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Ali MR, Nacer H, Lawson CA, Khunti K. Racial and Ethnic Disparities in Primary Prevention of Cardiovascular Disease. Can J Cardiol 2024; 40:1016-1030. [PMID: 38309463 DOI: 10.1016/j.cjca.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 02/05/2024] Open
Abstract
Cardiovascular disease (CVD) disproportionately affects ethnic-minority groups globally. Ethnic-minority groups face particularly high CVD burden and mortality, exacerbated by disparities across modifiable risk factors, wider determinants of health, and limited access to preventative interventions. This narrative review summarizes evidence on modifiable risk factors, such as physical activity, hypertension, diet, smoking, alcohol consumption, diabetes, and the polypill for the primary prevention of CVD in ethnic minorities. Across these factors, we find inequities in risk factor prevalence. The evidence underscores that inequalities in accessibility to interventions and treatments impede progress in reducing CVD risk using primary prevention interventions for ethnic-minority people. Although culturally tailored interventions show promise, further research is required across the different risk factors. Social determinants of health and structural inequities also exacerbate CVD risk for ethnic-minority people and warrant greater attention. Additionally, we find that only limited ethnicity-specific data and guidelines are available on CVD primary prevention interventions for most risk factors. To address these gaps in research, we provide recommendations that include the following: investigating the sustainability and real-world effectiveness of culturally sensitive interventions; ensuring that ethnic-minority peoples' perspectives are considered in research; longitudinal tracking of risk factors; interventions and outcomes in ethnic-minority people; and ensuring that data collection and reporting of ethnicity data are standardized.
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Affiliation(s)
- Mohammad R Ali
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; National Institute for Health Research (NIHR) Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom; Diabetes Research Centre, University of Leicester, Leicester, United Kingdom.
| | | | - Claire A Lawson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; National Institute for Health Research (NIHR) Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom; National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands, University of Leicester, Leicester, United Kingdom
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2
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Tyson CC, Svetkey LP, Lin PH, Granados I, Kennedy D, Dunbar KT, Redd C, Bennett G, Boulware LE, Fish LJ. Self-Perceived Barriers and Facilitators to Dietary Approaches to Stop Hypertension Diet Adherence Among Black Americans With Chronic Kidney Disease: A Qualitative Study. J Ren Nutr 2023; 33:59-68. [PMID: 35597318 PMCID: PMC10344422 DOI: 10.1053/j.jrn.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/25/2022] [Accepted: 05/01/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE The Dietary Approaches to Stop Hypertension (DASH) eating plan improves hypertension in Black individuals and is associated with favorable chronic kidney disease (CKD) outcomes. Yet, adherence to DASH is low among US adults in general, particularly among Black Americans. We assessed perceptions about DASH, its cultural compatibility, and barriers and facilitators to DASH adherence in Black adults with CKD. DESIGN AND METHODS We conducted focus groups and semistructured individual interviews involving 22 Black men and women with CKD Stages 3-4 from outpatient clinics at a US academic medical center. Transcripts of audio-recorded interviews were analyzed using thematic analysis. RESULTS Among participants (2 focus groups [N = 8 and 5] and 9 individual interviews), 13 (59%) had CKD Stage 3, 13 (59%) were female, the median age was 61 years, and 19 (90%) had hypertension. After receiving information about DASH, participants perceived it as culturally compatible based on 3 emergent themes: (1) Black individuals already eat DASH-recommended foods ("Blacks eat pretty much like this"), (2) traditional recipes (e.g., southern or soul food) can be modified into healthy versions ("you can come up with decent substitutes to make it just as good"), and ( 3) diet is not uniform among Black individuals ("I can't say that I eat traditional"). Perceived barriers to DASH adherence included unfamiliarity with serving sizes, poor cooking skills, unsupportive household members, and high cost of healthy food. Eleven (52%) reported after paying monthly bills that they "rarely" or "never" had leftover money to purchase healthy food. Perceived facilitators included having local access to healthy food, living alone or with supportive household members, and having willpower and internal/external motivation for change. CONCLUSIONS Black adults with CKD viewed DASH as a healthy, culturally compatible diet. Recognizing that diet in Black adults is not uniform, interventions should emphasize person-centered, rather than stereotypically culture-centered, approaches to DASH adherence.
