Using Multivariate Quantile Regression Analysis to Explore Cardiovascular Risk Differences in Subjects with Chronic Kidney Disease by Race and Ethnicity: Findings from the U.S. Chronic Renal Insufficiency Cohort Study
Background and Aims: Adults with chronic kidney disease (CKD) carry an extraordinarily high risk for cardiovascular disease (CVD).The present study aimed to test two hypotheses that: (1) CVD risk factors disproportionately affect non-Hispanic black (NHB) with CKD than non-Hispanic white (NHW). (2) This difference significantly contributes to an excess risk of CVD in NHB versus NHW.
Methods: A total of 3,939 aged 21-74 years old participating in the Chronic Renal Insufficiency Cohort Study was analyzed. A sum weighted CVDRisk score was constructed from well-established CVD risk factors. Differences in CVDRisk score by race/ethnicity were tested using quantile regression (Qreg) analysis.
Results: The prevalence of CVD was 30.7% in NHW and 38.2% in NHB (p<0.001). The means (SD) of CVDRisk score were 12.6 (5.7) in NHW and 14.6 (6.4) in NHB (p<0.001). Qreg analysis indicated that NHB with estimate glomerular filtration rate (eGFR) 30-59.9 ml/min/1.73m2 had significantly higher (worse) CVDRisk scores across all quantiles (Qs) than NHW. This race differences in CVDRisk were also significantly higher in NHB with eGFR 60-70 ml/min/1.73m2 in Qs 1 and 2 as compared to their NHW counterparts. An estimated 35.8% of the excess prevalent CVD could be attributable to the difference in CVDRisk for NHB versus NHW.
Conclusion: NHB have a significantly higher CVD risk factor score in those with moderate and mild CKD than NHW.
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