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Killian AC, Shelton B, MacLennan P, McLeod MC, Carter A, Reed R, Qu H, Orandi B, Kumar V, Sawinski D, Locke JE. Evaluation of Community-Level Vulnerability and Racial Disparities in Living Donor Kidney Transplant. JAMA Surg 2021; 156:1120-1129. [PMID: 34524392 PMCID: PMC8444059 DOI: 10.1001/jamasurg.2021.4410] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/11/2021] [Indexed: 11/14/2022]
Abstract
Importance Living donor kidney transplant (LDKT) is the ideal treatment for end-stage kidney disease, but racial disparities in LDKT have increased over the last 2 decades. Recipient clinical and social factors do not account for LDKT racial inequities, although comprehensive measures of community-level vulnerability have not been assessed. Objective To determine if racial disparities persist in LDKT independent of community-level vulnerability. Design, Setting, and Participants This retrospective, multicenter, cross-sectional study included data from 19 287 adult kidney-only transplant recipients in the Scientific Registry of Transplant Recipients. The study included individuals who underwent transplant between January 1 and December 31, 2018. Exposures Recipient race and the 2018 US Centers for Disease Control and Prevention Social Vulnerability Index (SVI). Census tract-level SVI data were linked to census tracts within each recipient zip code. The median SVI measure among the census tracts within a zip code was used to describe community-level vulnerability. Main Outcomes and Measures Kidney transplant donor type (deceased vs living). Modified Poisson regression was used to evaluate the association between SVI and LDKT, and to estimate LDKT likelihood among races, independent of community-level vulnerability and recipient-level characteristics. Results Among 19 287 kidney transplant recipients, 6080 (32%) received LDKT. A total of 11 582 (60%) were male, and the median (interquartile range) age was 54 (43-63) years. There were 760 Black LDKT recipients (13%), 4865 White LDKT recipients (80%), and 455 LDKT recipients of other races (7%; American Indian, Asian, multiracial, and Pacific Islander). Recipients who lived in communities with higher SVI (ie, more vulnerable) had lower likelihood of LDKT compared with recipients who lived in communities with lower SVI (ie, less vulnerable) (adjusted relative risk [aRR], 0.97; 95% CI, 0.96-0.98; P < .001). Independent of community-level vulnerability, compared with White recipients, Black recipients had 37% lower likelihood (aRR, 0.63; 95% CI, 0.59-0.67; P < .001) and recipients of other races had 24% lower likelihood (aRR, 0.76; 95% CI, 0.70-0.82; P < .001) of LDKT. The interaction between SVI and race was significant among Black recipients, such that the disparity in LDKT between Black and White recipients increased with greater community-level vulnerability (ratio of aRRs, 0.67; 95% CI, 0.51-0.87; P = .003). Conclusions and Relevance Community-level vulnerability is associated with access to LDKT but only partially explains LDKT racial disparities. The adverse effects of living in more vulnerable communities were worse for Black recipients. The interaction of these constructs is worrisome and suggests evaluation of other health system factors that may contribute to LDKT racial disparities is needed.
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Affiliation(s)
| | - Brittany Shelton
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | - Paul MacLennan
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | | | - Alexis Carter
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | - Rhiannon Reed
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | - Haiyan Qu
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | - Babak Orandi
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | - Vineeta Kumar
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | - Deirdre Sawinski
- Department of Medicine, University of Pennsylvania, Philadelphia
| | - Jayme E. Locke
- Comprehensive Transplant Institute, University of Alabama at Birmingham
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Ladin K, Porteny T, Perugini JM, Gonzales KM, Aufort KE, Levine SK, Wong JB, Isakova T, Rifkin D, Gordon EJ, Rossi A, Koch-Weser S, Weiner DE. Perceptions of Telehealth vs In-Person Visits Among Older Adults With Advanced Kidney Disease, Care Partners, and Clinicians. JAMA Netw Open 2021; 4:e2137193. [PMID: 34870680 PMCID: PMC8649833 DOI: 10.1001/jamanetworkopen.2021.37193] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/04/2021] [Indexed: 12/11/2022] Open
Abstract
Importance Telehealth has been posited as a cost-effective means for improving access to care for persons with chronic conditions, including kidney disease. Perceptions of telehealth among older patients with chronic illness, their care partners, and clinicians are largely unknown but are critical to successful telehealth use and expansion efforts. Objective To identify patient, care partner, and nephrologists' perceptions of the patient-centeredness, benefits, drawbacks of telehealth compared to in-person visits. Design, Setting, and Participants This qualitative study used semistructured interviews conducted from August to December 2020 with purposively sampled patients (aged 70 years or older, chronic kidney disease stages 4 to 5), care partners, and clinicians in Boston, Massachusetts; Chicago, Illinois; Portland, Maine; and San Diego, California. Main Outcomes and Measures Participants described telehealth experiences, including factors contributing to and impeding engagement, satisfaction, and quality of care. Thematic analysis was used to analyze data. Results Of 60 interviews, 19 (32%) were with clinicians, 30 (50%) with patients, and 11 (18%) with care partners; 16 clinicians (84%) were nephrologists; 17 patient participants (43%) were non-Hispanic Black, and 38 (67%) were women. Four overarching themes characterized telehealth's benefits and drawbacks for patient-centered care among older, chronically ill adults: inconsistent quality of care, patient experience and engagement, loss of connection and mistrust (eg, challenges discussing bad news), and disparities with accessing telehealth. Although telehealth improved convenience and care partner engagement, participants expressed concerns about clinical effectiveness and limitations of virtual physical examinations and potentially widening disparities in access. Many participants shared concerns about harms to the patient-clinician relationship, limited ability to comfort patients in virtual settings, and reduced patient trust. Conclusions and Relevance Older patients, care partners, and kidney clinicians (ie, nephrologists and physician assistants) shared divergent views of patient-centered telehealth care, especially its clinical effectiveness, patient experience, access to care, and clinician-patient relationship. Understanding older patients' and kidney clinicians' perceptions of telehealth elucidate barriers that should be addressed to promote high-quality care and telehealth use.
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Affiliation(s)
- Keren Ladin
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts
- Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts
| | - Thalia Porteny
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts
- Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts
| | - Julia M. Perugini
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts
| | - Kristina M. Gonzales
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts
- Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts
| | - Kate E. Aufort
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts
- Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts
| | - Sarah K. Levine
- William B. Schwartz MD Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - John B. Wong
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Tamara Isakova
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dena Rifkin
- Division of Nephrology, Veterans’ Affairs Healthcare System, San Diego, California
- University of California, San Diego
| | - Elisa J. Gordon
- Department of Surgery-Division of Transplantation, and Center for Health Services and Outcomes Research, and Center for Bioethics and Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ana Rossi
- Piedmont Transplant Institute, Atlanta, Georgia
| | - Susan Koch-Weser
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Massachusetts
| | - Daniel E. Weiner
- William B. Schwartz MD Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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103
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Saks BR, Ouyang VW, Domb ES, Jimenez AE, Maldonado DR, Lall AC, Domb BG. Equality in Hip Arthroscopy Outcomes Can Be Achieved Regardless of Patient Socioeconomic Status. Am J Sports Med 2021; 49:3915-3924. [PMID: 34739305 DOI: 10.1177/03635465211046932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Access to quality health care and treatment outcomes can be affected by patients' socioeconomic status (SES). PURPOSE To evaluate the effect of patient SES on patient-reported outcome measures (PROMs) after arthroscopic hip surgery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Demographic, radiographic, and intraoperative data were prospectively collected and retrospectively reviewed on all patients who underwent hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and labral tear between February 2008 and September 2017 at one institution. Patients were divided into 4 cohorts based on the Social Deprivation Index (SDI) of their zip code. SDI is a composite measure that quantifies the level of disadvantage in certain geographical areas. Patients had a minimum 2-year follow-up for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), International Hip Outcome Tool-12, and visual analog scale (VAS) for both pain and satisfaction. Rates of achieving the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were calculated for the mHHS, NAHS, and VAS pain score. Rates of secondary surgery were also recorded. RESULTS A total of 680 hips (616 patients) were included. The mean follow-up time for the entire cohort was 30.25 months. Division of the cohort into quartiles based on the SDI national averages yielded 254 hips (37.4%) in group 1, 184 (27.1%) in group 2, 148 (21.8%) in group 3, and 94 (13.8%) in group 4. Group 1 contained the most affluent patients. There were significantly more men in group 4 than in group 2, and the mean body mass index was greater in group 4 than in groups 1 and 2. There were no differences in preoperative radiographic measurements, intraoperative findings, or rates of concomitant procedures performed. All preoperative and postoperative PROMs were similar between the groups, as well as in the rates of achieving the MCID or PASS. No differences in the rate of secondary surgeries were reported. CONCLUSION Regardless of SES, patients were able to achieve significant improvements in several PROMs after hip arthroscopy for FAIS and labral tear at the minimum 2-year follow-up. Additionally, patients from all SES groups achieved clinically meaningful improvement at similar rates.
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Affiliation(s)
- Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,Core Physicians, Exeter, New Hampshire, USA
| | - Vivian W Ouyang
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Elijah S Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,Core Physicians, Exeter, New Hampshire, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,Core Physicians, Exeter, New Hampshire, USA.,American Hip Institute, Chicago, Illinois, USA
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104
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Cintron Pregosin N, Bronstein R, Mallipattu SK. Recent Advances in Kidney Bioengineering. Front Pediatr 2021; 9:743301. [PMID: 34900859 PMCID: PMC8655860 DOI: 10.3389/fped.2021.743301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/02/2021] [Indexed: 12/03/2022] Open
Abstract
Kidney disease is an epidemic that affects more than 600 million people worldwide. The socioeconomic impacts of the disease disproportionately affect Hispanic and non-Hispanic Black Americans, making the disease an issue of social inequality. The urgency of this situation has only become worse during the COVID-19 pandemic, as those who are hospitalized for COVID-19 have an increased risk of kidney failure. For researchers, the kidney is a complex organ that is difficult to accurately model and understand. Traditional cell culture models are not adequate for studying the functional intricacies of the kidney, but recent experiments have offered improvements for understanding these systems. Recent progress includes organoid modeling, 3D bioprinting, decellularization, and microfluidics. Here, we offer a review of the most recent advances in kidney bioengineering.
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Affiliation(s)
- Nina Cintron Pregosin
- Division of Nephrology, Department of Medicine, Stony Brook University, Stony Brook, NY, United States
- Graduate Program in Molecular and Cellular Pharmacology, Stony Brook University, Stony Brook, NY, United States
| | - Robert Bronstein
- Division of Nephrology, Department of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Sandeep K. Mallipattu
- Division of Nephrology, Department of Medicine, Stony Brook University, Stony Brook, NY, United States
- Renal Section, Northport VA Medical Center, Northport, NY, United States
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105
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Conner CK, Jain B, Khan A, Laragh ML, Lowery S, Nichols N, Steffan J, Weber JK, White S. A Step Toward Health Equity for Veterans: Evidence Supports Removing Race From Kidney Function Calculations. Fed Pract 2021; 38:368-373. [PMID: 34733089 DOI: 10.12788/fp.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The practice of race-based medicine fails to recognize that race cannot be used as a proxy for genetic ancestry and that racial and ethnic categories are complex sociopolitical constructs without biological basis. Clinical algorithms and equations that incorporate race modifiers and are currently considered standard for diagnosis and management of disease are appropriately being scrutinized for lack of biological plausibility and their role in exacerbating health inequities. In this paper, we review the history, evidence, and implications of using a Black race coefficient when calculating estimated glomerular filtration rate (eGFR) in the diagnosis and management of kidney disease. Observations Currently, the US Department of Veterans Affairs (VA) uses the Modification of Diet in Renal Disease (MDRD) equation for eGFR. This equation includes a Black race coefficient that results in an eGFR that is 21% higher for a Black patient when compared with a patient of any other race. The rationale for the inclusion of this coefficient is based on racist science that incorrectly assumes race as a proxy for genetic ancestry. Multiple studies across diverse Black populations demonstrate that the application of a race coefficient in kidney function estimation equations is inferior when compared with the race-neutral option. Furthermore, the most utilized eGFR equations are biased and imprecise. Because eGFR is the primary diagnostic method for detecting and managing kidney disease, preventing its progression, planning for dialysis, and evaluating for transplantation, it is vital that eGFR be as accurate, precise, and equitable as possible. Conclusions The incorporation of a race coefficient in kidney estimation equations lacks biological plausibility and its use exacerbates kidney health disparities. Until a better method to estimate kidney function becomes available, a race-neutral option for current estimation equations should be applied for all patients.