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Affiliation(s)
- Crystal C Tyson
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
| | - Laura P Svetkey
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Stedman Nutrition & Metabolism Center, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Pao-Hwa Lin
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Stedman Nutrition & Metabolism Center, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Isa Granados
- Duke Cancer Institute, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Kayla T Dunbar
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Cynthia Redd
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Gary Bennett
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Department of Psychology and Neuroscience, Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
| | - L Ebony Boulware
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Laura J Fish
- Duke Cancer Institute, Duke University, Durham, North Carolina; Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
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Ramsey MW, Reese-Smith J, Lemacks JL, Madson MB, Greer T, Bradford L, Aras S, Gipson JA, McLin DB. Key Focus Group Themes to Inform Weight Management Interventions in Deep South African Americans. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:647-659. [PMID: 35568686 PMCID: PMC9351227 DOI: 10.1016/j.jneb.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To understand African Americans' perceptions, barriers, and facilitators to recruitment, enrollment, adoption, maintenance, and retention in a nutrition and physical activity promotion program. DESIGN Four focus groups were conducted. SETTING Two community settings located in Jackson and Hattiesburg, Mississippi. PARTICIPANTS Participants (n = 28) were aged 18-50 years. MAIN OUTCOME MEASURE(S) Barriers and facilitators associated with healthy eating, physical activity, achieving a healthy weight, and participation in a health behavior change program. ANALYSIS A conventional thematic content analysis approach includes data familiarization, initial code generation, initial theme generation, themes review, and team review for finalization of themes. RESULTS Major themes related to health behaviors and participation in a behavior change program were identified by participants, including time constraints, costs, social support, consistency and self-efficacy, motivation for longevity and disease prevention, physical appearance, fear of injury/pain, social norms/stigma associated with outdoor physical activity, body criticism from family members, and having empathic and validating program staff support. CONCLUSIONS AND IMPLICATIONS Several social determinants of health were identified as essential considerations for promoting healthy nutrition and physical activity behaviors among African American adult Mississippians. Cultural and spiritual implications were also identified. Study insights inform policy approaches for designing culturally appropriate health behavior change programs in the Deep South.
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Affiliation(s)
- Michael W Ramsey
- Mississippi INBRE Telenutrition Center, Hattiesburg, MS; Department of Psychology, Jackson State University, Jackson, MS.
| | - Jacqueline Reese-Smith
- Mississippi INBRE Telenutrition Center, Hattiesburg, MS; Houston Fire Department-Firefighter Support Network, Houston, TX
| | - Jennifer L Lemacks
- Mississippi INBRE Telenutrition Center, Hattiesburg, MS; University of Southern Mississippi, Hattiesburg, MS; Mississippi INBRE Community Engagement and Training Core, Hattiesburg, MS
| | - Michael B Madson
- Mississippi INBRE Telenutrition Center, Hattiesburg, MS; University of Southern Mississippi, Hattiesburg, MS
| | - Tammy Greer
- Mississippi INBRE Telenutrition Center, Hattiesburg, MS; University of Southern Mississippi, Hattiesburg, MS
| | | | - Sermin Aras
- University of Southern Mississippi, Hattiesburg, MS
| | - June A Gipson
- Mississippi INBRE Community Engagement and Training Core, Hattiesburg, MS
| | - Dawn B McLin
- Department of Psychology, Jackson State University, Jackson, MS
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Rahman HH, Niemann D, Munson-McGee SH. Association of albumin to creatinine ratio with urinary arsenic and metal exposure: evidence from NHANES 2015-2016. Int Urol Nephrol 2021; 54:1343-1353. [PMID: 34643861 DOI: 10.1007/s11255-021-03018-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 10/05/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Urinary metals can be used to identify metal exposure in humans from various sources in the environment. Decreased renal function and cardiovascular dysfunction may occur due to low levels of metal exposure in the general population. The purpose of this study is to assess the association between urinary arsenic and metals and a higher albumin to creatinine ratio (ACR) among adults in the general US population. METHODS We conducted a cross sectional analyses using the 2015-2016 National Health and Nutrition Examination Survey (NHANES) dataset. Multiple linear logistic models were used to examine the association between 21 urinary arsenic and metal concentrations (arsenous acid, arsenic acid, arsenobetaine, arsenocholine, dimethylarsinic acid, monomethylarsonic acid, total arsenic, mercury, barium, cadmium, cobalt, cesium, molybdenum, manganese, lead, antinomy, tin, strontium, thallium, tungsten, uranium) and increased ACR (≥ 30 mg/g). RESULTS The sample included 4122 adults, of whom approximately 9.4% of males and 10.7% females had increased ACRs. The exposure included urinary arsenic compounds (7) and urinary metal compounds (14) at or above the limit of detection. Urinary dimethylarsinic acid [OR 38.9, 95% CI 3.6-414.6], urinary monomethylarsonic acid [OR 18.6, 95% CI 1.1-308.2], urinary cadmium [OR 11.9, 95% CI 1.2-122.0], urinary cesium [OR 17.0, 95% CI 2.7-105.8], and urinary antimony [OR 10.7, 95% CI 2.2-51.3] were associated with an increased ACR. No other urinary metals were significantly associated with increased ACR. CONCLUSION Increased ACR was positively associated with urinary dimethylarsinic acid, monomethylarsonic acid, cadmium, cesium, and antimony.
