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Addressing Disparities in Healthcare

Chronic kidney disease in African Americans: Puzzle pieces are falling into place

Joseph V. Nally, MD
Cleveland Clinic Journal of Medicine November 2017, 84 (11) 855-862; DOI: https://doi.org/10.3949/ccjm.84gr.17007
Joseph V. Nally Jr
Former Director, Center for Chronic Kidney Disease
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    FIGURE 1

    Prognosis of chronic kidney disease (CKD) by glomerular filtration rate (GFR) and albuminuria.

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    FIGURE 2

    Risk for all-cause and major cause-specific death in black vs white patients.

    Adapted from Navaneethan SD, Schold JD, Arrigain S, Jolly SE, Nally JV Jr. Cause-specific deaths in non-dialysis-dependent CKD. J Am Soc Nephrol 2015; 26:2512–2520.

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    FIGURE 3

    Variants in the APOL1 gene that are common in sub-Saharan Africa protect against African sleeping sickness, but homozygosity for these variants increases the risk of chronic kidney disease.

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    FIGURE 4

    Proportion of patients free from progression of chronic kidney disease, according to APOL1 genotype, in the African American Study of Kidney Disease and Hypertension. The primary outcome was reduction in the glomerular filtration rate (as measured by iothalamate clearance) or incident end-stage renal disease.

    From Parsa A, Kao WH, Xie D, et al; AASK Study Investigators; CRIC Study Investigators. APOL1 risk variants, race, and progression of chronic kidney disease. N Engl J Med 2013; 369:2183–2196. Reprinted with permission from Massachusetts Medical Society.

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    TABLE 1

    Causes of death in patients with non-dialysis-dependent chronic kidney disease

    Cause of death, n (%)Overall (n = 6,661)eGFR 45–59 (n = 3,308)eGFR 30–44 (n = 2,261)eGFR < 30 (n = 1,092)
    Cardiovascular disease2,311 (34.7)1,017 (30.7)862 (38.1)432 (39.6)
     Ischemic heart disease1,227 (18.4)532 (16.1)457 (20.2)238 (21.8)
     Heart failure163 (2.4)61 (1.8)75 (3.3)27 (2.5)
     Cerebrovascular disease255 (3.8)123 (3.7)94 (4.2)38 (3.5)
     Other cardiovascular disease666 (10.0)301 (9.1)236 (10.4)129 (11.8)
    Malignant neoplasm2,117 (31.8)1,282 (38.8)616 (27.2)219 (20.1)
    Other cause2,233 (33.5)1,009 (30.5)783 (34.7)441 (40.3)
    • eGFR = estimated glomerular filtration rate

    • Adapted from reference 9.

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Cleveland Clinic Journal of Medicine: 84 (11)
Cleveland Clinic Journal of Medicine
Vol. 84, Issue 11
1 Nov 2017
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Chronic kidney disease in African Americans: Puzzle pieces are falling into place
Joseph V. Nally
Cleveland Clinic Journal of Medicine Nov 2017, 84 (11) 855-862; DOI: 10.3949/ccjm.84gr.17007

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Chronic kidney disease in African Americans: Puzzle pieces are falling into place
Joseph V. Nally
Cleveland Clinic Journal of Medicine Nov 2017, 84 (11) 855-862; DOI: 10.3949/ccjm.84gr.17007
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  • Article
    • ABSTRACT
    • ADVANCING UNDERSTANDING OF CHRONIC KIDNEY DISEASE
    • DEATHS FROM KIDNEY DISEASE
    • AFRICAN AMERICANS WITH KIDNEY DISEASE: A DISTINCT GROUP
    • GENETIC VARIANTS FOUND
    • EFFECT OF GENOTYPE ON KIDNEY TRANSPLANTS IN AFRICAN AMERICANS
    • KEEPING SCIENCE RELEVANT
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  • Alpha Globin Gene Copy Number Is Associated with Prevalent Chronic Kidney Disease and Incident End-Stage Kidney Disease among Black Americans
  • HBA Copy Number and Kidney Disease Risk among Black Americans: a Longitudinal Cohort Study
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