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Title: Exploration of Anaemia as a Progression Factor in African Americans with Cardiovascular Disease

Author
item NEWSOME, BRITT - UNIV OF AL-BIRMINGHAM
item Onufrak, Stephen
item WARNOCK, DAVID - UNIV OF AL-BIRMINGHAM
item MCCLELLAN, WILLIAM - EMORY UNIVERSITY

Submitted to: Nephrology Dialysis Transplantation
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/28/2009
Publication Date: 8/23/2009
Citation: Newsome, B.B., Onufrak, S.J., Warnock, D., Mcclellan, W.M. 2009. Exploration of Anaemia as a Progression Factor in African Americans with Cardiovascular Disease. Nephrology Dialysis Transplantation. 24(11):3404-3411.

Interpretive Summary: Blacks face an increased risk of developing en stage renal disease (ESRD) but the reasons for this disparity are unknown. Anemia is a risk factor for ESRD and occurs more frequently among Blacks. The purpose of this study was to examine if anemia was a stronger risk factor for ESRD among Blacks as compared to whites. We found that anemia increased the risk of ESRD similarly among Blacks and whites. We also found that anemia was a stronger risk factor for ESRD among people with low baseline kidney function.

Technical Abstract: Despite the higher incidence of end stage renal disease (ESRD) among African Americans, whites in the United States population have a higher prevalence of chronic kidney disease. This may be due, in part, to a faster rate of progression to ESRD among African Americans with kidney disease. Anemia is associated with increased risk of progressive kidney disease and is more prevalent among African Americans. The purpose of this study is to determine if anemia is associated with progression to ESRD differently according to race. This a retrospective cohort analysis of Cooperative Cardiovascular Project data for 87,693 Medicare beneficiaries = 65 years old without ESRD admitted to 4,047 hospitals with acute myocardial infarction between February 1994 and June 1995. Follow-up was collected through June 2004 for ESRD and mortality. There were 92,993 patients, 6.9% African American, 50.1% female. Mean age was 77.0 years. African Americans had higher prevalence of anemia (40.2% of African Americans verses 26.7% of whites; p<0.0001). Lower baseline hematocrit was associated with increased ESRD rates in both races and after controlling for other risk factors, the effect of hematocrit on ESRD incidence did not vary significantly according to race (p = 0.19). The effect of hematocrit on ESRD risk was strongest at the lowest baseline kidney function (GFR<15) with hazard ratios increasing seven fold as hematocrit decreased from = 42% to <28%. Within a nationally representative sample of patients with cardiovascular disease anemia was associated equally among African Americans and whites with increased risk of developing ESRD.