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Palliative Care in Patients with End-Stage Renal Disease: A Meta Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010651. [PMID: 34682395 PMCID: PMC8535479 DOI: 10.3390/ijerph182010651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 01/20/2023]
Abstract
End-stage renal disease is the last stage of chronic kidney disease and is associated with a decreased quality of life and life expectancy. This study aimed to explore palliative care with end-stage renal disease. Qualitative meta-synthesis was used as the study design. The search was performed for qualitative studies published until June 2021 and uses reciprocal translation and synthesis of in vivo and imported concepts. Five themes were included: Struggling to face the disease, experiencing deterioration, overcoming the challenges of dialysis, leading to a positive outlook, and preparing for the end of life. In facing chronic disease with life-limiting potential, patients experienced some negative feelings and deterioration in their quality of life. Adaptation to the disease then leads patients to a better outlook through increased spirituality and social status. Furthermore, by accepting the present condition, they started to prepare for the future. Increasing awareness of mortality leads them to discuss advance care (ACP) planning with healthcare professionals and families.
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Bukhsh A, Goh BH, Zimbudzi E, Lo C, Zoungas S, Chan KG, Khan TM. Type 2 Diabetes Patients' Perspectives, Experiences, and Barriers Toward Diabetes-Related Self-Care: A Qualitative Study From Pakistan. Front Endocrinol (Lausanne) 2020; 11:534873. [PMID: 33329377 PMCID: PMC7729167 DOI: 10.3389/fendo.2020.534873] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/25/2020] [Indexed: 01/03/2023] Open
Abstract
Objective: This study aimed to qualitatively explore perspectives, practices, and barriers to self-care practices (eating habits, physical activity, self-monitoring of blood glucose, and medicine intake behavior) in urban Pakistani adults with type 2 diabetes mellitus (T2DM). Methods: Pakistani adults with T2DM were recruited from the outpatient departments of two hospitals in Lahore. Semistructured interviews were conducted and audiorecorded until thematic saturation was reached. Two researchers thematically analyzed the data independently using NVivo® software with differences resolved by a third researcher. Results: Thirty-two Pakistani adults (aged 35-75 years, 62% female) participated in the study. Six themes were identified from qualitative analysis: role of family and friends, role of doctors and healthcare, patients' understanding about diabetes, complication of diabetes and other comorbidities, burden of self care, and life circumstances. A variable experience was observed with education and healthcare. Counseling by healthcare providers, family support, and fear of diabetes-associated complications are the key enablers that encourage study participants to adhere to diabetes-related self-care practices. Major barriers to self care are financial constraints, physical limitations, extreme weather conditions, social gatherings, loving food, forgetfulness, needle phobia, and a hectic job. Conclusion: Respondents identified many barriers to diabetes self care, particularly related to life situations and diabetes knowledge. Family support and education by healthcare providers were key influencers to self-care practices among Pakistani people with diabetes.
