Effects of Race and Sex on Measured GFR: The Multi-Ethnic Study of Atherosclerosis

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• 作者：Lesley A. Inker ; MD ; MS¹ ; ^{linker@tuftsmedicalcenter.org" class="auth_mail" title="E-mail the corresponding author} ; Tariq Shafi ; MBBS ; MHS² ; Aghogho Okparavero ; MBBS ; MPH¹ ; Hocine Tighiouart ; MS¹ ; ³ ; ⁴ ; John H. Eckfeldt ; MD ; PhD⁵ ; Ronit Katz ; DPhil⁶ ; W. Craig Johnson ; MS⁷ ; Norma Dermond ; BA⁷ ; Zarqa Tariq ; MD² ; Imene Benayache ; MD² ; Wendy S. Post ; MD ; MS² ; Josef Coresh ; MD ; PhD² ; Andrew S. Levey ; MD¹ ; Michael G. Shlipak ; MD ; MPH⁸
• 关键词：Glomerular filtration rate (GFR) ; measured GFR ; iohexol ; albuminuria ; albumin-creatinine ratio (ACR) ; race ; ethnicity ; sex ; chronic kidney disease (CKD) ; renal function ; health disparities ; racial differences ; body size ; GFR decline trajectory
• 刊名：American Journal of Kidney Diseases
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：68
• 期：5
• 页码：743-751
• 全文大小：850 K

文摘

Kidney failure disproportionately affects older blacks versus whites. The reasons are unknown and may be related to lower measured glomerular filtration rate (GFR) and higher levels of albuminuria in community-based population samples.

Study Design

Cross-sectional analysis of a substudy of a prospective cohort.

Setting & Participants

Ancillary study following Multi-Ethnic Study of Atherosclerosis (MESA) visit 5.

Predictor

Age, sex, and race.

Outcomes & Measurements

Measured GFR using plasma clearance of iohexol and urine albumin-creatinine ratio (ACR).

Results

GFR was measured in 294 participants. Mean age was 71 ± 9 (SD) years, 47% were black, 48% were women, mean GFR was 73 ± 19 mL/min/1.73 m², and median ACR was 10.0 (IQR, 5.8-20.9) mg/g. Measured GFR was on average 1.02 (95% CI, 0.79-1.24) mL/min/1.73 m² lower per year older. Mean GFR indexed for body surface area was not different between blacks versus whites (mean difference, 2.94 [95% CI, −1.37 to 7.26] mL/min/1.73 m²), but was lower in women than men (mean difference, −9.34 [95% CI, −13.53 to −5.15] mL/min/1.73 m²); this difference persisted and remained significant after adjustment for demographics, clinical characteristics, and measures of body size. The difference between men and women, but not between blacks and whites, was substantially greater when GFR was not indexed for body surface area. ACR was higher in older versus younger participants (mean difference, 3.2% [95% CI, 1.5%-4.8%] per year), but geometric mean ratio of ACR did not differ between blacks versus whites (mean difference, 19.7%; 95% CI, −39.1% to 6.1%) or between men versus women (mean difference, −4.4%; 95% CI, −27.7% to 26.3%).

Limitations

This is a study of survivors. People who agreed to participate were younger than those who refused.

Conclusions

In this first community-based study that included blacks and whites, no differences in measured GFR between races were found, suggesting that other factors must account for the disproportionately higher burden of kidney failure in older blacks versus whites.