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PubMed2004

Resting energy expenditure of chronic kidney disease patients: influence of renal function and subclinical inflammation.

BACKGROUND: The resting energy expenditure (REE) of patients with chronic kidney disease (CKD) might be influenced by the degree of renal function and by a subclinical inflammatory condition. The aim of this study is to evaluate the impact of these 2 variables on the REE of patients with CKD. METHODS: A cross-sectional study was performed on 91 nondialyzed and nondiabetic patients with CKD with no clinical signs of inflammation. Patients were divided into quartiles of creatinine clearance (CrCl) and tertiles of C-reactive protein (CRP) level. REE was measured by means of indirect calorimetry, and the presence of a subclinical inflammatory condition was assessed by means of serum CRP concentration. RESULTS: CrCl interquartile ranges calculated were: quartile 1 (CrCl < or = 18 mL/min [< or =0.30 mL/s]; n = 24); quartile 2 (CrCl, 19 to 29 mL/min [0.31 to 0.48 mL/s]; n = 22); quartile 3 (CrCl, 30 to 42 mL/min [0.49 to 0.70 mL/s]; n = 23), and quartile 4 (CrCl > or = 43 mL/min [> or =0.71 mL/s]; n = 22). Nonadjusted REE and REE adjusted for sex, age, and lean body mass did not differ among the 4 CrCl quartiles. The following ranges were calculated for CRP tertiles: tertile 1 (CRP < or = 0.14 mg/dL; n = 30), tertile 2 (CRP, 0.15 to 0.49 mg/dL; n = 31), and tertile 3 (CRP > or = 0.50 mg/dL; n = 30). The nonadjusted REE in CRP tertile 3 was significantly greater than those in tertiles 1 and 2. REE adjusted for sex, age, and lean body mass was greater in CRP tertile 3 than tertile 1, a difference equivalent to 123.7 kcal/d (P = 0.003; 95% confidence interval, 42.9 to 204.5). A borderline difference was observed between CRP tertiles 3 and 2. When analyzing the entire group, REE did not correlate with either serum creatinine level or CrCl, and a borderline correlation between REE and log of CRP was observed (r = 0.19; P = 0.07). CONCLUSION: This study suggests that REE is not influenced by degree of renal function, but it may be elevated during a condition of subclinical inflammation.

Chronic Disease↗
PubMed2005

Chronic kidney disease and cognitive impairment in menopausal women.

BACKGROUND: Although end-stage renal disease has been associated with cognitive impairment, the relation between lesser degrees of chronic kidney disease (CKD) and cognitive impairment is less well understood. METHODS: Data for 1,015 women enrolled at 10 of the 20 Heart Estrogen/Progestin Replacement Study clinical sites were analyzed. All participants were younger than 80 years and had established coronary artery disease at study entry. Participants underwent 6 standard tests of cognitive function evaluating various domains. Unadjusted, residual age- and race-adjusted, and multivariable-adjusted linear and logistic regression models were used. Glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease regression equation. In addition to analyses across the spectrum of GFRs, CKD was categorized as mild (estimated GFR [eGFR], 45 to 60 mL/min/1.73 m2), moderate (eGFR, 30 to 44 mL/min/1.73 m2), and severe (eGFR, <30 mL/min/1.73 m2) according to a modification of recently established classification guidelines. RESULTS: Mean eGFR was 57 +/- 14 mL/min/1.73 m2. In multivariable analyses, eGFR was associated significantly with impairment in global cognition, executive function, language, and memory (approximately 15% to 25% increase in risk for dysfunction/10-mL/min/1.73 m2 decrement in eGFR). Associations among eGFR and cognitive function were independent of residual effects of age and race (2 key determinants of GFR) and the contributions of education, lifestyle factors, stroke, diabetes, and other laboratory variables. CONCLUSION: CKD is associated with cognitive impairment in menopausal women with coronary artery disease.

Adult↗
PubMed2005

Darbepoetin alfa treatment for post-renal transplantation anemia during pregnancy.