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Affiliation(s)
- Allah Bukhsh
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Bey-Hing Goh
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- Malaysia School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Edward Zimbudzi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Nephrology, Monash Health, Melbourne, VIC, Australia
| | - Clement Lo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Monash Diabetes, Monash Health, Melbourne, VIC, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kok-Gan Chan
- Division of Genetics and Molecular Biology, Faculty of Science, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Guangdong Provincial Key Laboratory of Marine Biology, Institute of Marine Sciences, Shantou University, Shantou, China
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
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Abstract
Kidney disease is a global public health problem, affecting over 750 million persons worldwide. The burden of kidney disease varies substantially across the world, as does its detection and treatment. In many settings, rates of kidney disease and the provision of its care are defined by socio-economic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. Here, we highlight that many countries still lack access to basic diagnostics, a trained nephrology workforce, universal access to primary health care, and renal replacement therapies. We point to the need for strengthening basic infrastructure for kidney care services for early detection and management of acute kidney injury and chronic kidney disease across all countries and advocate for more pragmatic approaches to providing renal replacement therapies. Achieving universal health coverage worldwide by 2030 is one of the World Health Organization's Sustainable Development Goals. While universal health coverage may not include all elements of kidney care in all countries, understanding what is feasible and important for a country or region with a focus on reducing the burden and consequences of kidney disease would be an important step towards achieving kidney health equity.
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Crews DC, Bello AK, Saadi G. Burden, access, and disparities in kidney disease. Kidney Int 2020; 95:242-248. [PMID: 30665560 DOI: 10.1016/j.kint.2018.11.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
| | - Aminu K Bello
- Division of Nephrology & Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Gamal Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
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Crews DC, Bello AK, Saadi G. Burden, Access, and Disparities in Kidney Disease. EXP CLIN TRANSPLANT 2019; 17:131-137. [PMID: 30945627 DOI: 10.6002/ect.2019.wkde] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Deidra C Crews
- From the Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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10
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Crews DC, Bello AK, Saadi G. Burden, access, and disparities in kidney disease. TERAPEVT ARKH 2019; 91:40-46. [DOI: 10.26442/00403660.2019.06.000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Indexed: 11/22/2022]
Abstract
For the World Kidney Day Steering Committee Kidney disease is a global public health problem that affects more than 750 million persons worldwide. The burden of kidney disease varies substantially across the world, as does its detection and treatment. Although the magnitude and impact of kidney disease is better defined in developed countries, emerging evidence suggests that developing countries have a similar or even greater kidney disease burden. In many settings, rates of kidney disease and the provision of its care are defined by socioeconomic, cultural, and political factors, leading to significant disparities in disease burden, even in developed countries. These disparities exist across the spectrum of kidney disease - from preventive efforts to curb development of acute kidney injury or chronic kidney disease, to screening for kidney disease among persons at high risk, to access to subspecialty care and treatment of kidney failure with renal replacement therapy. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. In this editorial, we highlight these disparities and emphasize the role of public policies and organizational structures in addressing them. We outline opportunities to improve our understanding of disparities in kidney disease, the best ways for them to be addressed, and how to streamline efforts toward achieving kidney health equity across the globe.
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Crews DC, Bello AK, Saadi G. Burden, access, and disparities in kidney disease. Nefrologia 2019; 40:4-11. [PMID: 30954303 DOI: 10.1016/j.nefro.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, Estados Unidos; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, Estados Unidos; Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland, Estados Unidos.
| | - Aminu K Bello
- Division of Nephrology & Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Canadá
| | - Gamal Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
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Abstract
Kidney disease is a global public health problem, affecting over 750 million persons worldwide. The burden of kidney disease varies substantially across the world, as does its detection and treatment. In many settings, rates of kidney disease and the provision of its care are defined by socio-economic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. Here, we highlight that many countries still lack access to basic diagnostics, a trained nephrology workforce, universal access to primary health care, and renal replacement therapies. We point to the need for strengthening basic infrastructure for kidney care services for early detection and management of acute kidney injury and chronic kidney disease across all countries and advocate for more pragmatic approaches to providing renal replacement therapies. Achieving universal health coverage worldwide by 2030 is one of the World Health Organization's Sustainable Development Goals. While universal health coverage may not include all elements of kidney care in all countries, understanding what is feasible and important for a country or region with a focus on reducing the burden and consequences of kidney disease would be an important step toward achieving kidney health equity.
