Editorial Reverse Race and Ethnic Disparities in Survival Increase with Severity of Chronic Kidney Disease: What Does This Mean?

E nd-stage renal disease (ESRD) is more prevalent amongblack Americans (1). Early studies suggested that thiswas due to a higher incidence of renal disease progres-sion, 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 stud