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Affiliation(s)
| | - Cheryl K Conner
- and are Attending Physicians; is the Section Chief for Hospital Medicine; is an Inpatient Pharmacy Clinical Pharmacy Specialist; is a Nurse Practitioner Section of Palliative Care; and is Facility Transplant Coordinator; all at the Jesse Brown Veterans Affairs Medical Center in Chicago, Illinois. is an Internal Medicine Resident; and Bijal Jain and Natasha Nichols are Assistant Professors, Department of Medicine; and all at Northwestern University Feinberg School of Medicine. Marci Laragh, Cheryl Conner and Ambareen Khan are Clinical Assistant Professors of Medicine, and Sheryl Lowery is Adjunct Clinical Assistant Professor School of Pharmacy; all at the University of Illinois at Chicago
| | - Bijal Jain
- and are Attending Physicians; is the Section Chief for Hospital Medicine; is an Inpatient Pharmacy Clinical Pharmacy Specialist; is a Nurse Practitioner Section of Palliative Care; and is Facility Transplant Coordinator; all at the Jesse Brown Veterans Affairs Medical Center in Chicago, Illinois. is an Internal Medicine Resident; and Bijal Jain and Natasha Nichols are Assistant Professors, Department of Medicine; and all at Northwestern University Feinberg School of Medicine. Marci Laragh, Cheryl Conner and Ambareen Khan are Clinical Assistant Professors of Medicine, and Sheryl Lowery is Adjunct Clinical Assistant Professor School of Pharmacy; all at the University of Illinois at Chicago
| | - Ambareen Khan
- and are Attending Physicians; is the Section Chief for Hospital Medicine; is an Inpatient Pharmacy Clinical Pharmacy Specialist; is a Nurse Practitioner Section of Palliative Care; and is Facility Transplant Coordinator; all at the Jesse Brown Veterans Affairs Medical Center in Chicago, Illinois. is an Internal Medicine Resident; and Bijal Jain and Natasha Nichols are Assistant Professors, Department of Medicine; and all at Northwestern University Feinberg School of Medicine. Marci Laragh, Cheryl Conner and Ambareen Khan are Clinical Assistant Professors of Medicine, and Sheryl Lowery is Adjunct Clinical Assistant Professor School of Pharmacy; all at the University of Illinois at Chicago
| | - Marci L Laragh
- and are Attending Physicians; is the Section Chief for Hospital Medicine; is an Inpatient Pharmacy Clinical Pharmacy Specialist; is a Nurse Practitioner Section of Palliative Care; and is Facility Transplant Coordinator; all at the Jesse Brown Veterans Affairs Medical Center in Chicago, Illinois. is an Internal Medicine Resident; and Bijal Jain and Natasha Nichols are Assistant Professors, Department of Medicine; and all at Northwestern University Feinberg School of Medicine. Marci Laragh, Cheryl Conner and Ambareen Khan are Clinical Assistant Professors of Medicine, and Sheryl Lowery is Adjunct Clinical Assistant Professor School of Pharmacy; all at the University of Illinois at Chicago
| | - Sheryl Lowery
- and are Attending Physicians; is the Section Chief for Hospital Medicine; is an Inpatient Pharmacy Clinical Pharmacy Specialist; is a Nurse Practitioner Section of Palliative Care; and is Facility Transplant Coordinator; all at the Jesse Brown Veterans Affairs Medical Center in Chicago, Illinois. is an Internal Medicine Resident; and Bijal Jain and Natasha Nichols are Assistant Professors, Department of Medicine; and all at Northwestern University Feinberg School of Medicine. Marci Laragh, Cheryl Conner and Ambareen Khan are Clinical Assistant Professors of Medicine, and Sheryl Lowery is Adjunct Clinical Assistant Professor School of Pharmacy; all at the University of Illinois at Chicago
| | - Natasha Nichols
- and are Attending Physicians; is the Section Chief for Hospital Medicine; is an Inpatient Pharmacy Clinical Pharmacy Specialist; is a Nurse Practitioner Section of Palliative Care; and is Facility Transplant Coordinator; all at the Jesse Brown Veterans Affairs Medical Center in Chicago, Illinois. is an Internal Medicine Resident; and Bijal Jain and Natasha Nichols are Assistant Professors, Department of Medicine; and all at Northwestern University Feinberg School of Medicine. Marci Laragh, Cheryl Conner and Ambareen Khan are Clinical Assistant Professors of Medicine, and Sheryl Lowery is Adjunct Clinical Assistant Professor School of Pharmacy; all at the University of Illinois at Chicago
| | - Janine Steffan
- and are Attending Physicians; is the Section Chief for Hospital Medicine; is an Inpatient Pharmacy Clinical Pharmacy Specialist; is a Nurse Practitioner Section of Palliative Care; and is Facility Transplant Coordinator; all at the Jesse Brown Veterans Affairs Medical Center in Chicago, Illinois. is an Internal Medicine Resident; and Bijal Jain and Natasha Nichols are Assistant Professors, Department of Medicine; and all at Northwestern University Feinberg School of Medicine. Marci Laragh, Cheryl Conner and Ambareen Khan are Clinical Assistant Professors of Medicine, and Sheryl Lowery is Adjunct Clinical Assistant Professor School of Pharmacy; all at the University of Illinois at Chicago
| | - Jane K Weber
- and are Attending Physicians; is the Section Chief for Hospital Medicine; is an Inpatient Pharmacy Clinical Pharmacy Specialist; is a Nurse Practitioner Section of Palliative Care; and is Facility Transplant Coordinator; all at the Jesse Brown Veterans Affairs Medical Center in Chicago, Illinois. is an Internal Medicine Resident; and Bijal Jain and Natasha Nichols are Assistant Professors, Department of Medicine; and all at Northwestern University Feinberg School of Medicine. Marci Laragh, Cheryl Conner and Ambareen Khan are Clinical Assistant Professors of Medicine, and Sheryl Lowery is Adjunct Clinical Assistant Professor School of Pharmacy; all at the University of Illinois at Chicago
| | - Samantha White
- and are Attending Physicians; is the Section Chief for Hospital Medicine; is an Inpatient Pharmacy Clinical Pharmacy Specialist; is a Nurse Practitioner Section of Palliative Care; and is Facility Transplant Coordinator; all at the Jesse Brown Veterans Affairs Medical Center in Chicago, Illinois. is an Internal Medicine Resident; and Bijal Jain and Natasha Nichols are Assistant Professors, Department of Medicine; and all at Northwestern University Feinberg School of Medicine. Marci Laragh, Cheryl Conner and Ambareen Khan are Clinical Assistant Professors of Medicine, and Sheryl Lowery is Adjunct Clinical Assistant Professor School of Pharmacy; all at the University of Illinois at Chicago
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Cohen BJ. Should Estimated Glomerular Filtration Rate Be Adjusted for Race? Clin Pharmacol Drug Dev 2021; 10:1254-1262. [PMID: 34734499 DOI: 10.1002/cpdd.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Brian J Cohen
- Division of Clinical Decision Making, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
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107
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Newman DK, Burgio KL, Cain C, Hebert-Beirne J, Low LK, Palmer MH, Smith AL, Rickey L, Rudser K, Gahagan S, Harlow BL, James AS, Lacoursiere DY, Hardacker CT, Wyman JF. Toileting behaviors and lower urinary tract symptoms: A cross-sectional study of diverse women in the United States. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021; 3. [DOI: 10.1016/j.ijnsa.2021.100052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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108
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Wu J, Raman A, Coffey NJ, Sheng X, Wahba J, Seasock MJ, Ma Z, Beckerman P, Laczkó D, Palmer MB, Kopp JB, Kuo JJ, Pullen SS, Boustany-Kari CM, Linkermann A, Susztak K. The key role of NLRP3 and STING in APOL1-associated podocytopathy. J Clin Invest 2021; 131:136329. [PMID: 34651582 DOI: 10.1172/jci136329] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 09/02/2021] [Indexed: 12/13/2022] Open
Abstract
Coding variants in apolipoprotein L1 (APOL1), termed G1 and G2, can explain most excess kidney disease risk in African Americans; however, the molecular pathways of APOL1-induced kidney dysfunction remain poorly understood. Here, we report that expression of G2 APOL1 in the podocytes of Nphs1rtTA/TRE-G2APOL1 (G2APOL1) mice leads to early activation of the cytosolic nucleotide sensor, stimulator of interferon genes (STING), and the NLR family pyrin domain-containing 3 (NLRP3) inflammasome. STING and NLRP3 expression was increased in podocytes from patients with high-risk APOL1 genotypes, and expression of APOL1 correlated with caspase-1 and gasdermin D (GSDMD) levels. To demonstrate the role of NLRP3 and STING in APOL1-associated kidney disease, we generated transgenic mice with the G2 APOL1 risk variant and genetic deletion of Nlrp3 (G2APOL1/Nlrp3 KO), Gsdmd (G2APOL1/Gsdmd KO), and STING (G2APOL1/STING KO). Knockout mice displayed marked reduction in albuminuria, azotemia, and kidney fibrosis compared with G2APOL1 mice. To evaluate the therapeutic potential of targeting NLRP3, GSDMD, and STING, we treated mice with MCC950, disulfiram, and C176, potent and selective inhibitors of NLRP3, GSDMD, and STING, respectively. G2APOL1 mice treated with MCC950, disulfiram, and C176 showed lower albuminuria and improved kidney function even when inhibitor treatment was initiated after the development of albuminuria.
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Affiliation(s)
- Junnan Wu
- Department of Medicine, Renal-Electrolyte and Hypertension Division, and Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Archana Raman
- Department of Medicine, Renal-Electrolyte and Hypertension Division, and Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nathan J Coffey
- Department of Medicine, Renal-Electrolyte and Hypertension Division, and Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Xin Sheng
- Department of Medicine, Renal-Electrolyte and Hypertension Division, and Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph Wahba
- Department of Medicine, Renal-Electrolyte and Hypertension Division, and Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew J Seasock
- Department of Medicine, Renal-Electrolyte and Hypertension Division, and Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ziyuan Ma
- Department of Medicine, Renal-Electrolyte and Hypertension Division, and Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pazit Beckerman
- Department of Medicine, Renal-Electrolyte and Hypertension Division, and Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dorottya Laczkó
- Department of Medicine, Renal-Electrolyte and Hypertension Division, and Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew B Palmer
- Department of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey B Kopp
- Kidney Disease Section, Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jay J Kuo
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, USA
| | - Steven S Pullen
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, USA
| | | | - Andreas Linkermann
- Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - Katalin Susztak
- Department of Medicine, Renal-Electrolyte and Hypertension Division, and Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Drewry KM, Trivedi AN, Wilk AS. Organizational Characteristics Associated with High Performance in Medicare's Comprehensive End-Stage Renal Disease Care Initiative. Clin J Am Soc Nephrol 2021; 16:1522-1530. [PMID: 34620648 PMCID: PMC8499003 DOI: 10.2215/cjn.04020321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/20/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Medicare plans to extend financial structures tested through the Comprehensive End-Stage Renal Disease Care (CEC) Initiative-an alternative payment model for maintenance dialysis providers-to promote high-value care for beneficiaries with kidney failure. The End-Stage Renal Disease Seamless Care Organizations (ESCOs) that formed under the CEC Initiative varied greatly in their ability to generate cost savings and improve patient health outcomes. This study examined whether organizational or community characteristics were associated with ESCOs' performance. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used a retrospective pooled cross-sectional analysis of all 37 ESCOs participating in the CEC Initiative during 2015-2018 (n=87 ESCO-years). Key exposures included ESCO characteristics: number of dialysis facilities, number and types of physicians, and years of CEC Initiative experience. Outcomes of interest included were above versus below median gross financial savings (2.4%) and standardized mortality ratio (0.93). We analyzed unadjusted differences between high- and low-performing ESCOs and then used multivariable logistic regression to construct average marginal effect estimates for parameters of interest. RESULTS Above-median gross savings were obtained by 23 (52%) ESCOs with no program experience, 14 (32%) organizations with 1 year of experience, and seven (16%) organizations with 2 years of experience. The adjusted likelihoods of achieving above-median gross savings were 23 (95% confidence interval, 8 to 37) and 48 (95% confidence interval, 24 to 68) percentage points higher for ESCOs with 1 or 2 years of program experience, respectively (versus none). The adjusted likelihood of achieving above-median gross savings was 1.7 (95% confidence interval, -3 to -1) percentage points lower with each additional affiliated dialysis facility. Adjusted mortality rates were lower for ESCOs located in areas with higher socioeconomic status. CONCLUSIONS Smaller ESCOs, organizations with more experience in the CEC Initiative, and those located in more affluent areas performed better under the CEC Initiative.