Anemia is common in patients with chronic kidney disease (CKD) and those who have received a kidney allograft. Anemia is most prevalent in kidney transplant recipients before and immediately after transplantation, but also can occur months after transplantation if the donor kidney begins to fail. Replacement therapy for CKD-related and posttransplantation anemia is effective through the administration of exogenous erythropoiesis-stimulating proteins. Darbepoetin alfa (Aranesp; Amgen Inc, Thousand Oaks, CA) is a unique erythropoiesis-stimulating protein that can be administered at an extended dosing interval relative to recombinant human erythropoietin because of its approximately 3-fold longer serum half-life. Although darbepoetin alfa has been shown to be an effective treatment for patients with anemia of CKD and anemia after kidney transplantation, limited data have been published showing efficacy in treating women with anemia of these conditions during pregnancy. We report a case of successful darbepoetin alfa treatment for severe anemia in a pregnant transplant recipient.

Adult↗
PubMed2006

Prevalence and severity of renal disease in familial dysautonomia.

BACKGROUND: One of the less well-defined complications of familial dysautonomia (FD) is chronic kidney disease (CKD). The goal of this report is to better define the prevalence and severity of kidney disease in this population and identify associated risk factors. METHODS: We conducted a retrospective analysis of the database of the Dysautonomia Treatment and Evaluation Center at New York University School of Medicine for patients with FD who were seen at ages 15, 20, 25, 30, 35, and 40 years. Estimated glomerular filtration rate (GFR) was compared with that of the general population. Changes in mean blood pressure from supine to erect at ages 15 and 20 years were analyzed for patients who eventually required dialysis therapy and compared with those of the other patients with FD. Percentage of patients requiring dialysis and duration of treatment also were analyzed. RESULTS: Mean estimated GFR of each predefined age group was considerably less than that of the general population starting at age 15 years (P < 0.001). Patients with FD were more likely to develop stage 3, 4, or 5 CKD than the general population. Of patients who remained alive at age 25 years, 19% eventually required dialysis. Those who required dialysis therapy were less likely to have had a feeding gastrostomy tube placed (P < 0.001) and had much more pronounced postural changes in blood pressure (P < 0.0001) by age 15 years. For those requiring dialysis therapy, average duration of treatment was 9 months. CONCLUSION: Patients with FD are far more likely than the general population to develop CKD. Patients with FD who eventually required dialysis showed a greater degree of orthostatic hypotension and were significantly less likely to have had a feeding gastrostomy tube placed for hydration before the age of 15 years. Dialysis therapy is not well tolerated in this population.

Adolescent↗
PubMed2004

Ethical implications of ethnic disparities in chronic kidney disease and kidney transplantation.

Chronic kidney disease (CKD) is a major epidemic in underserved and minority populations largely due to excess rates of hypertensive and diabetic kidney disease. Multiple complex socioeconomic barriers to early diagnosis and optimal therapies as well as delayed referral for kidney transplantation have created disparities in CKD care provided to ethnic minorities. Disparities exist in wait list time and kidney transplant rates for Native Americans and blacks, independent of insurance status. Moreover, independent of genetic matching, long-term transplant outcomes in blacks remain significantly lower than all other ethnic groups, suggesting that poorly understood social factors contribute to these survival differences. The existence of these disparities raises ethical concerns of equity and social justice in terms of the allocation of scarce resources. Although current changes in allocation policies will improve some disparities, more efforts are ultimately needed to improve access to care and the overall health and survival for all individuals at risk for CKD, independent of their race, ethnicity, or socioeconomic status.

Black or African American↗
PubMed2004

Dietary treatment of blood pressure in kidney disease.

Most patients with chronic kidney disease (CKD) also have hypertension. It is critical to control blood pressure in CKD to decrease the risk of negative outcomes. Modification of diet can reduce blood pressure, most notably in people with hypertension and in older adults. Current guidelines recommend reducing sodium intake to less than 2.4 g/day and increasing potassium and calcium intakes. Sodium reduction is supported for CKD patients in general. However, increasing potassium intake should be restricted in patients with glomerular filtration rate (GFR) less than 60 mL/min/1.73 m(2). In addition, because of the high phosphorus levels of many calcium-rich foods such as dairy products, calcium intake also should be limited in this low-GFR population. There is increasing evidence for the association of other nutrients such as omega-3 polyunsaturated fatty acids and vitamin C with blood pressure. Those nutrients are also discussed here.

Blood Pressure↗
PubMed2005

Is energy intake underestimated in nondialyzed chronic kidney disease patients?

