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

Lesley A. Inker; Tariq Shafi; Aghogho Okparavero; Hocine Tighiouart; John H. Eckfeldt; Ronit Katz; W. Craig Johnson; Norma Dermond; Zarqa Tariq; Imene Benayache; Wendy S. Post; Josef Coresh; Andrew S. Levey; Michael G. Shlipak

doi:10.1053/j.ajkd.2016.06.021

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

Lesley A. Inker, Tariq Shafi, Aghogho Okparavero, Hocine Tighiouart, John H. Eckfeldt, Ronit Katz, W. Craig Johnson, Norma Dermond, Zarqa Tariq, Imene Benayache, Wendy S. Post, Josef Coresh, Andrew S. Levey, Michael G. Shlipak

Laboratory Medicine and Pathology

Research output: Contribution to journal › Article › peer-review

36 Scopus citations

Abstract

Background 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.

Original language	English (US)
Pages (from-to)	743-751
Number of pages	9
Journal	American Journal of Kidney Diseases
Volume	68
Issue number	5
DOIs	https://doi.org/10.1053/j.ajkd.2016.06.021
State	Published - Nov 1 2016

Bibliographical note

Funding Information:
Financial Disclosure: Drs Inker, Coresh, and Levey have a provisional patent filed August 15, 2014: “Precise estimation of glomerular filtration rate from multiple biomarkers” PCT/US2015/044567. The technology is not licensed in whole or in part to any company; Tufts Medical Center, Johns Hopkins University, and Metabolon Inc have a collaboration agreement to develop a product to estimate GFR from a panel of markers. Dr Inker reports funding to Tufts Medical Center for research and contracts with the NIH, NKF, Pharmalink AB, Gilead Sciences, and Otsuka. Dr Eckfeldt is a consultant to Gentian, Moss, Norway. Siemens Healthcare Diagnostics Inc, Tarrytown, New York, has provided free or steeply discounted reagents for studies performed in Dr Eckfeldt’s research laboratory. Dr Coresh reports funding to Johns Hopkins University for research and contracts with the NIH and NKF. Dr Levey reports funding to Tufts Medical Center for research and contracts with the NIH, NKF, Amgen, Pharmalink AB, and Gilead Sciences. Drs Shafi and Post receive funding from the NIH. Dr Shlipak receives funding from the NIH and serves as an Advisor to Cricket Health and Tai Diagnostics. The other authors declare that they have no other relevant financial interests.

Funding Information:
Support: Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (NIH). This publication was made possible by the Johns Hopkins Institute for Clinical and Translational Research, which is funded in part by grant UL1 TR 001079 from the National Center for Advancing Translational Sciences , a component of the NIH, and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins Institute for Clinical and Translational Research, National Center for Advancing Translational Sciences, or NIH. This research was also supported by grant R01DK087961 from the NIH ; contracts N01-HC-95159 , N01-HC-95160 , N01-HC-95161 , N01-HC-95162 , N01-HC-95163 , N01-HC-95164 , N01-HC-95165 , N01-HC-95166 , N01-HC-95167 , N01-HC-95168 , and N01-HC-95169 from the National Heart, Lung and Blood Institute ; and grants UL1-TR-000040 and UL1-TR-001079 from the National Center for Research Resources . The funders of this study had no role in the study design; collection, analysis, and interpretation of the data; writing of the report; or the decision to submit the report for publication.

Publisher Copyright:
© 2016 National Kidney Foundation, Inc.

Keywords

GFR decline trajectory
Glomerular filtration rate (GFR)
albumin-creatinine ratio (ACR)
albuminuria
body size
chronic kidney disease (CKD)
ethnicity
health disparities
iohexol
measured GFR
race
racial differences
renal function
sex

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1053/j.ajkd.2016.06.021

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Inker, L. A., Shafi, T., Okparavero, A., Tighiouart, H., Eckfeldt, J. H., Katz, R., Johnson, W. C., Dermond, N., Tariq, Z., Benayache, I., Post, W. S., Coresh, J., Levey, A. S., & Shlipak, M. G. (2016). Effects of Race and Sex on Measured GFR: The Multi-Ethnic Study of Atherosclerosis. American Journal of Kidney Diseases, 68(5), 743-751. https://doi.org/10.1053/j.ajkd.2016.06.021

@article{ac8c2d64c88a41f1a5778747a92f2780,

title = "Effects of Race and Sex on Measured GFR: The Multi-Ethnic Study of Atherosclerosis",

abstract = "Background 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.",

keywords = "GFR decline trajectory, Glomerular filtration rate (GFR), albumin-creatinine ratio (ACR), albuminuria, body size, chronic kidney disease (CKD), ethnicity, health disparities, iohexol, measured GFR, race, racial differences, renal function, sex",

author = "Inker, {Lesley A.} and Tariq Shafi and Aghogho Okparavero and Hocine Tighiouart and Eckfeldt, {John H.} and Ronit Katz and Johnson, {W. Craig} and Norma Dermond and Zarqa Tariq and Imene Benayache and Post, {Wendy S.} and Josef Coresh and Levey, {Andrew S.} and Shlipak, {Michael G.}",