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MESH Headings
- Accountable Care Organizations/economics
- Accountable Care Organizations/organization & administration
- Cost Savings
- Cost-Benefit Analysis
- Cross-Sectional Studies
- Delivery of Health Care, Integrated/economics
- Delivery of Health Care, Integrated/organization & administration
- Health Care Costs
- Humans
- Kidney Failure, Chronic/diagnosis
- Kidney Failure, Chronic/economics
- Kidney Failure, Chronic/mortality
- Kidney Failure, Chronic/therapy
- Medicare/economics
- Medicare/organization & administration
- Neighborhood Characteristics
- Outcome and Process Assessment, Health Care/economics
- Outcome and Process Assessment, Health Care/organization & administration
- Quality Assurance, Health Care/organization & administration
- Quality Indicators, Health Care/organization & administration
- Renal Dialysis/adverse effects
- Renal Dialysis/economics
- Renal Dialysis/mortality
- Retrospective Studies
- Social Class
- Time Factors
- Treatment Outcome
- United States
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Affiliation(s)
- Kelsey M. Drewry
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Amal N. Trivedi
- Department of Health Services, Policy and Practice, Department of Medicine, Brown University, Providence, Rhode Island
- Department of Medicine, Brown University, Providence, Rhode Island
| | - Adam S. Wilk
- Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia
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110
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Beech BM, Ford C, Thorpe RJ, Bruce MA, Norris KC. Poverty, Racism, and the Public Health Crisis in America. Front Public Health 2021; 9:699049. [PMID: 34552904 PMCID: PMC8450438 DOI: 10.3389/fpubh.2021.699049] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/06/2021] [Indexed: 01/13/2023] Open
Abstract
The purpose of this article is to discuss poverty as a multidimensional factor influencing health. We will also explicate how racism contributes to and perpetuates the economic and financial inequality that diminishes prospects for population health improvement among marginalized racial and ethnic groups. Poverty is one of the most significant challenges for our society in this millennium. Over 40% of the world lives in poverty. The U.S. has one of the highest rates of poverty in the developed world, despite its collective wealth, and the burden falls disproportionately on communities of color. A common narrative for the relatively high prevalence of poverty among marginalized minority communities is predicated on racist notions of racial inferiority and frequent denial of the structural forms of racism and classism that have contributed to public health crises in the United States and across the globe. Importantly, poverty is much more than just a low-income household. It reflects economic well-being, the ability to negotiate society relative to education of an individual, socioeconomic or health status, as well as social exclusion based on institutional policies, practices, and behaviors. Until structural racism and economic injustice can be resolved, the use of evidence-based prevention and early intervention initiatives to mitigate untoward effects of socioeconomic deprivation in communities of color such as the use of social media/culturally concordant health education, social support, such as social networks, primary intervention strategies, and more will be critical to address the persistent racial/ethnic disparities in chronic diseases.
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Affiliation(s)
- Bettina M. Beech
- Department of Health Systems and Population Health Science, University of Houston College of Medicine, Houston, TX, United States
| | - Chandra Ford
- Department of Community Health Sciences, Center for the Study of Racism, Social Justice and Health at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Roland J. Thorpe
- Department of Health, Behavior, and Society, Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Marino A. Bruce
- Program for Research on Faith, Justice, and Health, Department of Behavioral and Social Sciences, University of Houston College of Medicine, Houston, TX, United States
| | - Keith C. Norris
- Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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111
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A randomized trial of race-related stress among African Americans with chronic kidney disease. Psychoneuroendocrinology 2021; 131:105339. [PMID: 34175554 DOI: 10.1016/j.psyneuen.2021.105339] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/24/2021] [Accepted: 06/16/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE African Americans progress from early to late-stage chronic kidney disease (CKD) at a rate that is three times that of Whites. Given research that implicates social stress in poor kidney outcomes, there is a need to examine whether race-related stress contributes to these disparities. Through experimental manipulation, this study sought to determine whether acute race-related stress was associated with autonomic arousal and an inflammatory marker, which are well-established pathways to poor kidney outcomes. Further we tested the hypothesis that expectations of racism may moderate this relationship. METHOD Fifty-two African American patients along the CKD continuum were randomized to recall a general or race-related stressful experience. Before, during, and after the recall, patients' blood pressure and Interleukin-6 (IL-6) were monitored. Prior to the experimental manipulation, participants completed self-reported measures of expectations of racism. RESULTS Across both study conditions, change in self-reported distress from baseline to stress was associated with both systolic and diastolic reactivity (both ps <.01), but not change in IL-6 responses (all ps > 0.05). A significant interaction revealed that those who were randomized to recall a race-related stressor demonstrated less diastolic blood pressure reactivity (F=4.80, p<.05) if they scored lower in expectations of racism as compared to those who scored high. Moreover, those who were randomized to the race-related stressor demonstrated greater increase in IL-6 from 45 to 90 min post-recall than those who recalled a general stressor (F=6.35, p<.05). CONCLUSIONS Acute race-related stress may be associated with autonomic arousal and inflammatory response among African American patients along the CKD continuum, suggesting the need to further understand its role in racial disparities in CKD progression.
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112
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Bignall ONR, Harer MW, Sanderson KR, Starr MC. Commentary on "Trends and Racial Disparities for Acute Kidney Injury in Premature Infants: the US National Database". Pediatr Nephrol 2021; 36:2587-2591. [PMID: 33829326 DOI: 10.1007/s00467-021-05062-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 11/27/2022]
Affiliation(s)
- O N Ray Bignall
- Division of Nephrology and Hypertension, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Matthew W Harer
- Department of Pediatrics, Division of Neonatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Keia R Sanderson
- Department of Medicine-Pediatrics, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC, USA
| | - Michelle C Starr
- Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, HITS Building, Suite 2000A, 410 West 10th Street, Indianapolis, IN, 46202, USA.
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113
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Cervantes L, Rizzolo K, Carr AL, Steiner JF, Chonchol M, Powe N, Cukor D, Hasnain-Wynia R. Social and Cultural Challenges in Caring for Latinx Individuals With Kidney Failure in Urban Settings. JAMA Netw Open 2021; 4:e2125838. [PMID: 34533567 PMCID: PMC8449281 DOI: 10.1001/jamanetworkopen.2021.25838] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Latinx individuals with end-stage kidney disease (ESKD) constitute 19% of US patients receiving in-center scheduled hemodialysis. Compared with non-Latinx White patients, Latinx individuals often face poor economic, environmental, and living circumstances. The challenges for health care professionals engendered by these circumstances when Latinx individuals present with ESKD and possible solutions have not been well described. OBJECTIVE To examine the perceptions of interdisciplinary health care professionals who work in dialysis centers in urban settings with large racial and ethnic minority populations about how social challenges affect the care of Latinx patients with ESKD. DESIGN, SETTING, AND PARTICIPANTS This qualitative study administered semistructured interviews of interdisciplinary health care professionals at 4 urban dialysis centers in Denver, Colorado, from April 1 to June 30, 2019. Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. MAIN OUTCOMES AND MEASURES Themes and subthemes of barriers to care. RESULTS Thirty interdisciplinary dialysis center health care professionals (23 [77%] female; mean [SD] age, 42.0 [11.6] years) participated. Four themes were identified. The first 3 themes and their respective subthemes (in parentheses) describe challenges to kidney care: compromised quality of care attributable to communication and cultural barriers (language interpretation by telephone, in-person language interpretation, burden of ad hoc interpretation, low-quality health care, lack of language- and culturally concordant materials, and health literacy levels), difficulty with health care access (unreliable transportation, economic instability, and loss of insurance benefits), and concerns about patient psychosocial well-being (social isolation, hopelessness, stigma of illness, and balancing personal social challenges). The fourth theme describes solutions to improve care (culturally responsive care, patient empowerment and activation, supporting primary caregivers, and peer support with navigation of the health care system). CONCLUSIONS AND RELEVANCE This study's findings suggest that dialysis center policies are needed that require high-quality language interpretation and the availability of culturally concordant educational materials. Community-based interventions that improve patient activation and provide peer support as well as culturally responsive care may improve the care of Latinx patients with ESKD receiving in-center scheduled hemodialysis.
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Affiliation(s)
- Lilia Cervantes
- Division of Hospital Medicine, Denver Health, Denver, Colorado
- Office of Research, Denver Health, Denver, Colorado
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Katherine Rizzolo
- Department of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora
| | - Alaina L. Carr
- Department of Psychology, University of Colorado, Denver
| | - John F. Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
| | - Michel Chonchol
- Department of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora
| | - Neil Powe
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, San Francisco, California
- Department of Medicine, University of California, San Francisco
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114
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Gershengorn HB, Patel S, Shukla B, Warde PR, Bhatia M, Parekh D. Association of Race and Ethnicity with COVID-19 Test Positivity and Hospitalization Is Mediated by Socioeconomic Factors. Ann Am Thorac Soc 2021; 18:1326-1334. [PMID: 33724166 PMCID: PMC8513657 DOI: 10.1513/annalsats.202011-1448oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/16/2021] [Indexed: 12/12/2022] Open
Abstract
Rationale: Black race and Hispanic ethnicity are associated with increased risks for coronavirus disease (COVID-19) infection and severity. It is purported that socioeconomic factors may drive this association, but data supporting this assertion are sparse. Objectives: To evaluate whether socioeconomic factors mediate the association of race/ethnicity with COVID-19 incidence and outcomes. Methods: We conducted a retrospective cohort study of adults tested for (cohort 1) or hospitalized with (cohort 2) COVID-19 between March 1, 2020, and July 23, 2020, at the University of Miami Hospital and Clinics. Our primary exposure was race/ethnicity. We considered socioeconomic factors as potential mediators of our exposure's association with outcomes. We used standard statistics to describe our cohorts and multivariable regression modeling to identify associations of race/ethnicity with our primary outcomes, one for each cohort, of test positivity (cohort 1) and hospital mortality (cohort 2). We performed a mediation analysis to see whether household income, population density, and household size mediated the association of race/ethnicity with outcomes. Results: Our cohorts included 15,473 patients tested (29.0% non-Hispanic White, 48.1% Hispanic White, 15.0% non-Hispanic Black, 1.7% Hispanic Black, and 1.6% other) and 295 patients hospitalized (9.2% non-Hispanic White, 56.9% Hispanic White, 21.4% non-Hispanic Black, 2.4% Hispanic Black, and 10.2% other). Among those tested, 1,256 patients (8.1%) tested positive, and, of the hospitalized patients, 47 (15.9%) died. After adjustment for demographics, race/ethnicity was associated with test positivity-odds-ratio (95% confidence interval [CI]) versus non-Hispanic White for Non-Hispanic Black: 3.21 (2.60-3.96), Hispanic White: 2.72 (2.28-3.26), and Hispanic Black: 3.55 (2.33-5.28). Population density mediated this association (percentage mediated, 17%; 95% CI, 11-31%), as did median income (27%; 95% CI, 18-52%) and household size (20%; 95% CI, 12-45%). There was no association between race/ethnicity and mortality, although this analysis was underpowered. Conclusions: Black race and Hispanic ethnicity are associated with an increased odds of COVID-19 positivity. This association is substantially mediated by socioeconomic factors.
