shame issue in most of their cultures.

    My beloved is a counselor; other than substance abuse, and domestic violence issues she rarely sees black clients. The majority she does see are merely there because they have a court order to be there. I can tell you that of the populations she does see, even comparing apples to apples (e.g. white drug addicts, with black drug addicts) the degree of antisocial tendencies, full blown antisocial personality disorders, other personality disorders, schizophrenia, and bi-polar (which is often a label attached to those with anti-social personality disorder so that they can bill for it) are higher. Extreme risk taking behavior is higher, violence is higher (in particular directed at counselors & other treatment staff) and the failure rate for treatment is dramatically higher. [This is partially because so many blacks get kicked out of the program for making threats to counselors, sexually harassing (evening attempting to grope & rape) counselors, other bad behavior in treatment, and a lack of ability to develop insight.

    She honestly considers it a breakthrough for the female clients if they can blame their problems on someone else. Not because they haven’t perpetuated the situation long after, or even initiated the things which led them there, but because its at least some insight into how they became to be prostitutes, rape victims, heroin, crack, and alcohol addicts. Its a short leap from there to actual understanding of their own roles, and participation, but most don’t make that leap. The few that do are the ones that are often successful in getting out of those lifestyles.

    Its not that I blame many of the blacks directly. I have a lot of pity for them. Having seen more than my fill of black parenting, and child abuse it is a wonder that there aren’t more black addicts out there, with more, and more severe mental health problems.

    As soon as her supervision period is over I’ll be glad when she moves on to working with different population groups. In the meantime, all I can do is help her pass the CCW exam, and make sure she carries at work even if the rules don’t permit it. I would rather have her alive & unemployed than the victim of a client with poor impulse control.

    There aren’t a lot of things I respect Malcolm Little for, but the one thing he did do right – he setup treatment for black addicts that forced them to be accountable to groups, and made them accept responsibility for the stuff that got them there as a condition of it. He also made them stay a lot longer than the 18-25 days they typically allow now for a run of rehab. When it takes 5 drug treatment runs just to get to the first level of insight, you aren’t going to reach those that are slow on the uptake, and the majority of black addicts are indeed slow on the uptake.

  • Frank

    This cannot be true. We all know that blacks and whites are the same except for color. On the other hand, if this study is correct, we need to somehow infect more whites with kidney problems to level the playing field.

  • shaunantijihad

    Grrr… racist White kidneys. Don’t Blacks have the right to White kidneys too?

  • rjp

    From kidney.org:

    What does diabetes do to the kidneys?

    With diabetes, the small blood vessels in the body are injured. When the blood vessels in the kidneys are injured, your kidneys cannot clean your blood properly. Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. You may have protein in your urine. Also, waste materials will build up in your blood.

    Diabetes also may cause damage to nerves in your body. This can cause difficulty in emptying your bladder. The pressure resulting from your full bladder can back up and injure the kidneys. Also, if urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in urine that has a high sugar level.

    How many diabetic patients will develop kidney disease?

    About 30 percent of patients with Type 1 (juvenile onset) diabetes and 10 to 40 percent of those with Type 2 (adult onset) diabetes eventually will suffer from kidney failure.

    Kidney disease is really just a side-effect of diabetes.

    Top 10 causes of blacks deaths: heart disease, cancer, stroke, AIDS, accidents, homicide, diabetes, pneumonia and influenza, chronic pulmonary diseases such as asthma and bronchitis, and infant mortality.

  • Anonymous

    Generally if you have kidney problems you must exercise a great deal of discipline in following a very, very careful diet. My father was diagnosed several years ago with stage 4 kidney level. This means his kidneys were functioning at 20% capacity. The next level is failure and regular dialysis. He had to go on a very strict diet. My father had to give up just about all the delicious foods he had enjoyed eating his whole life. Recently his kidneys have improved to stage 3 level because of this. The nurse said this was very unusual and was quite impressed. Interestingly I see an awful lot of blacks at the kidney clinic and know of several of them on dialysis. I wonder if lack of discipline, planning and restraint might be a factor?

  • Anonymous

    If you can’t explain a disparity, just blame whites. Explained!