OBJECTIVE: To evaluate whether energy intake of nondialyzed chronic kidney disease (CKD) patients is underestimated. DESIGN: Cross-sectional study. SETTING: Outpatient clinic of the Federal University of Sao Paulo, Oswaldo Ramos Foundation. PATIENTS: One hundred and thirty-one nondialyzed CKD patients (86 male, 66%; body mass index [BMI] 26 +/- 4.21, mean +/- standard deviation) were included. Body weight change was evaluated after 6 to 12 months in 59 patients of the entire group. METHODS: Energy intake was evaluated using 4-day food diaries (3 weekdays and 1 weekend day), and resting energy expenditure (REE) was measured by indirect calorimetry. The ratio of energy intake to REE (EI/REE) was used to evaluate the accuracy of the recorded energy intake. An EI/REE ratio below 1.27 was used to identify patients who were underreporting their current energy intake. RESULTS: The majority of the patients reported an energy intake substantially below the recommendation (22.4 +/- 7.15 kcal/kg/d) and had an EI/REE ratio lower than 1.27. In patients with a BMI >or= 25, the mean EI/REE ratio was significantly lower than that of patients with a BMI < 25 (1.01 +/- 0.28 versus 1.27 +/- 0.42, P < .01, respectively). In addition, only in the group with higher BMI was the mean ratio indicative of underreporting. When the body weight of a subgroup of patients (n = 59) was evaluated after 7.9 +/- 2.4 months, it was observed that the subgroup of patients who maintained or gained body weight had a mean EI/REE not compatible with this condition (1.13 +/- 0.38). The low ratio, despite increasing or maintaining body weight, is highly suggestive of underreported energy intake. CONCLUSION: Energy intake of nondialyzed CKD patients seemed to be underestimated and was more pronounced in overweight and obese patients.

Body Mass Index↗
PubMed2005

Prospective nutritional surveillance using bioelectrical impedance in chronic kidney disease patients.

Malnutrition is a well-known risk factor influencing survival in chronic maintenance dialysis patients. Chronic kidney disease (CKD) patients are also predisposed to malnutrition because of dietary restrictions and the catabolic effects of uremia. Therefore, a significant degree of malnutrition may be present before the initiation of renal replacement therapy. We consequently initiated a prospective evaluation of subjects attending the CKD clinic, where all patients are seen by a renal dietitian and nutritional, biochemical, and bioimpedance parameters are measured every 3 months. A total of 40 patients have completed 9 months of follow-up and are the subject of this report. Their mean age is 65 +/- 12 years, 48% female, 68% black, and 58% diabetic patients. The glomerular filtration rate did not change during follow-up (36 +/- 12 versus 34 +/- 14 mL/min/1.72 m 2 , at baseline and 9 months, respectively). Similarly, no differences between baseline and 9 months were noted in weight (88.0 +/- 20.3 versus 86.8 +/- 18.7 kg, respectively) or body mass index (30.6 +/- 5.8 versus 30.2 +/- 5.4 kg/m 2 , respectively). In addition, no differences between baseline and 9 months were noted in total body water (44.4 +/- 11.4 versus 44.6 +/- 10.8 L, respectively), body cell mass (25.3 +/- 7.4 versus 25.2 +/- 7.0 kg, respectively), and fat-free mass (59.2 +/- 16.6 versus 59.4 +/- 15.7 kg, respectively). The bioimpedance vector decreased with time in 25 subjects (62%), indicating a state of overhydration. Subjects were further analyzed by vector category. Body cell mass did not change in either group. As expected, total body water increased in the group with a decreasing bioimpedance vector. Because body cell mass did not increase, the greater total body water reflected an increase in extracellular volume (edema). In the group with stable vectors, no changes were noted with time in weight or total body water. These results indicate that CKD patients with stable renal function following a judicious dietary protein intake (0.6 to 0.8 g/kg normalized body weight/day) have no loss of body cell mass or fat-free mass over a 9-month period. Of note, a high proportion of patients (62%) developed clinically unrecognized fluid retention, which is promptly identified by a decreasing bioimpedance vector.

Aged↗
PubMed2006

New therapies for uremic secondary hyperparathyroidism.

