Asian Americans & chronic kidney disease in a nationally representative cohort

Kataoka-Yahiro et al. BMC Nephrology (2019) 20:10 https://doi.org/10.1186/s12882-018-1145-5 RESEARCH ARTICLE Open Access Asian Americans & chronic kidney disease in a nationally representative cohort Merle Kataoka-Yahiro1* , James Davis2, Krupa Gandhi2, Connie M. Rhee3 and Victoria Page4 Abstract Background: There is a paucity of specific data on early stages of chronic kidney disease (CKD) among Asian Americans (AAs). The objective of this study was to examine the independent association of Asian race/ethnicity and socio-demographic and co-morbidity factors with markers of early kidney damage, ascertained by ACR levels, as well as kidney dysfunction, ascertained by eGFR levels in a large cross-sectional sample of AAs enrolled in the National Health and Nutrition Examination Survey (NHANES). Methods: Secondary data analyses of the NHANES 2011–2014 data of a nationally representative sample of 5907 participants 18 years and older, US citizens, and of Asian and White race. NHANES data included race (Asian vs. White), as well as other socio-demographic information and comorbidities. Urine albumin-to-creatinine ratio (ACR) categories and estimated glomerular filtration rate (eGFR) were used as indicators for CKD. Descriptive analyses using frequencies, means (standard deviations), and chi-square tests was first conducted, then multivariable logistic regression serial adjustment models were used to examine the associations between race/ethnicity, other socio-demographic factors (age, sex, education), and co-morbidities (obesity, diabetes, hypertension) with elevated ACR levels (A2 & A3 – CKD Stages 3 and 4–5, respectively) as well as reduced eGFR (G3a-G5 and G3b –G5 - CKD Stage 3–5). Results: AAs were more likely than White participants to have ACR levels > 300 mg/g (A3) (adjusted OR (aOR) (95% CI) 2.77 (1.55, 4.97), p = 0.001). In contrast, adjusted analyses demonstrated that AAs were less likely to have eGFR levels < 60 ml/min/1.73 m2 (G3a-G5) (aOR (95% CI) 0.50 (0.35, 0.72), p < .001). Conclusions: This is one of the first large U.S. population-based studies of AAs that has shown a comparatively higher risk of elevated ACR > 300 mg/g levels (A3) but lower risk of having eGFR levels < 60 ml/min/1.732 m2 (G3a-G5). The findings support the need to address the gaps in knowledge regarding disparities in risk of early stage CKD among AAs. Background Asian Americans (AA)s are projected to be the second fastest growing racial/ethnic group in the U.S and are projected to nearly double to 9.3% of the total population by 2060 [1]. Currently, AAs represent 5.8% of the overall U.S. population [2] and there are approximately 20.4 million Asian adults and children living in the U.S. [3, 4]. Furthermore based on the 2016 U.S. Census, major Asian subgroups of people reported were Chinese (except Taiwanese) (4.9 million), Asian Indian (4.1 million), Filipino (3.9 million), Vietnamese (2.1 million), Korean (1.8 million), and Japanese (1.5 million). * Correspondence: 1 Department of Nursing, School of Nursing and Dental Hygiene, University of Hawai’i at Manoa, 2528 McCarthy Mall, Webster Hall 409, Honolulu, HI 96822, USA Full list of author information is available at the end of the article Thirty million adults in the United States (US) have chronic kidney disease (CKD) [5]. Compared to Whites, the prevalence of end-stage renal disease is 1.5 times greater for AAs [6]. AAs constitute about 5.5% of all patients in the U.S. receiving dialysis [7] and 5% of patients living with a functioning kidney transplant in 2013 [8]. In 2011, total Medicare spending rose 5% to $549.1 billion, while end-stage-renal disease expenditures rose 5.4% to $34.3 billion. In addition, total fee-for-service Medicare expenditures per person per year were $87,945 in 2011 [9]. The costs and spending will continue to increase based on the projected population growth of AAs in the U.S. in the next 50 years. Given these projections, disease prevention are imperative to address in the early stages of CKD among this population. While state-level data exists on end-stage renal disease and its treatment, there are no © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Kataoka-Yahiro et al. BMC Nephrology (2019) 20:10 granular and precise data on early stages of CKD specifically among AAs. CKD is common in people with cardiovascular disease (CVD), diabetes mellitus (DM), hypertension (HTN), and obesity [10]. DM and HTN are the two major risk factors for CKD worldwide [11] and are listed as the primary causes for 70% of new cases of CKD in the U.S. [12]. The prevalence of DM is approximately 40% higher in AAs relative to Whites [12] and 19% of AAs have HTN [13, 14]. Obesity is disproportionately more prevalent in certain Asian subgroups, is also associated with increased risk of development of CKD [15–17] as well as various kidney disease risk factors (e.g., HTN, DM, and dyslipidemia) [18]. There is a paucity of studies exploring the association of albumin to creatinine ratio (ACR) and estimated glomuerular filtration rate (eGFR) with CKD among AAs. International researchers who studied ACR and eGFR with CKD among Asians were from countries such as China, Korea, Japan, and Thailand. Among Asian populations with DM, CKD progresses twice as rapidly [19]. HTN has been associated with CKD among Chinese, Japanese, Filipino, and South Asians [14, 20, 21]. International researchers also found that obesity led to CKD through both indirect (i.e., DM, HTN, dyslipidemia) and direct mechanisms (i.e., glomerular hyperfiltration, inflammation) [22, 23]. Jolly et al. [24] and Mau et al. [25] utilized the U.S. National Kidney Foundation (NKF) Kidney Early Evaluation Program (KEEP) cross-sectional data of communitydwelling racial/ethnic participants and found AAs to have one of the highest odds for CKD based ACR levels. Kataoka-Yahiro et al. [26] and Wong et al. [27] conducted a cross-sectional study of the National Kidney Foundation of Hawaii (NKFH) Kidney Early Screening Program (KEDS) of community dwelling participants to further examine the relationship of risk factors and CKD of Asian Pacific Islanders (Native Hawaiians, Japanese, Chinese, Filipino, and Whites) in Hawaii. ACR and/or urine albumin levels, respectively were used as predictors for CKD. Significant results related to ACR in these studies included BMI, glucose, HTN, and Asian and/or Pacific Islander race/ethnicity. Ra (...truncated)