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13
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Crews DC, Bello AK, Saadi G. Burden, access, and disparities in kidney disease. ACTA ACUST UNITED AC 2019; 52:e8338. [PMID: 30916222 PMCID: PMC6437937 DOI: 10.1590/1414-431x20198338] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 01/01/2023]
Abstract
This article was published in Kidney International volume 95, pages 242–248,
https://doi.org/10.1016/j.kint.2018.11.007, Copyright World
Kidney Day 2019 Steering Committee (2019) and is reprinted concurrently in
several journals. The articles cover identical concepts and wording, but vary in
minor stylistic and spelling changes, detail, and length of manuscript in
keeping with each journal's style. Any of these versions may be used in citing
this article. Note that all authors contributed equally to the conception,
preparation, and editing of the manuscript. Kidney disease is a global public health problem, affecting over 750 million
persons worldwide. The burden of kidney disease varies substantially across the
world, as does its detection and treatment. In many settings, rates of kidney
disease and the provision of its care are defined by socio-economic, cultural,
and political factors leading to significant disparities. World Kidney Day 2019
offers an opportunity to raise awareness of kidney disease and highlight
disparities in its burden and current state of global capacity for prevention
and management. Here, we highlight that many countries still lack access to
basic diagnostics, a trained nephrology workforce, universal access to primary
health care, and renal replacement therapies. We point to the need for
strengthening basic infrastructure for kidney care services for early detection
and management of acute kidney injury and chronic kidney disease across all
countries and advocate for more pragmatic approaches to providing renal
replacement therapies. Achieving universal health coverage worldwide by 2030 is
one of the World Health Organization's Sustainable Development Goals. While
universal health coverage may not include all elements of kidney care in all
countries, understanding what is feasible and important for a country or region
with a focus on reducing the burden and consequences of kidney disease would be
an important step towards achieving kidney health equity.
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Affiliation(s)
- D C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.,Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - A K Bello
- Division of Nephrology & Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - G Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
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Crews DC, Bello AK, Saadi G. Burden, access and disparities in kidney disease. Intern Med J 2019; 49:287-294. [PMID: 30897663 DOI: 10.1111/imj.14216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 01/08/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.,Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Aminu K Bello
- Division of Nephrology and Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Gamal Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
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Crews DC, Bello AK, Saadi G. Burden, Access, and Disparities in Kidney Disease. Am J Hypertens 2019; 32:433-439. [PMID: 30877303 DOI: 10.1093/ajh/hpz007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/16/2019] [Indexed: 01/05/2023] Open
Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Aminu K Bello
- Division of Nephrology and Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Gamal Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
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Crews DC, Bello AK, Saadi G. Burden, Access, and Disparities in Kidney Disease. Can J Kidney Health Dis 2019; 6:2054358119836124. [PMID: 30886725 PMCID: PMC6415472 DOI: 10.1177/2054358119836124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/05/2019] [Indexed: 12/12/2022] Open
Abstract
Kidney disease is a global public health problem, affecting more than 750 million persons worldwide. The burden of kidney disease varies substantially across the world, as does its detection and treatment. In many settings, rates of kidney disease and the provision of its care are defined by socioeconomic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. Here, we highlight that many countries still lack access to basic diagnostics, a trained nephrology workforce, universal access to primary health care, and renal replacement therapies. We point to the need for strengthening basic infrastructure for kidney care services for early detection and management of acute kidney injury and chronic kidney disease across all countries and advocate for more pragmatic approaches to providing renal replacement therapies. Achieving universal health coverage worldwide by 2030 is one of the World Health Organization’s Sustainable Development Goals. Although universal health coverage may not include all elements of kidney care in all countries, understanding what is feasible and important for a country or region with a focus on reducing the burden and consequences of kidney disease would be an important step toward achieving kidney health equity.
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Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Aminu K Bello
- Division of Nephrology & Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Gamal Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
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Abstract
Kidney disease is a global public health problem, affecting over 750 million persons worldwide. The burden of kidney disease varies substantially across the world. In many settings, rates of kidney disease and the provision of its care are defined by socioeconomic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. Here, we highlight the need for strengthening basic infrastructure for kidney care services for early detection and management of acute kidney injury and chronic kidney disease across all countries and advocate for more pragmatic approaches to providing renal replacement therapies. Achieving universal health coverage worldwide by 2030 is a World Health Organization Sustainable Development Goal. While universal health coverage may not include all elements of kidney care in all countries, understanding what is locally feasible and important with a focus on reducing the burden and consequences of kidney disease would be an important step towards achieving kidney health equity.
