rans had a 2.5-fold higher cumulative incidence of kidney failure, compared with White veterans, in any follow-up period from CKD onset. This disparity resulted from a combination of higher hazards of progression to kidney failure and lower hazards of competing-risk death in Black veterans. Both, in turn, were largely explained by the younger age at CKD onset in Black veterans, underscoring an urgent need to prevent early onset and slow progression of CKD in younger Black adults. Background The Black adult population is well known to have higher incidence of kidney failure than their White counterpart in the United States, but the reasons underlying this disparity are unclear. We assessed the racial differences in kidney failure and death from onset of CKD on the basis of the race-free 2021 CKD Epidemiology Collaboration equation and examined the extent to which these differences could be explained by factors at the time of CKD onset. Methods We analyzed a national cohort consisting of 547,188 US veterans (103,821 non-Hispanic Black and 443,367 non-Hispanic White), aged 18–85 years, with new-onset CKD between 2005 and 2016 who were followed through 10 years or May 2018 for incident kidney failure with replacement therapy (KFRT) and pre-KFRT death. Results At CKD onset, Black veterans were, on average, 7.8 years younger than White veterans. In any time period from CKD onset, the cumulative incidence of KFRT was 2.5-fold higher for Black versus White veterans. Meanwhile, Black veterans had persistently >2-fold higher hazards of KFRT throughout follow-up (overall hazard ratio [95% confidence interval], 2.38 [2.31 to 2.45]) and conversely had 17%–48% decreased hazards of pre-KFRT death. These differences were reduced after accounting for the racial difference in age at CKD onset. Conclusions The 2.5-fold higher cumulative incidence of kidney failure in Black adults resulted from a combination of higher hazards of progression to kidney failure and lower hazards of the competing risk of death, both of which can be largely explained by the younger age at CKD onset in Black compared with White adults....

中文翻译：

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年龄和竞争性死亡风险在 CKD 发病后肾衰竭发病率种族差异中的作用

在 CKD 发病后的任何随访期内，与白人退伍军人相比，黑人退伍军人的肾衰竭累积发生率高出 2.5 倍。这种差异是由于黑人退伍军人进展为肾衰竭的较高风险和竞争风险死亡的较低风险共同造成的。反过来，这在很大程度上可以用黑人退伍军人 CKD 发病年龄较小来解释，这强调了迫切需要预防年轻黑人成年人中 CKD 的早期发病和缓慢进展。背景 众所周知，美国黑人成年人口的肾衰竭发病率高于白人成年人口，但造成这种差异的原因尚不清楚。我们根据不分种族的 2021 年 CKD 流行病学协作方程评估了 CKD 发病时肾衰竭和死亡的种族差异，并研究了这些差异在多大程度上可以通过 CKD 发病时的因素来解释。方法 我们分析了由 547,188 名美国退伍军人（103,821 名非西班牙裔黑人和 443,367 名非西班牙裔白人）组成的全国队列，年龄为 18-85 岁，在 2005 年至 2016 年间患有新发 CKD，并对他们进行了 10 年或 2018 年 5 月的随访替代治疗（KFRT）发生的肾衰竭和 KFRT 前死亡。结果 CKD 发病时，黑人退伍军人平均比白人退伍军人年轻 7.8 岁。在 CKD 发病后的任何时间段内，黑人退伍军人的 KFRT 累积发病率是白人退伍军人的 2.5 倍。与此同时，在整个随访过程中，黑人退伍军人的 KFRT 风险持续高出 2 倍以上（总体风险比 [95% 置信区间]，2.38 [2.31 至 2.45]），相反，KFRT 前的风险降低了 17%–48%死亡。考虑到 CKD 发病年龄的种族差异后，这些差异有所减少。结论 黑人成人肾衰竭的累积发生率高出 2.5 倍，这是由于进展为肾衰竭的风险较高和死亡竞争风险较低的综合原因，这两者在很大程度上可以通过 CKD 发病年龄较小来解释黑人与白人成年人相比......