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Affiliation(s)
- Hayley B. Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York; and
| | - Samira Patel
- Care Transformation, University of Miami Hospital and Clinics, Miami, Florida
| | | | - Prem R. Warde
- Care Transformation, University of Miami Hospital and Clinics, Miami, Florida
| | | | - Dipen Parekh
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - on behalf of the UHealth-DART Research Group
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine
- Division of Infectious Diseases, Department of Medicine
- Department of Medicine, and
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York; and
- Care Transformation, University of Miami Hospital and Clinics, Miami, Florida
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115
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Zhang Y, Khullar D, Wang F, Steel P, Wu Y, Orlander D, Weiner M, Kaushal R. Socioeconomic variation in characteristics, outcomes, and healthcare utilization of COVID-19 patients in New York City. PLoS One 2021; 16:e0255171. [PMID: 34324574 PMCID: PMC8321227 DOI: 10.1371/journal.pone.0255171] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/10/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES There is limited evidence on how clinical outcomes differ by socioeconomic conditions among patients with coronavirus disease 2019 (COVID-19). Most studies focused on COVID-19 patients from a single hospital. Results based on patients from multiple health systems have not been reported. The objective of this study is to examine variation in patient characteristics, outcomes, and healthcare utilization by neighborhood social conditions among COVID-19 patients. METHODS We extracted electronic health record data for 23,300 community dwelling COVID-19 patients in New York City between March 1st and June 11th, 2020 from all care settings, including hospitalized patients, patients who presented to the emergency department without hospitalization, and patients with ambulatory visits only. Zip Code Tabulation Area-level social conditions were measured by the Social Deprivation Index (SDI). Using logistic regressions and Cox proportional-hazards models, we examined the association between SDI quintiles and hospitalization and death, controlling for race, ethnicity, and other patient characteristics. RESULTS Among 23,300 community dwelling COVID-19 patients, 60.7% were from neighborhoods with disadvantaged social conditions (top SDI quintile), although these neighborhoods only account for 34% of overall population. Compared to socially advantaged patients (bottom SDI quintile), socially disadvantaged patients (top SDI quintile) were older (median age 55 vs. 53, P<0.001), more likely to be black (23.1% vs. 6.4%, P<0.001) or Hispanic (25.4% vs. 8.5%, P<0.001), and more likely to have chronic conditions (e.g., diabetes: 21.9% vs. 10.5%, P<0.001). Logistic and Cox regressions showed that patients with disadvantaged social conditions had higher risk for hospitalization (odds ratio: 1.68; 95% confidence interval [CI]: [1.46, 1.94]; P<0.001) and mortality (hazard ratio: 1.91; 95% CI: [1.35, 2.70]; P<0.001), adjusting for other patient characteristics. CONCLUSION Substantial socioeconomic disparities in health outcomes exist among COVID-19 patients in NYC. Disadvantaged neighborhood social conditions were associated with higher risk for hospitalization, severity of disease, and death.
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Affiliation(s)
- Yongkang Zhang
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
| | - Dhruv Khullar
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
- Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
- NewYork-Presbyterian Hospital, New York, NY, United States of America
| | - Fei Wang
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
| | - Peter Steel
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, United States of America
| | - Yiyuan Wu
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
| | - Duncan Orlander
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
| | - Mark Weiner
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
| | - Rainu Kaushal
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
- Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
- NewYork-Presbyterian Hospital, New York, NY, United States of America
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, United States of America
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116
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Topmiller M, McCann J, Rankin J, Hoang H, Bolton J, Sripipatana A. Exploring the association of social determinants of health and clinical quality measures and performance in HRSA-funded health centres. Fam Med Community Health 2021; 9:fmch-2020-000853. [PMID: 34215670 PMCID: PMC8256755 DOI: 10.1136/fmch-2020-000853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This paper explores the impact of service area-level social deprivation on health centre clinical quality measures. Design Cross-sectional data analysis of Health Resources and Services Administration (HRSA)-funded health centres. We created a weighted service area social deprivation score for HRSA-funded health centres as a proxy measure for social determinants of health, and then explored adjusted and unadjusted clinical quality measures by weighted service area Social Deprivation Index quartiles for health centres. Settings HRSA-funded health centres in the USA. Participants Our analysis included a subset of 1161 HRSA-funded health centres serving more than 22 million mostly low-income patients across the country. Results Higher levels of social deprivation are associated with statistically significant poorer outcomes for all clinical quality outcome measures (both unadjusted and adjusted), including rates of blood pressure control, uncontrolled diabetes and low birth weight. The adjusted and unadjusted results are mixed for clinical quality process measures as higher levels of social deprivation are associated with better quality for some measures including cervical cancer screening and child immunisation status but worse quality for other such as colorectal cancer screening and early entry into prenatal care. Conclusions This research highlights the importance of incorporating community characteristics when evaluating clinical outcomes. We also present an innovative method for capturing health centre service area-level social deprivation and exploring its relationship to health centre clinical quality measures.
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Affiliation(s)
- Michael Topmiller
- HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
| | - Jessica McCann
- HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
| | - Jennifer Rankin
- HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
| | - Hank Hoang
- Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, Maryland, USA
| | - Joshua Bolton
- Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, Maryland, USA
| | - Alek Sripipatana
- Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, Maryland, USA
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117
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Madhavan SM. APOL1 genotyping in kidney transplantation: a look into the future. Kidney Int 2021; 100:32-34. [PMID: 34154721 DOI: 10.1016/j.kint.2021.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Sethu M Madhavan
- Division of Nephrology, Department of Medicine, The Ohio State University, Columbus, Ohio, USA.
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118
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Population Kidney Health. A New Paradigm for Chronic Kidney Disease Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136786. [PMID: 34202623 PMCID: PMC8297314 DOI: 10.3390/ijerph18136786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/20/2021] [Accepted: 06/20/2021] [Indexed: 12/12/2022]
Abstract
Statistical data extracted from national databases demonstrate a continuous growth in the incidence and prevalence of chronic kidney disease (CKD) and the ineffectiveness of current policies and strategies based on individual risk factors to reduce them, as well as their mortality and costs. Some innovative programs, telemedicine and government interest in the prevention of CKD did not facilitate timely access to care, continuing the increased demand for dialysis and transplants, high morbidity and long-term disability. In contrast, new forms of kidney disease of unknown etiology affected populations in developing countries and underrepresented minorities, who face socioeconomic and cultural disadvantages. With this background, our objective was to analyze in the existing literature the effects of social determinants in CKD, concluding that it is necessary to strengthen current kidney health strategies, designing in a transdisciplinary way, a model that considers demographic characteristics integrated into individual risk factors and risk factors population, incorporating the population health perspective in public health policies to improve results in kidney health care, since CKD continues to be an important and growing contributor to chronic diseases.
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119
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Abstract
Peripheral artery disease is an obstructive, atherosclerotic disease of the lower extremities causing significant morbidity and mortality. Black Americans are disproportionately affected by this disease while they are also less likely to be diagnosed and promptly treated. The consequences of this disparity can be grim as Black Americans bear the burden of lower extremity amputation resulting from severe peripheral artery disease. The risk factors of peripheral artery disease and how they differentially affect certain groups are discussed in addition to a review of pharmacological and nonpharmacological treatment modalities. The purpose of this review is to highlight health care inequities and provide a review and resource of available recommendations for clinical management of all patients with peripheral artery disease.
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Affiliation(s)
- Eddie L Hackler
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH (E.L.H., K.W.S.)
| | - Naomi M Hamburg
- Cardiology, Boston University School of Medicine, Medicine, MA (N.M.H.)
| | - Khendi T White Solaru
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH (E.L.H., K.W.S.)
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120
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Childhood risk factors for adulthood chronic kidney disease. Pediatr Nephrol 2021; 36:1387-1396. [PMID: 32500249 DOI: 10.1007/s00467-020-04611-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/03/2020] [Accepted: 05/11/2020] [Indexed: 12/25/2022]
Abstract
Chronic kidney disease (CKD) is a major public health challenge, affecting as much as 8 to 18% of the world population. Identifying childhood risk factors for future CKD may help clinicians make early diagnoses and initiation of preventive interventions for CKD and its attendant comorbidities as well as monitoring for complications. The purpose of this review is to describe childhood risk factors that may predict development of overt kidney disease later in life. Currently, there are multiple childhood risk factors associated with future onset and progression of CKD. These risk factors can be grouped into five categories: genetic factors (e.g., monogenic or risk alleles), perinatal factors (e.g., low birth weight and prematurity), childhood kidney diseases (e.g., congenital anomalies, glomerular diseases, and renal cystic ciliopathies), childhood onset of chronic conditions (e.g., cancer, diabetes, hypertension, dyslipidemia, and obesity), and different lifestyle factors (e.g., physical activity, diet, and factors related to socioeconomic status). The available published information suggests that the lifelong risk for CKD can be attributed to multiple factors that appear already during childhood. However, results are conflicting on the effects of childhood physical activity, diet, and dyslipidemia on future renal function. On the other hand, there is consistent evidence to support follow-up of high-risk groups.
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121
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Fevrier-Paul A, Soyibo AK, De Silva N, Mitchell S, Nwokocha C, Voutchkov M. Addressing the Challenge of Potentially Hazardous Elements in the Reduction of Hypertension, Diabetes and Chronic Kidney Disease in the Caribbean. J Health Pollut 2021; 11:210613. [PMID: 34268000 PMCID: PMC8276730 DOI: 10.5696/2156-9614-11.30.210613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/16/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Environmental surveys have characterized trace elements such as lead (Pb), cadmium (Cd) and arsenic (As) as potential risk factors for non-communicable diseases. There have been few studies conducted in the Caribbean region to explore, define or clarify such findings locally. Furthermore, local pollution control efforts are often juxtaposed against more seemingly immediate economic concerns in poor communities. OBJECTIVES The present commentary is a call to action for the evaluation of potentially hazardous elements as potential risk indicators and/or factors of common noncommunicable diseases in the Caribbean. DISCUSSION Findings from Jamaican studies have identified exposure to potentially hazardous elements (PHE) via water, food, and other anthropogenic activities to the detriment of the resident population. Several attempts have been made to abate toxic metal exposure in children with relative success. However, high levels of PHE have been noted in vulnerable populations such as patients with hypertension, diabetes mellitus and chronic kidney disease. Currently, there is low priority towards infrastructure building within the Caribbean region that would promote and sustain long term monitoring and better inform environmental polices impacting chronic diseases. CONCLUSIONS Further investigations are needed to clarify the role that PHE play in increasing the risk or progression of non-communicable diseases, especially in vulnerable groups. COMPETING INTERESTS The authors declare no competing financial interests.
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Affiliation(s)
- Adwalia Fevrier-Paul
- Department of Physics, Faculty of Science and Technology, University of the West Indies, Mona, Jamaica
| | - Adedamola K. Soyibo
- Department of Medicine, University Hospital of the West Indies, Kingston, Jamaica
| | - Nimal De Silva
- Earth and Environmental Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sylvia Mitchell
- The Biotechnology Centre, Faculty of Science and Technology, University of the West Indies, Mona , Jamaica
| | - Chukwuemeka Nwokocha
- Department of Basic Medical Sciences, The University of the West Indies, Mona, Jamaica
| | - Mitko Voutchkov
- Department of Physics, Faculty of Science and Technology, University of the West Indies, Mona, Jamaica
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122
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Norris KC, Beech BM. Social Determinants of Kidney Health: Focus on Poverty. Clin J Am Soc Nephrol 2021; 16:809-811. [PMID: 33441465 PMCID: PMC8259475 DOI: 10.2215/cjn.12710820] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Keith C. Norris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Bettina M. Beech
- Department of Health Systems and Population Health Sciences, University of Houston, Houston, Texas
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123
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Weinstein AM, Kimmel PL. Social Determinants of Health in People with Kidney Disease: An Introduction. Clin J Am Soc Nephrol 2021; 16:803-805. [PMID: 33441467 PMCID: PMC8259481 DOI: 10.2215/cjn.12600720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Alan M. Weinstein
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Paul L. Kimmel
- Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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124
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Cukor D, Edwards DP. Personal Experiences of Patients in the Interaction of Culture and Kidney Disease. Clin J Am Soc Nephrol 2021; 16:818-819. [PMID: 33441468 PMCID: PMC8259487 DOI: 10.2215/cjn.12400720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Daniel Cukor
- Behavioral Health, The Rogosin Institute, New York, New York
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Luyckx VA, Moosa MR. Priority Setting as an Ethical Imperative in Managing Global Dialysis Access and Improving Kidney Care. Semin Nephrol 2021; 41:230-241. [PMID: 34330363 DOI: 10.1016/j.semnephrol.2021.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Priority-setting dilemmas arise when trade-offs must be made regarding the kinds of services that should be provided and to whom, thereby withholding other services from individuals or groups that could benefit from them. Currently, it is practically impossible for lower-income countries to provide dialysis for all patients with kidney failure; however, the fundamental premise of the human right to health, while acknowledging the current resource constraints, is the progressive realization of access to care for all. In this article we outline the rationale for priority setting, starting with the global goal of achieving universal health coverage, the prerequisites for fair and transparent priority setting, and discuss how these may apply to expensive care such as dialysis. Priority is inherently a value-laden process, and cannot be whittled down to technical considerations of clinical or cost effectiveness alone. Fair and transparent priority setting should originate from population health needs, be based on evidence, and be associated with ethical values or principles. This requires effective engagement with relevant stakeholders. Once policies are developed and implemented, good oversight is crucial to ensure accountability and to provide iterative feedback such that the goals of universal health coverage may be progressively realized.