Secondary hyperparathyroidism (SHPT) is a common and serious complication of chronic kidney disease (CKD). It affects more than 300,000 end-stage renal disease patients treated by dialysis and probably more than 3 million patients with CKD worldwide. For a long time, traditional therapies for SHPT had consisted of correcting the hypocalcemia using calcium salts and vitamin D derivatives, preventing the hyperphosphatemia by calcium- or aluminum-containing intestinal phosphate binders, and recently by using no metal-containing intestinal phosphate binders; however, these therapies are limited by the occurrence of hypercalcemia, hyperphosphatemia, and the lack of specificity and long-term efficacy. Moreover, surgical parathyroidectomy (PTX), which remains the gold standard therapy, is not exempt from risk. PTX exposes patients to anesthesia risks, presurgical and postsurgical complications, and in many cases a permanent state of hypoparathyroidism. Thus, the medical treatment of SHPT became an ideal target for the development of new therapies and strategies. The purpose of this article is to provide an overview of these new therapies, including vitamin D analogs, intestinal phosphate binders, calcimimetics, parathyroidectomies, tyrosine kinase inhibitors, azydothymidine, anticalcineurins, N-terminal truncated parathyroid hormone fragments, bisphosphonates, calcitonin, osteoprotegerin, and others. The use of these new therapies alone or in combination may help to optimize the future treatment of SHPT in CKD patients.

Acidosis↗
PubMed2007

Disorders in high-density metabolism with insulin resistance and chronic kidney disease.

Cardiovascular risk increases with each decrement in renal function. Low-density lipoprotein (LDL) cholesterol levels are not associated with increased mortality, but high-density lipoprotein (HDL) levels are inversely associated with cardiovascular risk. Lipoprotein composition with increased abundance of small dense LDL and HDL and reduced levels of more buoyant isoforms is similar to what is found in states of insulin resistance and in the metabolic syndrome (MS). In both cases, high triglyceride levels are associated with reduced HDL levels. Chronic kidney disease (CKD) is itself associated with increasing insulin resistance as renal function fails. In both instances, decreased levels of apo A-I and apo A-II are a consequence of increased fractional catabolic rate (FCR), resulting from a predominance of small HDL particles. HDL maturation is impaired in CKD through decreased activity of lecithin:cholesterol acyltransferase (LCAT), and increased cholesterol ester transfer protein (CETP) activity in MS shuttles triglycerides back into HDL, thereby destabilizing it. Whether insulin resistance is entirely responsible for disorders of HDL metabolism in CKD, or whether the process is a result of unrelated pathophysiology, is currently unknown.

Apolipoproteins↗
PubMed2004

Special aspects of renal osteodystrophy in children.

Renal osteodystrophy represents a spectrum of skeletal lesions that range from high-turnover to low-turnover bone disease. Similar factors are involved in the pathogenesis of renal osteodystrophy in adult and pediatric patients with chronic kidney disease (CKD). However, growth retardation and the development of bone deformities are specific complications that occurred in pediatric patients with CKD. Metabolic acidosis, renal osteodystrophy, malnutrition, and disturbances in the insulin growth factor (IGF)/growth hormone (GH) are among the main factors involved and they are discussed briefly in this article. In addition to disturbances in bone remodeling, longitudinal bone growth occurs at the growth plate cartilage by endochondral ossification. Although young rats with experimental CKD have growth retardation, the characteristics of the growth plate are markedly different between animals with severe secondary hyperparathyroidism and those with calcium-induced adynamic osteodystrophy. These disturbances may suggest potential molecular mechanisms by which endochondral bone formation may be altered in renal failure, consequently leading to growth retardation.

Acidosis, Renal Tubular↗
PubMed2004

Vitamin D receptor and analogs.

In chronic kidney disease (CKD), high circulating levels of parathyroid hormone (PTH) cause osteitis fibrosa, bone loss, and cardiovascular complications that increase morbidity and mortality. Impaired production of 1,25-dihydroxyvitamin D (calcitriol), the hormonal form of vitamin D, is a major contributor to the generation and maintenance of parathyroid hyperplasia and increased synthesis and secretion of PTH. Calcitriol inhibits PTH gene transcription and ameliorates parathyroid hyperplasia by suppressing the expression of and growth signals from the autocrine transforming growth factor alpha (TGFalpha)/epidermal growth factor receptor (EGFR)-growth loop, a main determinant of parathyroid cell proliferation. Calcitriol reduction of parathyroid hyperplasia and serum PTH levels demands a functional vitamin D receptor (VDR). Although VDR is normal in CKD, parathyroid VDR content is reduced markedly. Furthermore, VDR function, as a transcriptional regulator of vitamin D responsive genes, is impaired by several factors including hypocalcemia, hyperphosphatemia, accumulation of uremic toxins, and reduction in cellular levels of the VDR partner, retinoid X receptor. Therapy with calcitriol analogs can overcome the antagonism on calcitriol-VDR actions induced by CKD. Although not all analog formulations are equally effective, they offer a wider therapeutic window in counteracting vitamin D resistance and survival advantage over exclusive calcitriol therapy.

