Reverse Race and Ethnic Disparities in Survival Increase with Severity of Chronic Kidney Disease

End-stage renal disease (ESRD) is more prevalent among black Americans (1). Early studies suggested that this was due to a higher incidence of renal disease progression, but evidence was lacking about rates of disease initiation or prevalence of early stages of chronic disease (2–3). More recently a higher prevalence of milder stages of kidney disease in blacks versus whites has been ruled out, suggesting that initiation of disease is not more common among blacks (4–6). Even more strongly, this evidence suggests that accelerated rates of renal disease progression at later stages are responsible for the higher incidence of ESRD among blacks. In this issue of CJASN , Newsome et al. provide intriguing evidence from the Cooperative Cardiovascular Project that there is a survival advantage for black chronic kidney disease patients and, most importantly, that it begins well before patients develop ESRD (7). From this large-scale quality improvement project begun in 1992 (8), Newsome et al. designed a retrospective cohort study of nearly 60,000 persons age ≥65 yr who were admitted for a first episode of acute myocardial infarction and followed passively for death over 3 yr using government records. The authors found that the magnitude of the survival advantage for blacks increases as GFR, estimated from the Modification of Diet in Renal Disease equation, decreases. …