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Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, .,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA, .,Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA,
| | - Aminu K Bello
- Division of Nephrology and Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gamal Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
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Crews DC, Bello AK, Saadi G. Burden, Access, and Disparities in Kidney Disease. Indian J Nephrol 2019; 29:77-83. [PMID: 30983746 PMCID: PMC6440331 DOI: 10.4103/ijn.ijn_55_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Deidra C. Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research; Johns Hopkins Center for Health Equity, MD, USA
- Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Aminu K. Bello
- Division of Nephrology and Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Gamal Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
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Abstract
Kidney disease is a global public health problem, affecting over 750 million persons worldwide. The burden of kidney disease varies substantially across the world. In many settings, rates of kidney disease and the provision of its care are defined by socioeconomic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. Here, we highlight the need for strengthening basic infrastructure for kidney care services for early detection and management of acute kidney injury and chronic kidney disease across all countries and advocate for more pragmatic approaches to providing renal replacement therapies. Achieving universal health coverage worldwide by 2030 is a World Health Organization Sustainable Development Goal. While universal health coverage may not include all elements of kidney care in all countries, understanding what is locally feasible and important with a focus on reducing the burden and consequences of kidney disease would be an important step towards achieving kidney health equity.
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Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA,
- Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA,
| | - Aminu K Bello
- Division of Nephrology and Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gamal Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
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Crews DC, Bello AK, Saadi G. Reprint of: Burden, access, and disparities in kidney disease. Nephrol Ther 2019; 15:3-8. [PMID: 30799281 DOI: 10.1016/j.nephro.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
| | - Aminu K Bello
- Division of Nephrology & Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Gamal Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
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Crews DC, Bello AK, Saadi G. Burden, access and disparities in kidney disease. Nephrol Dial Transplant 2019; 34:371-376. [PMID: 30776294 DOI: 10.1093/ndt/gfy371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 10/19/2018] [Indexed: 01/29/2023] Open
Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Aminu K Bello
- Division of Nephrology & Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Gamal Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
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Crews D, Bello A, Saadi G. Burden, Access, and Disparities in Kidney Disease. Nephron Clin Pract 2019; 141:219-226. [DOI: 10.1159/000495557] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Crews DC, Bello AK, Saadi G. Burden, access and disparities in kidney disease. Clin Kidney J 2019; 12:160-166. [PMID: 30976391 PMCID: PMC6452181 DOI: 10.1093/ckj/sfy128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Indexed: 12/16/2022] Open
Abstract
Kidney disease is a global public health problem, affecting over 750 million persons worldwide. The burden of kidney disease varies substantially across the world, as does its detection and treatment. In many settings, rates of kidney disease and the provision of its care are defined by socio-economic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. Here, we highlight that many countries still lack access to basic diagnostics, a trained nephrology workforce, universal access to primary health care, and renal replacement therapies. We point to the need for strengthening basic infrastructure for kidney care services for early detection and management of acute kidney injury and chronic kidney disease across all countries and advocate for more pragmatic approaches to providing renal replacement therapies. Achieving universal health coverage worldwide by 2030 is one of the World Health Organization's Sustainable Development Goals. While universal health coverage may not include all elements of kidney care in all countries, understanding what is feasible and important for a country or region with a focus on reducing the burden and consequences of kidney disease would be an important step towards achieving kidney health equity.
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Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.,Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Aminu K Bello
- Division of Nephrology & Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Gamal Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
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Prevalence of Dietary Behavior and Determinants of Quality of Diet among Beneficiaries of Government Welfare Assistance in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030501. [PMID: 30754683 PMCID: PMC6388226 DOI: 10.3390/ijerph16030501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/24/2019] [Accepted: 01/31/2019] [Indexed: 11/16/2022]
Abstract
Diet, as a modifiable factor for good health maintenance, reduces the risk of numerous non-communicable chronic diseases and prevents premature death. The aim of the study was to examine the prevalence of a dietary behavior and to find out what the determinants of diet quality among the low socio-economic status population are. The studied sample consisted of 1710 respondents. Only 3% of the beneficiaries had healthy dietary habits. Unhealthy dietary habits dominated in all the study group regardless of the subjects' level of education (p < 0.001). Higher odds of unhealthy dietary habits were reported among the respondents with primary, vocational, and secondary education than among the respondents with high education (for the primary education OR = 11.10; 95% CI: 5.86⁻21.01; p ≤ 0.001; for vocational education OR = 10.54; 95% CI: 5.79⁻19.18; p ≤ 0.001 and for secondary education OR = 5.83; 95% CI: 3.48⁻9.79; p ≤ 0.001). The unhealthy dietary behavior prevalence among beneficiaries of government welfare assistance in Poland is much higher than in the general population. Since only educational level is a determinant which is significantly correlated with the unhealthy dietary behavior, promotion of a healthy diet among disadvantaged individuals should be focused on this factor.