note = "Funding Information: Financial Disclosure: Drs Inker, Coresh, and Levey have a provisional patent filed August 15, 2014: “Precise estimation of glomerular filtration rate from multiple biomarkers” PCT/US2015/044567. The technology is not licensed in whole or in part to any company; Tufts Medical Center, Johns Hopkins University, and Metabolon Inc have a collaboration agreement to develop a product to estimate GFR from a panel of markers. Dr Inker reports funding to Tufts Medical Center for research and contracts with the NIH, NKF, Pharmalink AB, Gilead Sciences, and Otsuka. Dr Eckfeldt is a consultant to Gentian, Moss, Norway. Siemens Healthcare Diagnostics Inc, Tarrytown, New York, has provided free or steeply discounted reagents for studies performed in Dr Eckfeldt{\textquoteright}s research laboratory. Dr Coresh reports funding to Johns Hopkins University for research and contracts with the NIH and NKF. Dr Levey reports funding to Tufts Medical Center for research and contracts with the NIH, NKF, Amgen, Pharmalink AB, and Gilead Sciences. Drs Shafi and Post receive funding from the NIH. Dr Shlipak receives funding from the NIH and serves as an Advisor to Cricket Health and Tai Diagnostics. The other authors declare that they have no other relevant financial interests. Funding Information: Support: Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (NIH). This publication was made possible by the Johns Hopkins Institute for Clinical and Translational Research, which is funded in part by grant UL1 TR 001079 from the National Center for Advancing Translational Sciences , a component of the NIH, and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins Institute for Clinical and Translational Research, National Center for Advancing Translational Sciences, or NIH. This research was also supported by grant R01DK087961 from the NIH ; contracts N01-HC-95159 , N01-HC-95160 , N01-HC-95161 , N01-HC-95162 , N01-HC-95163 , N01-HC-95164 , N01-HC-95165 , N01-HC-95166 , N01-HC-95167 , N01-HC-95168 , and N01-HC-95169 from the National Heart, Lung and Blood Institute ; and grants UL1-TR-000040 and UL1-TR-001079 from the National Center for Research Resources . The funders of this study had no role in the study design; collection, analysis, and interpretation of the data; writing of the report; or the decision to submit the report for publication. Publisher Copyright: {\textcopyright} 2016 National Kidney Foundation, Inc.",

year = "2016",

month = nov,

day = "1",

doi = "10.1053/j.ajkd.2016.06.021",

language = "English (US)",

volume = "68",

pages = "743--751",

journal = "American Journal of Kidney Diseases",

issn = "0272-6386",

publisher = "W.B. Saunders",

number = "5",

}

TY - JOUR

T1 - Effects of Race and Sex on Measured GFR

T2 - The Multi-Ethnic Study of Atherosclerosis

AU - Inker, Lesley A.

AU - Shafi, Tariq

AU - Okparavero, Aghogho

AU - Tighiouart, Hocine

AU - Eckfeldt, John H.

AU - Katz, Ronit

AU - Johnson, W. Craig

AU - Dermond, Norma

AU - Tariq, Zarqa

AU - Benayache, Imene

AU - Post, Wendy S.

AU - Coresh, Josef

AU - Levey, Andrew S.

AU - Shlipak, Michael G.

N1 - Funding Information: Financial Disclosure: Drs Inker, Coresh, and Levey have a provisional patent filed August 15, 2014: “Precise estimation of glomerular filtration rate from multiple biomarkers” PCT/US2015/044567. The technology is not licensed in whole or in part to any company; Tufts Medical Center, Johns Hopkins University, and Metabolon Inc have a collaboration agreement to develop a product to estimate GFR from a panel of markers. Dr Inker reports funding to Tufts Medical Center for research and contracts with the NIH, NKF, Pharmalink AB, Gilead Sciences, and Otsuka. Dr Eckfeldt is a consultant to Gentian, Moss, Norway. Siemens Healthcare Diagnostics Inc, Tarrytown, New York, has provided free or steeply discounted reagents for studies performed in Dr Eckfeldt’s research laboratory. Dr Coresh reports funding to Johns Hopkins University for research and contracts with the NIH and NKF. Dr Levey reports funding to Tufts Medical Center for research and contracts with the NIH, NKF, Amgen, Pharmalink AB, and Gilead Sciences. Drs Shafi and Post receive funding from the NIH. Dr Shlipak receives funding from the NIH and serves as an Advisor to Cricket Health and Tai Diagnostics. The other authors declare that they have no other relevant financial interests. Funding Information: Support: Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (NIH). This publication was made possible by the Johns Hopkins Institute for Clinical and Translational Research, which is funded in part by grant UL1 TR 001079 from the National Center for Advancing Translational Sciences , a component of the NIH, and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins Institute for Clinical and Translational Research, National Center for Advancing Translational Sciences, or NIH. This research was also supported by grant R01DK087961 from the NIH ; contracts N01-HC-95159 , N01-HC-95160 , N01-HC-95161 , N01-HC-95162 , N01-HC-95163 , N01-HC-95164 , N01-HC-95165 , N01-HC-95166 , N01-HC-95167 , N01-HC-95168 , and N01-HC-95169 from the National Heart, Lung and Blood Institute ; and grants UL1-TR-000040 and UL1-TR-001079 from the National Center for Research Resources . The funders of this study had no role in the study design; collection, analysis, and interpretation of the data; writing of the report; or the decision to submit the report for publication. Publisher Copyright: © 2016 National Kidney Foundation, Inc.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Background 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.

AB - Background 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.

KW - GFR decline trajectory

KW - Glomerular filtration rate (GFR)

KW - albumin-creatinine ratio (ACR)

KW - albuminuria

KW - body size

KW - chronic kidney disease (CKD)

KW - ethnicity

KW - health disparities

KW - iohexol

KW - measured GFR

KW - race

KW - racial differences

KW - renal function

KW - sex

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DO - 10.1053/j.ajkd.2016.06.021

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AN - SCOPUS:84994851709

SN - 0272-6386

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

Abstract

Bibliographical note

Keywords

UN SDGs

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