Calcitriol↗
PubMed2002

The role of comprehensive renal clinic in chronic kidney disease stabilization and management: The Northwestern experience.

In this article, we maintain that the management of patients with chronic kidney disease (CKD) is best provided in a clinic setting that integrates nephrologic expertise, patient education, and comprehensive supportive services. Our experience with a CKD clinic in an urban academic setting is described. As a way to assess and quantify the impact of our clinic on clinical outcomes, we have analyzed our results in terms of 2 variables: presence of permanent access at the time of dialysis initiation and impact on renal function as assessed by calculated glomerular filtration rate (GFR). The number of clinic visits was taken as an index of comprehensive renal care before dialysis initiation. Individuals who started dialysis with a functioning permanent access had been seen in our clinic more frequently than those seen less frequently (20 +/- 3.5 and 4.4 +/- 2.1 visits, respectively, P <.005). The impact on renal function was analyzed in a group of 80 unselected patients stratified into 3 stages based on the recently published National Kidney Foundation Disease Outcomes Quality Initiative (K/DOQI) guidelines: stage III (mean GFR 39 +/- 1.5 mL/min, n = 21), stage IV (mean GFR 21 +/- 0.6 mL/min, n = 46), and stage V (mean GFR 12 +/-.76 mL/min, n = 13). Provision of comprehensive renal care in conjunction with anemia management using weekly injections of erythropoietin subcutaneously resulted in stabilization of GFR in patients with stages IV and V over a period of 15 months of follow-up evaluation. In patients with stage III CKD, GFR decreased over the initial period of follow-up evaluation (first few months), and to a lesser extent by the end of follow-up evaluation (15 mo). Further studies are underway to discern the factor(s) underlying the overall clinic effect versus a beneficial effect of anemia correction on GFR. Our data suggests that stabilization of GFR is a goal that can be accomplished with comprehensive renal care provided in an organized clinic setting.

Ambulatory Care Facilities↗
PubMed2003

Anticoagulation in acute cardiac care in patients with chronic kidney disease.

The number of patients with coexisting chronic kidney disease (CKD) and cardiovascular disease is growing rapidly. Treatment of these patients is challenging, primarily because of a lack of pharmacokinetic and clinical trial data associated with these combined disease entities. In this report, we discuss the cardiovascular disease risk associated with CKD and review the use of anticoagulation for acute cardiovascular disease in patients with CKD. We evaluate the potential role of direct thrombin inhibitors in patients with renal disease who have acute coronary syndromes, with particular focus on the clinical efficacy of bivalirudin. We conclude that direct thrombin inhibitors, including bivalirudin and argatroban, may be promising alternatives to heparin in patients who have renal insufficiency and are therefore at an increased risk for bleeding. In the treatment of patients with advanced renal insufficiency and cardiovascular disease, however, these agents should be used with dose modification to account for altered excretion.

Anticoagulants↗
PubMed2005

Delivery of predialysis care in an academic referral nephrology practice.

The purpose of this study was to obtain a detailed picture of the delivery of all aspects of pre-end stage renal disease (ESRD) care in an academic nephrology practice. The study consisted of a cross-sectional review of the charts of 111 patients with chronic kidney disease (CKD) (Creatinine >1.5 mg/dL for males, Creatinine > 1.3 mg/dL for females) followed either in a private practice or a public hospital clinic. Charts were reviewed for evidence of a number of quality of care items including the degree of blood pressure control, the use of angiotensin II blockade, treatment of anemia, bone disease, and cardiovascular risk factors, as well as evidence of dialysis orientation and vascular access placement. Compared with previous published studies, this study shows encouraging trends towards better outcomes in at least two areas with evidence of improvement in hemoglobin levels, use of angiotensin II blockade, and degree of blood pressure control. However it also reveals many areas where care could be improved. This was particularly true in the areas of access placement, bone and mineral metabolism, and cardiovascular disease. It will be interesting to see whether the recent introduction of CKD guidelines by the National Kidney Foundation (NKF) and the associated educational initiatives for primary care physicians and nephrologists that are planned will further serve to improve the management of CKD patients in the years to come.