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Crews DC, Bello AK, Saadi G. Burden, access and disparities in kidney disease. Nephrology (Carlton) 2019; 24:373-379. [PMID: 30724421 DOI: 10.1111/nep.13557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.,Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Aminu K Bello
- Division of Nephrology and Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Gamal Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
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Crews DC, Bello AK, Saadi G. Burden, Access, and Disparities in Kidney Disease. KIDNEY DISEASES 2019; 5:126-133. [PMID: 31019926 DOI: 10.1159/000494897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Kidney disease is a global public health problem, affecting over 750 million persons worldwide. The burden of kidney disease varies substantially across the world. In many settings, rates of kidney disease and the provision of its care are defined by socioeconomic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. Here, we highlight the need for strengthening basic infrastructure for kidney care services for early detection and management of acute kidney injury and chronic kidney disease across all countries and advocate for more pragmatic approaches to providing renal replacement therapies. Achieving universal health coverage worldwide by 2030 is a World Health Organization Sustainable Development Goal. While universal health coverage may not include all elements of kidney care in all countries, understanding what is locally feasible and important with a focus on reducing the burden and consequences of kidney disease would be an important step towards achieving kidney health equity.
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Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.,Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Aminu K Bello
- Division of Nephrology and Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gamal Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
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Song AY, Crews DC, Ephraim PL, Han D, Greer RC, Boyér LL, Ameling J, Gayles DJ, Sneed V, Carson KA, Albert M, Liu Y, Cooper LA, Boulware LE. Sociodemographic and Kidney Disease Correlates of Nutrient Intakes Among Urban African Americans With Uncontrolled Hypertension. J Ren Nutr 2019; 29:399-406. [PMID: 30709714 DOI: 10.1053/j.jrn.2018.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 11/18/2018] [Accepted: 12/12/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The objective of this study was to determine the association between sociodemographic factors and intakes of 4 nutrients and associations between intakes and markers of kidney disease to identify opportunities to improve outcomes among clinically high-risk African Americans. DESIGN AND METHODS We conducted a cross-sectional study of baseline data from the Achieving Blood Pressure Control Together study, a randomized controlled trial of 159 African Americans (117 females) with uncontrolled hypertension in Baltimore MD. To determine the association between sociodemographic factors and nutrient intakes, we constructed linear and logistic regression models. Using logistic regression, we determined the association between below-median nutrient intakes and kidney disease. Our outcomes of interest were daily intakes of vitamin C, magnesium, dietary fiber, and potassium as estimated by the Block Fruit-Vegetable-Fiber Screener and kidney disease defined as estimated glomerular filtration rate <60 mL/min per 1.73 m2 or urinary albumin-to-creatinine ratio >=30 mg/g. SETTING AND SUBJECTS Baseline data from the Achieving Blood Pressure Control Together study, a randomized controlled trial of 159 African Americans (117 females) with uncontrolled hypertension, were obtained. METHODS To determine the association between sociodemographic factors and nutrient intakes, we constructed linear and logistic regression models. Using logistic regression, we determined the association between below-median nutrient intakes and kidney disease. MAIN OUTCOME MEASURES Our outcomes of interest were daily intakes of vitamin C, magnesium, dietary fiber, and potassium as estimated by the Block Fruit-Vegetable-Fiber Screener and kidney disease defined as estimated glomerular filtration rate <60 mL/min per 1.73 m2 or urinary albumin-to-creatinine ratio ≥30 mg/g. RESULTS Overall, compared to Institute of Medicine recommendations, participants had lower intakes of magnesium, fiber, and potassium but higher vitamin C intakes. For females, sociodemographic factors that significantly associated with lower intake of the 4 nutrients were older age, obesity, lower health numeracy, and lesser educational attainment. For males, none of the sociodemographic factors were significantly associated with nutrient intakes. Below-median intake was significantly associated with albumin-to-creatinine ratio ≥30 (adjusted odds ratio [95% confidence interval]: 3.4 [1.5, 7.8] for vitamin C; 3.6 [1.6, 8.4] for magnesium; 2.9 [1.3, 6.5] for fiber; 3.6 [1.6, 8.4] for potassium), but not with estimated glomerular filtration rate <60. CONCLUSION African Americans with uncontrolled hypertension may have low intakes of important nutrients, which could increase their risk of chronic kidney disease. Tailored dietary interventions for African Americans at high risk for chronic kidney disease may be warranted.