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Affiliation(s)
- Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Child Health and Pediatrics, University of Cape Town, Cape Town, South Africa.
| | - M Rafique Moosa
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
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126
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Webel AR, Schexnayder J, Cioe PA, Zuñiga JA. A Review of Chronic Comorbidities in Adults Living With HIV: State of the Science. J Assoc Nurses AIDS Care 2021; 32:322-346. [PMID: 33595986 PMCID: PMC8815414 DOI: 10.1097/jnc.0000000000000240] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT People living with HIV are living longer, high-quality lives; however, as they age, this population is at increased risk for developing chronic comorbidities, including cardiovascular disease, certain types of cancer (e.g., lung, anal, and liver), and diabetes mellitus. The purpose of this state-of-the-science review is to provide an evidence-based summary on common physical comorbidities experienced by people living and aging with HIV. We focus on those chronic conditions that are prevalent and growing and share behavioral risk factors that are common in people living with HIV. We will discuss the current evidence on the epidemiology, physiology, prevention strategies, screening, and treatment options for people living with HIV across resource settings.
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Affiliation(s)
- Allison R Webel
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Julie Schexnayder
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Patricia A Cioe
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Julie A Zuñiga
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
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Jagannathan R, Rajagopalan K, Hogan J, Hart A, Newell KA, Pastan SO, Patzer RE. Association Between APOL1 Genotype and Kidney Diseases and Annual Kidney Function Change: A Systematic Review and Meta-Analysis of the Prospective Studies. Int J Nephrol Renovasc Dis 2021; 14:97-104. [PMID: 33854359 PMCID: PMC8039047 DOI: 10.2147/ijnrd.s294191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/23/2021] [Indexed: 01/11/2023] Open
Abstract
Background Two coding risk variants in the Apo L1 gene (APOL1) underlie most of the excess risk for kidney diseases in recent African ancestry patients. Strength and consistency of the relationship between APOL1 high-risk genotypes and the risk of chronic kidney diseases (CKD) and end-stage renal disease (ESRD) are not uniform. Objective To conduct a systematic review and meta-analysis of prospective studies assessing the association of APOL1 genotypes and the risk of developing CKD, ESRD, and CKD to ESRD in adults. Methods Systematic search of MEDLINE, EMBASE, and Google Scholar was performed for prospective studies assessing the associations between APOL1 genotypes and CKD, ESRD, and progression from CKD to ESRD. Secondary analyses were to evaluate the annual kidney function change by APOL1 gene status. Random effects models were used to estimate pooled risk ratios (RRs) and weighted mean differences for outcomes of interest. Results The search yield 10 prospective during a follow-up period ranging from 4.4 to 25 years. The high-risk APOL1 genotype was associated with the incidence of CKD (RR:1.41[95% CI: 1.14–1.75]), the progression from CKD to ESRD (RR: 1.70[95% CI:1.44; 2.01]) compared with the low-risk APOL1 genotype. There was no appreciable association between high-risk APOL1 genotype with the incidence of ESRD. Furthermore, high-risk APOL1 genotype was associated with a marginal decrement in the annual eGFR decline (−0.55[95% CI: −0.94 to −0.16]) mL/min/1.73m2 compared with low-risk APOL1 genotype status. Conclusion In summary, African Americans carrying APOL1 high-risk genotypes are at increased risk of developing CKD and ESRD. Given that the APOL1 risk alleles are common among individuals with African ancestry, with ~18% of African Americans carrying high-risk alleles, these findings highlight the potential identification of subgroups of patients who may benefit from APOL1 screening and developing culturally-appropriate interventions.
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Affiliation(s)
- Ram Jagannathan
- Department of Medicine, Division of Hospital Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Kanya Rajagopalan
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Julien Hogan
- Pediatric Nephrology Department, Robert Debre University Hospital, Paris, 75019, France.,Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, GA, USA
| | - Allyson Hart
- Division of Nephrology, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA.,University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kenneth A Newell
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephen O Pastan
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Rachel E Patzer
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, GA, USA.,Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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128
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Hannan M, Ansari S, Meza N, Anderson AH, Srivastava A, Waikar S, Charleston J, Weir MR, Taliercio J, Horwitz E, Saunders MR, Wolfrum K, Feldman HI, Lash JP, Ricardo AC. Risk Factors for CKD Progression: Overview of Findings from the CRIC Study. Clin J Am Soc Nephrol 2021; 16:648-659. [PMID: 33177074 PMCID: PMC8092061 DOI: 10.2215/cjn.07830520] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The Chronic Renal Insufficiency Cohort (CRIC) Study is an ongoing, multicenter, longitudinal study of nearly 5500 adults with CKD in the United States. Over the past 10 years, the CRIC Study has made significant contributions to the understanding of factors associated with CKD progression. This review summarizes findings from longitudinal studies evaluating risk factors associated with CKD progression in the CRIC Study, grouped into the following six thematic categories: (1) sociodemographic and economic (sex, race/ethnicity, and nephrology care); (2) behavioral (healthy lifestyle, diet, and sleep); (3) genetic (apoL1, genome-wide association study, and renin-angiotensin-aldosterone system pathway genes); (4) cardiovascular (atrial fibrillation, hypertension, and vascular stiffness); (5) metabolic (fibroblast growth factor 23 and urinary oxalate); and (6) novel factors (AKI and biomarkers of kidney injury). Additionally, we highlight areas where future research is needed, and opportunities for interdisciplinary collaboration.
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Affiliation(s)
- Mary Hannan
- Department of Medicine, University of Illinois, Chicago, Illinois
| | - Sajid Ansari
- Department of Medicine, University of Illinois, Chicago, Illinois
| | - Natalie Meza
- Department of Medicine, University of Illinois, Chicago, Illinois
| | - Amanda H. Anderson
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Anand Srivastava
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Division of Nephrology and Hypertension, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sushrut Waikar
- Nephrology Section, Boston University Medical Center, Boston, Massachusetts
| | - Jeanne Charleston
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Matthew R. Weir
- Division of Nephrology, Department of Medicine, University of Maryland, Baltimore, Maryland
| | - Jonathan Taliercio
- Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio
| | | | - Milda R. Saunders
- Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Katherine Wolfrum
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harold I. Feldman
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James P. Lash
- Department of Medicine, University of Illinois, Chicago, Illinois
| | - Ana C. Ricardo
- Department of Medicine, University of Illinois, Chicago, Illinois
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129
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Jing L, Chen W, Guo L, Zhao L, Liang C, Chen J, Wang C. Acute kidney injury after lung transplantation: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:717. [PMID: 33987415 PMCID: PMC8106087 DOI: 10.21037/atm-20-7644] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Acute kidney injury (AKI) is a commonly recognized complication after lung transplantation (LT) and is related to increased mortality and morbidity. With the improvement of survival after LT and the increasing number of lung transplant recipients, the detrimental impact of current management on renal function has become increasingly apparent. Multifarious risk factors in the perioperative setting contribute to the development of AKI, including the preoperative status and complications of the recipient, complex perioperative problems especially hemodynamic fluctuation, and exposure to nephrotoxic agents, mainly calcineurin inhibitors (CNIs) and antimicrobial drugs. Identification and minimization of the effects of these risk factors can relieve AKI severity and incidence in high-risk patients. Close monitoring of urine output and serum creatinine (sCr) levels and of specific biomarkers may promote early recognition of AKI and rapid nephrology intervention to improve outcomes. This review summarizes advances in the epidemiology, diagnostic criteria, biological markers of AKI, and further recommends appropriate treatment strategies for the long-term management of AKI related manifestations in lung transplant recipients. Future work will need to focus on developing more accurate measures of renal function and identifying patients before the occurrence of early renal damage. Combining renal protection strategies with the use of new biomarkers to develop early kidney risk identification and protection protocols is a promising idea that requires further investigation.
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Affiliation(s)
- Lei Jing
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Lung Transplantation, Centre of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Wenhui Chen
- Department of Lung Transplantation, Centre of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Lijuan Guo
- Department of Lung Transplantation, Centre of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Li Zhao
- Department of Lung Transplantation, Centre of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Chaoyang Liang
- Department of Lung Transplantation, Centre of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Jingyu Chen
- Department of Lung Transplantation, Centre of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
| | - Chen Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Lung Transplantation, Centre of Lung Transplantation, Centre of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,National Center for Respiratory Medicine, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,National Clinical Research Center for Respiratory Diseases, Beijing, China.,WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention, Beijing, China
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130
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Husain SA, King KL, Sanichar N, Crew RJ, Schold JD, Mohan S. Association Between Donor-Recipient Biological Relationship and Allograft Outcomes After Living Donor Kidney Transplant. JAMA Netw Open 2021; 4:e215718. [PMID: 33847748 PMCID: PMC8044734 DOI: 10.1001/jamanetworkopen.2021.5718] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE The proportion of living donor kidney transplants from donors unrelated to their recipients is increasing in the US. OBJECTIVE To examine the association between donor-recipient biological relationship and allograft survival after living donor kidney transplant. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used Organ Procurement and Transplantation Network data on US adult living donor kidney transplants (n = 86 154) performed from January 1, 2000, to December 31, 2014, excluding cases in which recipients previously received a kidney transplant (n = 10 342) or key data were missing (n = 2832). Last follow-up was March 20, 2020. EXPOSURES Donor-recipient biological relationship. MAIN OUTCOMES AND MEASURES The primary outcome was death-censored allograft failure. Univariate and multivariable time-to-event analyses were performed for death-censored allograft failure for the overall cohort, then separately for recipients with and without primary diagnoses of cystic kidney disease and for transplants from African American and non-African American donors. RESULTS Among the 72 980 transplant donor and recipients included in the study (median donor age, 41 years; interquartile range [IQR], 32-50 years; 43 990 [60%] female; 50 014 [69%] White), 43 174 (59%) donors and recipients were biologically related and 29 806 (41%) were unrelated. Donors related to their recipients were younger (median [IQR] age, 39 [31-48] vs 44 [35-52] years) and less likely to be female (24 848 [58%] vs 19 142 [64%]) or White (26 933 [62%] vs 23 081 [77%]). Recipients related to their donors were younger (median [IQR] age, 48 [34-58] vs 50 [40-58] years), more likely to be female (18 035 [42%] vs 10 530 [35%]), and less likely to have cystic kidney disease (2530 [6%] vs 4600 [15%]). Related pairs had fewer HLA mismatches overall (median [IQR], 3 [2-3] vs 5 [4-5]). After adjustment for HLA mismatches, donor and recipient characteristics, and transplant era, donor-recipient biological relationship was associated with higher death-censored allograft failure (hazard ratio, 1.05; 95% CI, 1.01-1.10; P = .03). When stratified by primary disease, this association persisted only for recipients without cystic kidney disease. When stratified by donor race, this association persisted only for transplants from African American donors. CONCLUSIONS AND RELEVANCE In this cohort study, living donor kidney transplants from donors biologically related to their recipients had higher rates of allograft failure than transplants from donors unrelated to their recipients after HLA matching was accounted for. Further study is needed to determine which genetic or socioenvironmental factors are associated with this finding.
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Affiliation(s)
- S. Ali Husain
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York
- The Columbia University Renal Epidemiology (CURE) Group, New York, New York
| | - Kristen L. King
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York
- The Columbia University Renal Epidemiology (CURE) Group, New York, New York
| | - Navin Sanichar
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - R. John Crew
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York
| | - Jesse D. Schold
- Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York
- The Columbia University Renal Epidemiology (CURE) Group, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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131
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Thurlow JS, Joshi M, Yan G, Norris KC, Agodoa LY, Yuan CM, Nee R. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy. Am J Nephrol 2021; 52:98-107. [PMID: 33752206 PMCID: PMC8057343 DOI: 10.1159/000514550] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/17/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The global epidemiology of end-stage kidney disease (ESKD) reflects each nation's unique genetic, environmental, lifestyle, and sociodemographic characteristics. The response to ESKD, particularly regarding kidney replacement therapy (KRT), depends on local disease burden, culture, and socioeconomics. Here, we explore geographic variation and global trends in ESKD incidence and prevalence and examine variations in KRT modality, practice patterns, and mortality. We conclude with a discussion on disparities in access to KRT and strategies to reduce ESKD global burden and to improve access to treatment in low- and middle-income countries (LMICs). SUMMARY From 2003 to 2016, incidence rates of treated ESKD were relatively stable in many higher income countries but rose substantially predominantly in East and Southeast Asia. The prevalence of treated ESKD has increased worldwide, likely due to improving ESKD survival, population demographic shifts, higher prevalence of ESKD risk factors, and increasing KRT access in countries with growing economies. Unadjusted 5-year survival of ESKD patients on KRT was 41% in the USA, 48% in Europe, and 60% in Japan. Dialysis is the predominant KRT in most countries, with hemodialysis being the most common modality. Variations in dialysis practice patterns account for some of the differences in survival outcomes globally. Worldwide, there is a greater prevalence of KRT at higher income levels, and the number of people who die prematurely because of lack of KRT access is estimated at up to 3 times higher than the number who receive treatment. Key Messages: Many people worldwide in need of KRT as a life-sustaining treatment do not receive it, mostly in LMICs where health care resources are severely limited. This large treatment gap demands a focus on population-based prevention strategies and development of affordable and cost-effective KRT. Achieving global equity in KRT access will require concerted efforts in advocating effective public policy, health care delivery, workforce capacity, education, research, and support from the government, private sector, nongovernmental, and professional organizations.
