April 22, 2008

African Americans Have Rapid Kidney Disease Progression

African Americans living with HIV and chronic kidney disease (CKD) progress far more rapidly to end-stage renal disease (ESRD)—requiring dialysis or kidney transplantation—than white people with HIV and CKD, according to a study to be published in a future issue of the Journal of Infectious Diseases.

Though previous studies of people living with HIV have found African Americans to have as much as 50 times more risk for developing ESRD than whites, no studies so far have looked closely at what might lead to this much higher rate. Some have speculated that African Americans may simply be at greater risk of developing CKD, which is a precursor to ESRD, but this has so far not been conclusively proven.

Gregory Lucas, MD, and his colleagues at Johns Hopkins University in Baltimore examined the medical records of a cohort of more than 5,000 HIV patients who receive their health care through the John Hopkins medical clinics. Lucas’s team found 4,259 non-Hispanic people, of whom 3,332 were African American and 927 were white, who had sufficient documentation to determine the rates and risk factors for the development of both CKD and ESRD.

Lucas’s team found that African Americans were slightly less than two times more likely to develop CKD than white patients, after controlling for factors like age, CD4 count and hepatitis C virus (HCV) coinfection (a risk factor for kidney disease, as well as liver disease). In contrast, after developing CKD, African Americans were 17 times more likely to further progress to ESRD than white patients.

Although certain measures of kidney health at the first clinic visit were also associated with the development of ESRD, none had anywhere near the predictive value of race. Given that African Americans were only somewhat more likely to develop CKD compared with whites in the study, Lucas’s team states that the higher rates of ESRD in African Americans is most likely due to a much more rapid progression of disease once they develop CKD.

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Previous Comments:

Andrew Williams, Silver Spring, 2008-04-27 23:14:02
I am a black dialysis patient (8yrs) who was diagnosed 7yrs before needing diaylsis and was NOT TREATED to prevent ESRD. In my mind and by my experience BLACKS are not treated and this is why blacks are more likely to progress to ESRD, and all other sicknesses, quicker than our white counterparts

Benny Cole, INDIANAPOLIS, 2008-04-26 11:10:50
Are there any pre-trial or clinical studies being done at the present time to determine what causes progression of CKD in African Americans. And if possible relay message to me by email.

Patrick, , 2008-04-23 17:41:22
I am curious as to the impact HIV medcations have on CKD and ESRD. I have often heard that renal capacity improves if the virus itself is controled.

Steve, New York, 2008-04-23 16:14:16
What tests are available to determine CDK early and what can be done to prolong good healthy kidney function?