2020/04/16 by Ana C. Ricardo, Matthew Shane Loop, Franklyn Gonzalez +8
paper · doi:10.1681/asn.2019101008
Significance Statement Although the incident rate of ESKD is higher among Hispanics/Latinos living in the United States compared with non-Hispanics, less is known about incident rates of CKD. The authors report that this community-based prospective cohort study of more than 8000 Hispanics/Latinos in the United States found the overall rate of incident CKD to be 10.6 per 1000 person-years, with the highest rate observed among Puerto Ricans (15.0 per 1000 person-years). Important risk factors for new-onset CKD included elevated BP and glycated hemoglobin, as well as lower baseline eGFR and higher baseline albumin-to-creatinine ratio. Culturally tailored public heath interventions among Hispanics/Latinos focusing on prevention and control of risk factors, including diabetes and hypertension, might help decrease their burden of CKD and ESKD. Background Although Hispanics/Latinos in the United States are often considered a single ethnic group, they represent a heterogenous mixture of ancestries who can self-identify as any race defined by the U.S. Census. They have higher ESKD incidence compared with non-Hispanics, but little is known about the CKD incidence in this population. Methods We examined rates and risk factors of new-onset CKD using data from 8774 adults in the Hispanic Community Health Study/Study of Latinos. Incident CKD was defined as eGFR 2 with eGFR decline ≥1 ml/min per 1.73 m 2 per year, or urine albumin/creatinine ratio ≥30 mg/g. Rates and incidence rate ratios were estimated using Poisson regression with robust variance while accounting for the study’s complex design. Results Mean age was 40.3 years at baseline and 51.6% were women. In 5.9 years of follow-up, 648 participants developed CKD (10.6 per 1000 person-years). The age- and sex-adjusted incidence rates ranged from 6.6 (other Hispanic/mixed background) to 15.0 (Puerto Ricans) per 1000 person-years. Compared with Mexican background, Puerto Rican background was associated with 79% increased risk for incident CKD (incidence rate ratios, 1.79; 95% confidence interval, 1.33 to 2.40), which was accounted for by differences in sociodemographics, acculturation, and clinical characteristics. In multivariable regression analysis, predictors of incident CKD included BP >140/90 mm Hg, higher glycated hemoglobin, lower baseline eGFR, and higher baseline urine albumin/creatinine ratio. Conclusions CKD incidence varies by Hispanic/Latino heritage and this disparity may be in part attributed to differences in sociodemographic characteristics. Culturally tailored public heath interventions focusing on the prevention and control of risk factors might ameliorate the CKD burden in this population.