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Affiliation(s)
- John S Thurlow
- Nephrology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Megha Joshi
- Nephrology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Guofen Yan
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Keith C Norris
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Lawrence Y Agodoa
- Office of the Director, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Christina M Yuan
- Nephrology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Robert Nee
- Nephrology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA,
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA,
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132
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Ozieh MN, Garacci E, Walker RJ, Palatnik A, Egede LE. The cumulative impact of social determinants of health factors on mortality in adults with diabetes and chronic kidney disease. BMC Nephrol 2021; 22:76. [PMID: 33639878 PMCID: PMC7916298 DOI: 10.1186/s12882-021-02277-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/15/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A growing body of evidence supports the potential role of social determinants of health on health outcomes. However, few studies have examined the cumulative effect of social determinants of health on health outcomes in adults with chronic kidney disease (CKD) with or without diabetes. This study examined the cumulative impact of social determinants of health on mortality in U.S. adults with CKD and diabetes. METHODS We analyzed data from National Health and Nutrition Examination Surveys (2005-2014) for 1376 adults age 20 and older (representing 7,579,967 U.S. adults) with CKD and diabetes. The primary outcome was all-cause mortality. CKD was based on estimated glomerular filtration rate and albuminuria. Diabetes was based on self-report or Hemoglobin A1c of ≥6.5%. Social determinants of health measures included family income to poverty ratio level, depression based on PHQ-9 score and food insecurity based on Food Security Survey Module. A dichotomous social determinant measure (absence vs presence of ≥1 adverse social determinants) and a cumulative social determinant score ranging from 0 to 3 was constructed based on all three measures. Cox proportional models were used to estimate the association between social determinants of health factors and mortality while controlling for covariates. RESULTS Cumulative and dichotomous social determinants of health score were significantly associated with mortality after adjusting for demographics, lifestyle variables, glycemic control and comorbidities (HR = 1.41, 95%CI 1.18-1.68 and HR = 1.41, 95%CI 1.08-1.84, respectively). When investigating social determinants of health variables separately, after adjusting for covariates, depression (HR = 1.52, 95%CI 1.10-1.83) was significantly and independently associated with mortality, however, poverty and food insecurity were not statistically significant. CONCLUSIONS Specific social determinants of health factors such as depression increase mortality in adults with chronic kidney disease and diabetes. Our findings suggest that interventions are needed to address adverse determinants of health in this population.
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Affiliation(s)
- Mukoso N Ozieh
- Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
- Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA.
| | - Emma Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anna Palatnik
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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133
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Lucas A, Wyatt CM, Inker LA. Removing race from GFR estimates: balancing potential benefits and unintended consequences. Kidney Int 2021; 100:11-13. [PMID: 33647323 DOI: 10.1016/j.kint.2021.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Anika Lucas
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christina M Wyatt
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lesley A Inker
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA.
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134
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Atamari-Anahui N, Ccorahua-Rios MS, Condori-Huaraka M, Huamanvilca-Yepez Y, Amaya E, Herrera-Añazco P. Epidemiology of chronic kidney disease in Peru and its relation to social determinants of health. Int Health 2021; 12:264-271. [PMID: 31670810 PMCID: PMC7322196 DOI: 10.1093/inthealth/ihz071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/28/2019] [Accepted: 07/16/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a growing public health problem and an important cause of morbidity and mortality. Disparities in CKD may be related to social determinants and health inequalities in low- and middle-income countries. This study determined how social determinants of health influence trends in the prevalence and mortality of CKD in Peru. METHODS This was an ecological study based on a secondary analysis of health care and death records obtained from the Ministry of Health of Peru for the period 2010-2016. The standardized prevalence and mortality rates of CKD were descriptively reported using geospatial exploratory analysis. We also determined the association with social determinants of health according to the domains suggested by Healthy People 2020. RESULTS In the studied period, CKD prevalence increased by 300% and was associated with the health insurance coverage rate (β=5.9 [95% CI 0.82 to 10.92]), proportion of people with a secondary education level (β=11.4 [95% CI 1.94 to 20.93]), mean age (β=-10.7 [95% CI -19.33 to -2.12]), monetary poverty rate (β=-2.2 [95% CI -3.88 to -0.60]) and gross domestic product per capita (β=-63.2 [95% CI -117.81 to -8.52]). The standardized mortality decreased by 10% and was associated with mean age (β=-0.6 [95% CI -1.22 to -0.06]) and the proportion of people with a primary education level (β=-0.5 [95% CI -0.9 to -0.05]). CONCLUSIONS During the period 2010-2016, the prevalence of CKD increased and the mortality associated with CKD decreased. The observed changes were associated with some social determinants of health, such as increased health coverage and education. The health system of Peru must be prepared to take on the challenge.
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Affiliation(s)
- Noé Atamari-Anahui
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Avenue La Fontana 750, La Molina, Lima, Perú
| | - Maycol Suker Ccorahua-Rios
- Asociación científica de estudiantes de medicina humana (ASOCIEMH CUSCO), Escuela de Medicina Humana, Universidad Nacional San Antonio Abad del Cusco, Avenue La Cultura 773, Cusco 08000, Perú
| | - Mirian Condori-Huaraka
- Asociación científica de estudiantes de medicina humana (ASOCIEMH CUSCO), Escuela de Medicina Humana, Universidad Nacional San Antonio Abad del Cusco, Avenue La Cultura 773, Cusco 08000, Perú
| | - Yerika Huamanvilca-Yepez
- Asociación científica de estudiantes de medicina humana (ASOCIEMH CUSCO), Escuela de Medicina Humana, Universidad Nacional San Antonio Abad del Cusco, Avenue La Cultura 773, Cusco 08000, Perú
| | - Elard Amaya
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Avenue La Fontana 750, La Molina, Lima, Perú
| | - Percy Herrera-Añazco
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Avenue La Fontana 750, La Molina, Lima, Perú
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Walther CP, Ix JH, Biggs ML, Kizer JR, Navaneethan SD, Djoussé L, Mukamal KJ. Nonesterified Fatty Acids and Kidney Function Decline in Older Adults: Findings From the Cardiovascular Health Study. Am J Kidney Dis 2021; 78:259-267. [PMID: 33548344 DOI: 10.1053/j.ajkd.2020.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/30/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Circulating nonesterified fatty acids (NEFAs) make up a small portion of circulating lipids but are a metabolically important energy source. Excessive circulating NEFAs may contribute to lipotoxicity in many tissues, including the kidneys. We investigated the relationship between total circulating NEFA concentration and kidney outcomes in older, community-dwelling adults. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 4,698 participants≥65 years of age in the Cardiovascular Health Study who underwent total fasting serum NEFA concentration measurements in 1992-1993. EXPOSURE Fasting serum NEFA concentration at one time point. OUTCOME Three primary outcomes: estimated glomerular filtration rate (eGFR) decline of≥30%, the composite of eGFR decline≥30% or kidney failure with replacement therapy, and change in eGFR. These outcomes were assessed over 4- and 13-year periods. ANALYTICAL APPROACH Logistic regression for the dichotomous outcomes and mixed effects models for the continuous outcome, with sequential adjustment for baseline covariates. Inverse probability of attrition weighting was implemented to account for informative attrition during the follow-up periods. RESULTS Serum NEFA concentrations were not independently associated with kidney outcomes. In unadjusted and partially adjusted analyses, the highest quartile of serum NEFA concentration (compared with lowest) was associated with a higher risk of≥30% eGFR decline at 4 years and faster rate of decline of eGFR. No associations were evident after adjustment for comorbidities, lipid levels, insulin sensitivity, medications, and vital signs: the odds ratio for the eGFR decline outcome was 1.33 (95% CI, 0.83-2.13), and the difference in eGFR slope in the highest versus lowest quartile of serum NEFA concentration was-0.15 (95% CI, -0.36 to 0.06) mL/min/1.73m2 per year. LIMITATIONS Single NEFA measurements, no measurements of post-glucose load NEFA concentrations or individual NEFA species, no measurement of baseline urine albumin. CONCLUSIONS A single fasting serum NEFA concentration was not independently associated with long-term adverse kidney outcomes in a cohort of older community-living adults.
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Affiliation(s)
- Carl P Walther
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX.
| | - Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, and Division of Nephrology-Hypertension, University of California-San Diego, La Jolla, CA
| | - Mary L Biggs
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA
| | - Jorge R Kizer
- Cardiology Section, San Francisco Veterans Affairs Healthcare System, and Departments of Medicine, Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA
| | - Sankar D Navaneethan
- Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX; Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Luc Djoussé
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, and Boston Veterans Affairs Healthcare System, Boston, MA
| | - Kenneth J Mukamal
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Cain-Shields L, Glover L, Young B, Sims M. Association between goal-striving stress and rapid kidney function decline among African Americans: the Jackson Heart Study. J Investig Med 2021; 69:382-387. [PMID: 33335024 PMCID: PMC8057281 DOI: 10.1136/jim-2020-001510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 11/04/2022]
Abstract
African Americans (AAs) are disproportionately affected by kidney disease and also report higher psychosocial stressors than other racial groups. Goal-striving stress (GSS) is an understudied psychosocial stressor related to attempting to accomplish one's life goals. Given the numerous social determinants that contribute to health inequities among AAs, stress from goal striving may also disproportionately affect the health of AAs and in particular kidney disease outcomes. The objective of this study was to explore the association between GSS and rapid kidney function decline (RKFD) in an AA cohort. Using examination 1 (2000-2004) and examination 3 (2009-2013) data from the Jackson Heart Study (n=2630), we examined associations of baseline levels of GSS with RKFD among AAs using multivariable Poisson regression models, adjusting for sociodemographics, health behaviors, chronic disease and discrimination. We also explored baseline cortisol as a mediator. The incidence of RKFD in this sample was 7.34% (mean years of follow-up: 8.06±0.84 years). The mean GSS score was 3.80 (±4.88) and total GSS score ranged from 0 to 36. Those who reported high (vs low) GSS were 1.60 times more likely to experience RKFD after full adjustment (incidence rate ratio (IRR) 1.60; 95% CI 1.11 to 2.14, p=0.01). After confirming cortisol as a mediator and adding it to the model, those who reported high (vs low) GSS had 1.58 times the rate of RKFD (IRR 1.58; 95% CI 1.09 to 2.30, p=0.0153). Stress related to not achieving goals was associated with a greater risk of RKFD in this sample of AAs.
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Affiliation(s)
- Loretta Cain-Shields
- Department of Data Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - LáShauntá Glover
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Bessie Young
- Division of Nephrology and Kidney Research Institute, University of Washington, Seattle, Washington, USA
- Veterans Affairs, Hospital and Specialty Medicine and Center for Innovation, Seattle, Washington, USA
| | - Mario Sims
- School of Medicine, Jackson Heart Study, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Golestaneh L, Karaboyas A, Cavanaugh K, Umeukeje EM, Johns TS, Thorpe RJ, Bruce MA, Griffith DM, Melamed ML, Norris KC. The Role of Place in Disparities Affecting Black Men Receiving Hemodialysis. Kidney Int Rep 2021; 6:357-365. [PMID: 33615061 PMCID: PMC7879205 DOI: 10.1016/j.ekir.2020.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/21/2020] [Accepted: 10/13/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Black men are over-represented in the end stage kidney disease population and are at disproportionate risk of unfavorable outcomes. There is a paucity of investigation to elucidate the mediators of this risk. This study attempts to identify residential community attributes as a possible contributor. METHODS A post-hoc analysis of prospectively collected data from a cohort of Black men enrolled in the US Dialysis Outcomes and Practice Patterns Study (DOPPS), 2010--2015, linked to the American Community Survey, by dialysis facility zip codes was undertaken. The exposure variable was the dialysis facility community composition as defined by percent Black residents. Negative binomial regression was used to estimate incidence rate ratio (IRR) of hospitalization (first outcome) for Black men in crude and adjusted models. Similarly, Cox proportional hazards modeling was used to estimate mortality (second outcome) for Black men by type of community. RESULTS A total of 702 Black men receiving chronic hemodialysis were included in the study. Black men receiving hemodialysis in communities with greater proportions of Black residents had lower Charlson scores and fewer comorbidities, but a higher rate of hypertension. They had equivalent adherence to dialysis treatments, but a lower rate of arteriovenous fistula use and fewer dialysis minutes prescribed. Black men receiving dialysis in communities with a greater proportion of Black residents (per 10% increase) had higher adjusted hospitalization rates (IRR 1.09, 95% confidence interval [CI] 1.00-1.19) and mortality (hazard ratio [HR] 1.29, 95% CI 1.05-1.59). CONCLUSIONS This study supports the unique role of residential community as a risk factor for Black men with end stage kidney disease, showing higher hospitalization and mortality in those treating in Black versus non-Black communities, despite equivalent adherence and fewer comorbidities.
