Racial differences in acute kidney injury of hospitalized adults with diabetes

Abstract

Objective: To determine whether there is a racial difference in the risk of acute kidney injury between hospitalized black and white adults with diabetes mellitus in the United States

Research design and methods: We analyzed cross-sectional data from the 2000-2010 National Hospital Discharge Survey (NHDS) to compare the odds of AKI among hospitalized black and white adults with diabetes. After excluding records in which race status was missing, race was other than white or black, discharge status was not provided, or end-stage renal disease was a diagnosis, we identified 276,138 eligible records for analysis. Multivariable logistic regression was used to analyze the association between race, AKI, and in-hospital mortality. Multivariable linear regression was used to analyze the association between length of stay and race among discharge records with a diagnosis of AKI.

Results: In this nationally representative sample of hospitalized U.S. adults with diabetes, blacks had a 50% higher age- and sex-adjusted odds of AKI compared to whites (odds ratio: 1.51; 95% CI 1.37-1.66). The association between black race and increased risk of AKI persisted after additional adjustment for multiple AKI-related risk factors, including chronic kidney disease, sepsis, hypertension, hypotension, length of stay, myocardial infarction, congestive heart failure, angiography, computed tomography scan, cirrhosis, admission source, payor source, hospital region, and hospital bed size (OR 1.71; 95% CI, 1.31-2.25). Among cases of AKI, there was no racial difference in length of stay or in-hospital mortality.

Conclusions: Among hospitalized adults in the U.S. with diabetes, black race is associated with a higher risk of AKI compared to white race.

Keywords: Acute kidney injury; Diabetes; Disparity; Ethnicity; Hospitalization; Race.