Kidney Function and Long-Term Risk of End-Stage Kidney Disease and Mortality in a Multiethnic Population

Suping Ling; Gang Xu; Francesco Zaccardi; Kamlesh Khunti; Nigel J Brunskill

doi:10.1016/j.ekir.2023.06.014

Kidney Function and Long-Term Risk of End-Stage Kidney Disease and Mortality in a Multiethnic Population

Kidney Int Rep. 2023 Jun 19;8(9):1761-1771. doi: 10.1016/j.ekir.2023.06.014. eCollection 2023 Sep.

Authors

Suping Ling^{1

2

3}, Gang Xu⁴, Francesco Zaccardi^{1

2}, Kamlesh Khunti², Nigel J Brunskill^{4

5}

Affiliations

¹ Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, UK.
² Leicester Diabetes Centre, National Institute for Health Research (NIHR) Applied Research Collaboration - East Midlands (ARC-EM), Leicester, UK.
³ Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, LSHTM, London, UK.
⁴ Department of Nephrology, Leicester General Hospital, Gwendolen Rd, Leicester, UK.
⁵ Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.

Abstract

Introduction: Contemporary differences between South Asian and White ethnicities in the incidence of end-stage kidney disease (ESKD) and mortality are poorly described.

Methods: Data for all South Asian patients who had an estimated glomerular filtration rate (eGFR) measure after January 1, 2006, and 1 million randomly selected participants of other ethnicities were extracted from the Clinical Practice Research Datalink (CPRD). All participants were followed-up with from index date until ESKD, all-cause mortality, or end of study. All-cause mortality rate and ESKD incidence rate by age were described among Whites and South Asians, and adjusted hazard ratios (HRs) of these 2 outcomes by baseline eGFR estimated using Cox proportional hazard model.

Results: A total of 40,888 South Asians and 236,634 Whites were followed for a median of 5.3 and 9.4 years for ESKD incidence and mortality outcomes, respectively. All-cause mortality rates were higher among Whites than South Asians; South Asian women aged between 70 and 85 years had a slightly higher ESKD incidence rate compared to their White counterparts. Compared to Whites with a baseline eGFR of 90 ml/min per 1.73 m², adjusted HRs for all-cause mortality were significantly lower among South Asians than Whites; however, adjusted HRs for ESKD incidence by baseline eGFR were similar in both ethnicities. Calculating South Asian eGFRs using an ethnicity-specific equation had no impact on the results.

Conclusions: South Asians experience lower mortality than Whites but not substantially higher rates of ESKD. Further research is warranted to better understand the reasons for these ethnic differences and possible impacts on chronic kidney disease (CKD) service delivery and patient outcomes.

Keywords: chronic kidney disease; dialysis; end-stage kidney disease; ethnicity; mortality; transplantation.

Abstract

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