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Affiliation(s)
- Ladan Golestaneh
- Division of Nephrology, Department of Medicine Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Angelo Karaboyas
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Kerri Cavanaugh
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Tanya S. Johns
- Division of Nephrology, Department of Medicine Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Roland J. Thorpe
- Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Marino A. Bruce
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Derek M. Griffith
- Center for Research on Men’s Health, Vanderbilt University, Nashville, Tennessee, USA
| | - Michal L. Melamed
- Division of Nephrology, Department of Medicine Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Keith C. Norris
- Division of General Internal Medicine and Nephrology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
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Zhao H, Song R, Ye Y, Chow WH, Shen J. Allostatic score and its associations with demographics, healthy behaviors, tumor characteristics, and mitochondrial DNA among breast cancer patients. Breast Cancer Res Treat 2021; 187:587-596. [PMID: 33507481 DOI: 10.1007/s10549-021-06102-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/09/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Allostatic load (AL), a composite index, has been used to capture variation in life-course stresses. However, few studies have been carried out among breast cancer patients. METHODS In this study, we examined the cross-sectional association of AL with demographics, healthy behaviors, tumor characteristics, and mitochondrial DNA copy number in breast cancer patients. The study used a sub-sample of 934 women with newly diagnosed breast cancer at M.D. Anderson from 2013 to 2018. To construct the AL score, the study used a battery of seventeen factors that represents the activity of five physiological systems: metabolic, cardiovascular, immunological, renal, and liver. RESULTS AL was positively associated with the age of disease diagnosis (P = 0.002), and was higher in Black and Hispanic populations than White (P = 0.001 and 0.032, respectively). AL was also found more abundant in those who experienced marital dissolution (P = 0.006), lacked a college education (P = 0.045), currently smoked (P = 0.011), and had low levels of physical activity (P = 0.037) than their counterparts. The study then found that higher AL was associated with increased odds of having poorly differentiated tumors (Odds ratio (OR): 1.40, 95% confidence interval (CI): 1.28, 1.62). An additional significant association was observed between AL with estrogen receptor negative (ER-) (OR = 1.56, 95%CI: 1.02, 2.36) among Black patients. Finally, we observed a significant positive correlation between AL with leukocyte mitochondrial DNA copy number variation (P < 0.001). CONCLUSIONS We conclude AL is influenced by selected demographics and healthy behaviors, and further is correlated with tumor characteristics and mitochondrial DNA copy number in breast cancer patients.
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Affiliation(s)
- Hua Zhao
- Departments of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA. .,Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23284, USA.
| | - Renduo Song
- Departments of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Yuanqing Ye
- Departments of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,Department of Precision Health and Data Science, School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wong-Ho Chow
- Departments of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Jie Shen
- Departments of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.,Department of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23284, USA
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Lyas C. A Call to Action for Addressing Disparities and Increasing Diversity in Academic Nephrology. KIDNEY360 2021; 2:532-533. [PMID: 35369016 PMCID: PMC8785993 DOI: 10.34067/kid.0006532020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/26/2021] [Indexed: 02/04/2023]
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Thorsteinsdottir B, Hickson LJ, Giblon R, Pajouhi A, Connell N, Branda M, Vasdev AK, McCoy RG, Zand L, Tangri N, Shah ND. Validation of prognostic indices for short term mortality in an incident dialysis population of older adults >75. PLoS One 2021; 16:e0244081. [PMID: 33471808 PMCID: PMC7816982 DOI: 10.1371/journal.pone.0244081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 12/03/2020] [Indexed: 11/29/2022] Open
Abstract
Rational and objective Prognosis provides critical knowledge for shared decision making between patients and clinicians. While several prognostic indices for mortality in dialysis patients have been developed, their performance among elderly patients initiating dialysis is unknown, despite great need for reliable prognostication in that context. To assess the performance of 6 previously validated prognostic indices to predict 3 and/or 6 months mortality in a cohort of elderly incident dialysis patients. Study design Validation study of prognostic indices using retrospective cohort data. Indices were compared using the concordance (“c”)-statistic, i.e. area under the receiver operating characteristic curve (ROC). Calibration, sensitivity, specificity, positive and negative predictive values were also calculated. Setting & participants Incident elderly (age ≥75 years; n = 349) dialysis patients at a tertiary referral center. Established predictors Variables for six validated prognostic indices for short term (3 and 6 month) mortality prediction (Foley, NCI, REIN, updated REIN, Thamer, and Wick) were extracted from the electronic medical record. The indices were individually applied as per each index specifications to predict 3- and/or 6-month mortality. Results In our cohort of 349 patients, mean age was 81.5±4.4 years, 66% were male, and median survival was 351 days. The c-statistic for the risk prediction indices ranged from 0.57 to 0.73. Wick ROC 0.73 (0.68, 0.78) and Foley 0.67 (0.61, 0.73) indices performed best. The Foley index was weakly calibrated with poor overall model fit (p <0.01) and overestimated mortality risk, while the Wick index was relatively well-calibrated but underestimated mortality risk. Limitations Small sample size, use of secondary data, need for imputation, homogeneous population. Conclusion Most predictive indices for mortality performed moderately in our incident dialysis population. The Wick and Foley indices were the best performing, but had issues with under and over calibration. More accurate indices for predicting survival in older patients with kidney failure are needed.
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Affiliation(s)
- Bjorg Thorsteinsdottir
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Biomedical Ethics Program, Mayo Clinic, Rochester, Minnesota, United States of America
- Knowledge Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, United States of America
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
| | - LaTonya J. Hickson
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Rachel Giblon
- Knowledge Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, United States of America
- Division of Health Care Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Atieh Pajouhi
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Natalie Connell
- Biomedical Ethics Program, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Megan Branda
- Knowledge Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, United States of America
| | - Amrit K. Vasdev
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Rozalina G. McCoy
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ladan Zand
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Navdeep Tangri
- Department of Medicine, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada
- Department of Community Health Sciences, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Canada
| | - Nilay D. Shah
- Knowledge Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, United States of America
- Division of Health Care Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
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Okoro RN, Ummate I, Ohieku JD, Yakubu SI, Adibe MO, Okonta MJ. Kidney Disease Knowledge and Its Determinants Among Patients With Chronic Kidney Disease. J Patient Exp 2021; 7:1303-1309. [PMID: 33457579 PMCID: PMC7786774 DOI: 10.1177/2374373520967800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The alarming rise in the incidence of end-stage renal disease in Nigeria is likely to continue if patients with chronic kidney disease (CKD) lack knowledge of this disease, its management, and practices to support effective self-management. The study aimed to assess CKD knowledge and to investigate its predictors. A cross-sectional survey was conducted using a paper-based questionnaire at the medical and nephrology outpatients' clinics of a secondary and tertiary hospital in Maiduguri. The study enrolled 220 patients with CKD stages 1 to 4. Sixty-five percent of the participants had poor CKD knowledge. The patients who had a tertiary level of education were significantly more likely to have higher CKD knowledge compared to those with no formal education (adjusted odds ratio: 2.62, 95% CI: 1.20-5.72). The study shows that the majority of the participants had poor CKD knowledge. Tertiary educational level was the only significant independent predictor of higher CKD knowledge. Therefore, targeted educational interventions are needed among patients with no or low formal education to be able to support them with self-management behaviors.
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Affiliation(s)
- Roland Nnaemeka Okoro
- Department of Clinical Pharmacy and Pharmacy Administration, University of Maiduguri, Maiduguri, Nigeria
| | - Ibrahim Ummate
- Department of Medicine, Nephrology Unit, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - John David Ohieku
- Department of Clinical Pharmacy and Pharmacy Administration, University of Maiduguri, Maiduguri, Nigeria
| | - Sani Ibn Yakubu
- Department of Clinical Pharmacy and Pharmacy Administration, University of Maiduguri, Maiduguri, Nigeria
| | - Maxwell Ogochukwu Adibe
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Nigeria
| | - Mathew Jegbefume Okonta
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Nigeria
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Promoting Peritoneal Dialysis Retention in Underserved Communities. Am J Med Sci 2021; 361:1-2. [PMID: 33422190 DOI: 10.1016/j.amjms.2020.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/23/2020] [Indexed: 11/22/2022]
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Affiliation(s)
- M R Moosa
- Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - K C Norris
- Department of Medicine, UCLA School of Medicine, Los Angeles, CA, USA.
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Chen TK, Coresh J, Daya N, Ballew SH, Tin A, Crews DC, Grams ME. Race, APOL1 Risk Variants, and Clinical Outcomes among Older Adults: The ARIC Study. J Am Geriatr Soc 2021; 69:155-163. [PMID: 32894582 PMCID: PMC7855571 DOI: 10.1111/jgs.16797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND/OBJECTIVES APOL1 high-risk genotypes confer an increased risk for kidney disease, but their clinical significance among older adults remains unclear. We aimed to determine whether APOL1 genotype status (high risk = 2 risk alleles; low risk = 0-1 risk alleles) and self-reported race (Black; White) are associated with number of hospitalizations, incident chronic kidney disease (CKD), end-stage renal disease (ESRD), and mortality among older adults participating in a community-based cohort study. DESIGN Observational longitudinal cohort study. SETTING The Atherosclerosis Risk in Communities (ARIC) study. PARTICIPANTS Community-dwelling older adults (mean age = 75.8 years; range = 66-90 years). RESULTS Among 5,564 ARIC participants (78.2% White, 19.1% APOL1 low-risk Black, and 2.7% APOL1 high-risk Black), the proportion with creatinine and cystatin C-based estimated glomerular filtration rate (eGFRCrCys ) below 60 mL/min/1.73 m2 at baseline was 40.6%, 34.8%, and 43.2%, respectively. Over a mean follow-up of 5.1 years, APOL1 high-risk Blacks had a 2.67-fold higher risk for ESRD compared with low-risk Blacks (95% confidence interval [CI] = 1.05-6.79) in models adjusted for age and sex. This association was no longer significant upon further adjustment for baseline eGFRCrCys and albuminuria (hazard ratio [HR] = 1.08; 95% CI = .39-2.96). Rate of hospitalizations and risks of mortality and incident CKD did not differ significantly by APOL1 genotype status. Compared with Whites, Blacks had 1.85-fold and 3.45-fold higher risks for incident CKD and ESRD, respectively, in models adjusted for age, sex, eGFRCrCys , and albuminuria. These associations persisted after additional adjustments for clinical/socioeconomic factors and APOL1 genotype (incident CKD: HR = 1.38; 95% CI = 1.06-1.81; ESRD: HR = 3.20; 95% CI = 1.16-8.86). CONCLUSION Among older Black adults, APOL1 high-risk genotypes were associated with lower kidney function and therefore higher risk of ESRD. Racial disparities in incident kidney disease persisted in older age and were not fully explained by APOL1.
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Affiliation(s)
- Teresa K. Chen
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Natalie Daya
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shoshana H. Ballew
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Adrienne Tin
- Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Deidra C. Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Morgan E. Grams
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Association of Educational Attainment With Incidence of CKD in Young Adults. Kidney Int Rep 2020; 5:2256-2263. [PMID: 33305119 PMCID: PMC7710886 DOI: 10.1016/j.ekir.2020.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/03/2020] [Accepted: 09/09/2020] [Indexed: 01/07/2023] Open
Abstract
Introduction Chronic kidney disease (CKD) is greatly affected by social determinants of health. Whether low educational attainment is associated with incident CKD in young adults is unclear. Methods We evaluated the association of education with incident CKD in 3139 Coronary Artery Risk Development in Young Adults participants. We categorized education into low (high school and less), medium (college), and high (master’s and professional studies) groups. Incident CKD was defined as new development of estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2 or urine albumin to creatinine ratio (ACR) ≥30 mg/g. Change in eGFR over 20 years was a secondary outcome. Results At baseline, mean age was 35.0 ± 3.6 years, 47% were Black, and 55% were women. Participants with lower educational attainment were less likely to have high income and health insurance and to engage in a healthy lifestyle. Over 20 years, 407 participants developed CKD (13%). Compared with individuals with low educational attainment, those with medium and high educational attainment had an unadjusted hazard ratios for CKD of 0.79 (95% confidence interval [CI] 0.65–0.97) and 0.44 (95% CI, 0.30–0.63), respectively. This association was no longer significant after adjusting for income, health insurance, lifestyle, and health status. Low educational attainment was significantly associated with a change in eGFR in crude and adjusted analyses, although the association was attenuated in the multivariable models (low: –0.83 [95% CI, –0.91 to –0.75], medium: –0.80 (95% CI, –0.95 to –0.64), and high: –0.70 (95% CI, –0.89 to –0.52) ml/min per 1.73 m2 per yr). Conclusions Health care access, lifestyle, and comorbid conditions likely help explain the association between low educational attainment and incident CKD in young adults.