Academic Medical Centers↗
PubMed2006

Risk factors and prevention of end stage renal disease in uruguay.

Uruguay is a developing country with a privileged established program for renal replacement therapy (RRT) for all patients with end stage renal disease (ESRD) since 1981. In December 2004, the RRT prevalence reached 916 patients per million population. The ESRD incidence has not changed significantly in the last eight years, differing with what is observed in other countries. In contrast, the ESRD incidence secondary to diabetic nephropathy has shown a permanent increase. The prevention of chronic kidney disease (CKD) began in 1989 with the Program of Prevention and Treatment of Glomerulonephritis (PPTG), being extended in 2002 to all CKD and canalized through the National Program of Renal Healthcare (NPRH) since 2004. The registry of glomerulonephritis has been demonstrated in recent years: patients are referral to nephrologists earlier, there is an increase of the frequency of patients with "clinical remission," and thus there is a decrease of the frequency of ESRD in the first three months after referral. The NPRH has been developed in a progressive way with the involvement of government authorities and the active participation of the nephrologists. A global prevention program, integrating the prevention of CKD, cardiovascular diseases, hypertension, and diabetes was developed. The first steps of the program have had important achievements: a rational reorientation of nephrologic care in the first level of attention, patient access to renoprotective medications without cost; a registration system of patients, the creation of a formal multidisciplinary team, and the instauration of a continuous medical education program.

Disease Progression↗
PubMed2004

Glomerular endothelial dysfunction in chronic kidney disease.

A dysfunctioning glomerular endothelium was demonstrated in chronic kidney disease (CKD) patients by means of in vitro endothelial cell cytotoxicity test and of in vivo intrarenal hemodynamic study. An enhanced endothelial cell cytotoxicity in CKD patients was 26.5 +/- 12% as compared to 0.4 +/- 1% of control. An altered intrarenal hemodynamics revealed 1) a reduction in renal plasma flow, 190 +/- 67 mL/min/1.73 m2 versus control 595 +/- 45 mL/min/1.73 m2, and in peritubular capillary flow, 149 +/- 55 mL/min/1.73 m2 versus control 479 +/- 46 mL/min/1.73 m2, 2) an elevated intraglomerular hydrostatic pressure, 55 +/- 2 mmHg versus control 51 mmHg, elevated afferent arteriolar resistance, 13184 dyne x s x cm(-5) versus control 2443 +/- 154 dyne x s x cm(5), and elevated efferent arteriolar resistance, 13591 +/- 7591 dyne x s x cm(-5) versus control 3062 +/- 177 dyne x s x cm(-5). Both enhanced endothelial cell cytotoxicity and altered intrarenal hemodynamics reflect glomerular endothelial dysfunction which is likely responsible for the renal disease progression in CKD.

Case-Control Studies↗
PubMed2004

Ankle brachial index independently predicts early kidney disease.

INTRODUCTION: Chronic kidney disease (CKD) and atherosclerotic cardiovascular disease (CVD) are often both present in selected populations. The independent association of early renal disease and atherosclerosis has not been studied in the general population. We hypothesized that the presence of low ankle brachial index (ABI), a surrogate measure of atherosclerotic cardiovascular disease, is associated with a low estimated glomerular filtration rate (GFR). METHODS: The study population consisted of 14,917 middle-aged black and white men and women from the Atherosclerosis Risk in Communities (ARIC) Study. An ABI<0.90 was defined as the exposure, and an estimated GFR<90 mL/min/1.73 m2 was defined as the outcome. Logistic regression analysis was performed cross-sectionally using an ABI of 1.00-1.19 as the reference, and was adjusted for the usual cardiovascular risk factors. RESULTS: The presence of an ABI<0.90 was associated with an increased odds of having an estimated GFR<90 (OR: 1.80; 95% C.I.: 1.40-2.32) compared to the reference group. After adjustment, an ABI<0.90 remained significant, and increased the odds of having an estimated GFR<90 (OR: 1.54; 95% C.I.: 1.17-2.04) compared to the reference group. The odds ratio for GFR<90 was higher among African Americans than Whites, 1.88 versus 1.36 respectively. DISCUSSION: This study gives support to the independent association of early CKD and atherosclerotic CVD. The relationship appears to be stronger among African Americans than among Whites. It will be necessary to investigate this observation more fully with prospective studies given the rising incidence of CKD.

Black or African American↗