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Luyckx VA, Al-Aly Z, Bello AK, Bellorin-Font E, Carlini RG, Fabian J, Garcia-Garcia G, Iyengar A, Sekkarie M, van Biesen W, Ulasi I, Yeates K, Stanifer J. Sustainable Development Goals relevant to kidney health: an update on progress. Nat Rev Nephrol 2020; 17:15-32. [PMID: 33188362 PMCID: PMC7662029 DOI: 10.1038/s41581-020-00363-6] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 12/13/2022]
Abstract
Globally, more than 5 million people die annually from lack of access to critical treatments for kidney disease — by 2040, chronic kidney disease is projected to be the fifth leading cause of death worldwide. Kidney diseases are particularly challenging to tackle because they are pathologically diverse and are often asymptomatic. As such, kidney disease is often diagnosed late, and the global burden of kidney disease continues to be underappreciated. When kidney disease is not detected and treated early, patient care requires specialized resources that drive up cost, place many people at risk of catastrophic health expenditure and pose high opportunity costs for health systems. Prevention of kidney disease is highly cost-effective but requires a multisectoral holistic approach. Each Sustainable Development Goal (SDG) has the potential to impact kidney disease risk or improve early diagnosis and treatment, and thus reduce the need for high-cost care. All countries have agreed to strive to achieve the SDGs, but progress is disjointed and uneven among and within countries. The six SDG Transformations framework can be used to examine SDGs with relevance to kidney health that require attention and reveal inter-linkages among the SDGs that should accelerate progress. Working towards sustainable development is essential to tackle the rise in the global burden of non-communicable diseases, including kidney disease. Five years after the Sustainable Development Goal agenda was set, this Review examines the progress thus far, highlighting future challenges and opportunities, and explores the implications for kidney disease. Each Sustainable Development Goal (SDG) has the potential to improve kidney health and prevent kidney disease by improving the general health and well-being of individuals and societies, and by protecting the environment. Achievement of each SDG is interrelated to the achievement of multiple other SDGs; therefore, a multisectoral approach is required. The global burden of kidney disease has been relatively underestimated because of a lack of data. Structural violence and the social determinants of health have an important impact on kidney disease risk. Kidney disease is the leading global cause of catastrophic health expenditure, in part because of the high costs of kidney replacement therapy. Achievement of universal health coverage is the minimum requirement to ensure sustainable and affordable access to early detection and quality treatment of kidney disease and/or its risk factors, which should translate to a reduction in the burden of kidney failure in the future.
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Affiliation(s)
- Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa. .,Institute of Biomedical Ethics and the History of Medicine, University of Zürich, Zürich, Switzerland.
| | - Ziyad Al-Aly
- Department of Medicine, Washington University in Saint Louis, Saint Louis, MO, USA.,Clinical Epidemiology Center, Veterans Affairs Saint Louis Health Care System, Saint Louis, MO, USA
| | - Aminu K Bello
- Division of Nephrology & Immunology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Raul G Carlini
- Sección de Investigación, Servicio de Nefrología y Trasplante Renal, Hospital Universitario de Caracas, Caracas, Venezuela
| | - June Fabian
- Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Witwatersrand, South Africa
| | - Guillermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Hospital, 278, Guadalajara, Mexico
| | - Arpana Iyengar
- Department of Paediatric Nephrology, St. John's National Academy of Health Sciences, Bangalore, India
| | | | - Wim van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Ifeoma Ulasi
- Renal Unit, Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Karen Yeates
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - John Stanifer
- Munson Nephrology, Munson Healthcare, Traverse City, MI, USA
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147
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Lett E, Dowshen NL, Baker KE. Intersectionality and Health Inequities for Gender Minority Blacks in the U.S. Am J Prev Med 2020; 59:639-647. [PMID: 32792281 PMCID: PMC7577994 DOI: 10.1016/j.amepre.2020.04.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Gender minority blacks represent the intersection of multiply marginalized populations that experience severe health inequities in the U.S. However, few studies focus on the unique health experiences of this multiply disadvantaged population. This study quantifies the health inequities experienced by gender minority blacks in the U.S. using an intersectional framework. METHODS This cross-sectional study analyzed data in 2018/2019 from the Behavioral Risk Factor Surveillance System, including all cisgender black, gender minority black, and gender minority white survey respondents who completed the gender identity module between 2014 and 2018. Investigators compared demographics, healthcare access, behavioral risk factors, chronic conditions, and perceived health status of gender minority blacks with those of cisgender blacks and gender minority whites. RESULTS In the primary analysis of weighted survey data, gender minority blacks were more likely to report experiencing severe mental distress (AOR=1.99, 95% CI=1.14, 3.47, p=0.02), longer periods of being physically or mentally unwell (adjusted RR=1.36, 95% CI=1.17, 1.59, p<0.001), and longer periods of activity limitations owing to poor health (adjusted RR=1.53, 95% CI=1.01, 1.41, p=0.003) than cisgender blacks. In a matched analysis, gender minority blacks had worse self-reported health than both cisgender blacks (OR=1.32, 95%: CI=1.05, 1.67, p=0.02) and gender minority whites (OR=1.53, 95% CI=1.15, 2.04, p=0.003). CONCLUSIONS Gender minority blacks have health experiences that are distinct from those of both the cisgender black and gender minority populations with which they intersect. Health policies and programs, including data collection efforts, must specifically consider this multiply marginalized population to effectively advance health equity.
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Affiliation(s)
- Elle Lett
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Nadia L Dowshen
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kellan E Baker
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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148
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Sloan CE, Zhong J, Mohottige D, Hall R, Diamantidis CJ, Boulware LE, Wang V. Fragmentation of care as a barrier to optimal ESKD management. Semin Dial 2020; 33:440-448. [PMID: 33128300 DOI: 10.1111/sdi.12929] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/04/2020] [Indexed: 12/15/2022]
Abstract
Caring for patients with end-stage kidney disease (ESKD) in the United States is challenging, due in part to the complex epidemiology of the disease's progression as well as the ways in which care is delivered. As CKD progresses toward ESKD, the number of comorbidities increases and care involves multiple healthcare providers from multiple subspecialties. This occurs in the context of a fragmented US healthcare delivery system that is traditionally siloed by provider specialty, organization, as well as systems of payment and administration. This article describes the role of care fragmentation in the delivery of optimal ESKD care and identifies research gaps in the evidence across the continuum of care. We then consider the impact of care fragmentation on ESKD care from the patient and health system perspectives and explore opportunities for system-level interventions aimed at improving care for patients with ESKD.
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Affiliation(s)
- Caroline E Sloan
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Judy Zhong
- Duke University Trinity College of Arts & Sciences, Durham, NC, USA
| | | | - Rasheeda Hall
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Clarissa J Diamantidis
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Leight E Boulware
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Virginia Wang
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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149
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Qian J, Lee T, Thamer M, Zhang Y, Crews DC, Allon M. Racial Disparities in the Arteriovenous Fistula Care Continuum in Hemodialysis Patients. Clin J Am Soc Nephrol 2020; 15:1796-1803. [PMID: 33082199 PMCID: PMC7769016 DOI: 10.2215/cjn.03600320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 09/17/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Arteriovenous fistulas are the optimal vascular access type for patients on hemodialysis. However, arteriovenous fistulas are used less frequently in Black than in White individuals. The arteriovenous fistula care continuum comprises a series of sequential steps. A better understanding is needed of where disparities exist along the continuum in order to mitigate racial differences in arteriovenous fistula use. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using Medicare claims data from the United States Renal Data System, longitudinal analyses of patients ≥67 years initiating hemodialysis with a central venous catheter between July 1, 2010 and June 30, 2012 were performed. Three patient cohorts were identified: patients initiating hemodialysis with a catheter (n=41,814), patients with arteriovenous fistula placement within 6 months of dialysis initiation (n=14,077), and patients whose arteriovenous fistulas were successfully used within 6 months of placement (n=7068). Three arteriovenous fistula processes of care outcomes were compared between Blacks and Whites: (1) arteriovenous fistula creation, (2) successful arteriovenous fistula use, and (3) primary arteriovenous fistula patency after successful use. RESULTS An arteriovenous fistula was placed within 6 months of dialysis initiation in 37% of patients initiating dialysis with a catheter. Among the patients with arteriovenous fistula placement, the arteriovenous fistula was successfully used for dialysis within 6 months in 48% of patients. Among patients with successful arteriovenous fistula use, 21% maintained primary arteriovenous fistula patency at 3 years. After adjusting for competing risks, Black patients on hemodialysis were 10% less likely to undergo arteriovenous fistula placement (adjusted subdistribution hazard ratio, 0.90; 95% confidence interval, 0.87 to 0.94); 12% less likely to have successful arteriovenous fistula use after placement (adjusted subdistribution hazard ratio, 0.88; 95% confidence interval, 0.83 to 0.93); and 22% less likely to maintain primary arteriovenous fistula patency after successful use (subdistribution hazard ratio, 0.78; 95% confidence interval, 0.74 to 0.84). CONCLUSIONS Lower arteriovenous fistula use among Blacks older than 67 years of age treated with hemodialysis was attributable to each step along the continuum of arteriovenous fistula processes of care.
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Affiliation(s)
- Joyce Qian
- Medical Technology and Practice Patterns Institute, Bethesda, Maryland
| | - Timmy Lee
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama .,Veterans Affairs Medical Center, Medical Service and Section of Nephrology, Birmingham, Alabama
| | - Mae Thamer
- Medical Technology and Practice Patterns Institute, Bethesda, Maryland
| | - Yi Zhang
- Medical Technology and Practice Patterns Institute, Bethesda, Maryland
| | - Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael Allon
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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150
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Nguyen NT, Maxwell AP, Donnelly M, O'Neill C. Prospective payment system and racial/ethnic disparities: a national retrospective observational study in anaemia complication among end-stage renal disease patients in the US. BMC Nephrol 2020; 21:423. [PMID: 33023486 PMCID: PMC7541203 DOI: 10.1186/s12882-020-02081-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/27/2020] [Indexed: 12/02/2022] Open
Abstract
Background A series of policy changes in 2011 altered reimbursement arrangements and guidance on use of erythropoiesis-stimulating agents for end-stage renal disease (ESRD) patients with anaemia in the US. While the policy changes were principally directed at care delivered in an outpatient setting, these had the potential to affect inpatient care also. This study used HCUP-NIS data (2008–2016) to examine trends in recorded anaemia among ESRD hospitalizations and analyse disparities in inpatient outcomes among ethnic groups following policy changes. Methods The International Classification of Diseases codes were used to identify ESRD admissions, recorded anaemia due to chronic kidney disease (CKD), and to generate an age-adjusted Deyo-Charlson comorbidity index. Linear splines with a knot placed at the time point of policy changes and multivariable logistic regression were used to examine the likelihood of recorded anaemia, adjusted for a range of socio-demographic and clinical covariates. Difference-in-difference analyses investigated the impact of policies on recorded anaemia. Other outcomes included hospital cost, mortality and place of discharge. Results The percentage of inpatient episodes with recorded anaemia arising from CKD increased from 26.2% in 2008 to 50.0% in 2016. Anaemia was more likely to be recorded as a complication of ESRD among minority ethnic groups and Native American admissions, in particular, (OR 1.20, 95%CI 1.15–1.25) relative to White American admissions; and these disparities widened following changes to reimbursement. Minorities were less likely to die in hospital and to be discharged to another healthcare facility, and (with the exception of Black American admissions) they were more expensive to treat. Conclusions Our findings provide evidence of an increase in recorded anaemia consistent with a shift of patients from outpatient to inpatient settings in the wake of changes to reimbursement enacted in 2011. In addition, the study highlights the existence of ethnic disparities that widened after the policy initiated reimbursement changes.
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Affiliation(s)
- Nga Tq Nguyen
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
| | - Alexander P Maxwell
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Michael Donnelly
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Ciaran O'Neill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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