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Affiliation(s)
- Annie Y Song
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - 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; Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | - Patti L Ephraim
- 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
| | - Dingfen Han
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Raquel C Greer
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - LaPricia Lewis Boyér
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jessica Ameling
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Debra J Gayles
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Valerie Sneed
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kathryn A Carson
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael Albert
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yang Liu
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Lisa A Cooper
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - L Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
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Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.,Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Aminu K Bello
- Division of Nephrology & Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Gamal Saadi
- Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
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Crews DC, Bello AK, Saadi G. 2019 World Kidney Day Editorial - burden, access, and disparities in kidney disease. J Bras Nefrol 2019; 41:1-9. [PMID: 31063178 PMCID: PMC6534018 DOI: 10.1590/2175-8239-jbn-2018-0224] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/20/2019] [Indexed: 12/11/2022] Open
Abstract
Kidney disease is a global public health problem, affecting over 750 million persons worldwide. The burden of kidney disease varies substantially across the world, as does its detection and treatment. In many settings, rates of kidney disease and the provision of its care are defined by socio-economic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. Here, we highlight that many countries still lack access to basic diagnostics, a trained nephrology workforce, universal access to primary health care, and renal replacement therapies. We point to the need for strengthening basic infrastructure for kidney care services for early detection and management of acute kidney injury and chronic kidney disease across all countries and advocate for more pragmatic approaches to providing renal replacement therapies. Achieving universal health coverage worldwide by 2030 is one of the World Health Organization's Sustainable Development Goals. While universal health coverage may not include all elements of kidney care in all countries, understanding what is feasible and important for a country or region with a focus on reducing the burden and consequences of kidney disease would be an important step towards achieving kidney health equity.
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Affiliation(s)
- Deidra C. Crews
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Medical Institutions, Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland, USA
- Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Aminu K. Bello
- University of Alberta, Department of Medicine, Edmonton, Canada
| | - Gamal Saadi
- Cairo University, Department of Internal Medicine, Faculty of Medicine, Giza, Cairo, Egypt
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Identifying and Prioritizing the Barriers and Facilitators to the Self-Management of Type 2 Diabetes Mellitus: A Community-Centered Approach. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 10:773-783. [PMID: 28510080 DOI: 10.1007/s40271-017-0248-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Self-management of type 2 diabetes mellitus is crucial to controlling the disease and preventing harm. Multiple factors have been identified in the literature as potential barriers and facilitators to self-management, but the magnitude and directionality of these factors are seldom studied. We sought to develop and test an instrument to identify and quantify the barriers and facilitators to self-management of type 2 diabetes. METHODS A community-centered approach was used to design, implement, and interpret the results of a stated-preference study. All activities were guided by a diverse stakeholder board. Based on previously reported development work, a novel survey instrument consisting of 13 potential barriers and facilitators was pretested and piloted in our local community. Participants were asked to discuss, rate, and rank each factor. A simple self-explicated method was used to quantify the data and Z scores were used for hypothesis testing. RESULTS In total, 25 patients with self-reported type 2 diabetes (64% female; 92% minorities) participated in the pretest and pilot. Time commitments (Z = -3.72), lack of active support groups (Z = -3.39) and other resources in the local community (Z = -2.96), and language/culture (Z = -2.69) were identified as barriers to self-management. Access to healthy food (Z = +5.68), personal understanding (Z = +4.81), and communication with healthcare providers (Z = +4.62) were identified as facilitators. CONCLUSION We demonstrate that factors impacting self-management can be quantified and categorized as barriers and facilitators. While further refinement to some factors and investigation into alternative prioritization methods is necessary, our stakeholder board endorsed moving this to a large nationally representative study to see how these factors vary across different people.
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Crews DC, Banerjee T, Wesson DE, Morgenstern H, Saran R, Burrows NR, Williams DE, Powe NR. Race/Ethnicity, Dietary Acid Load, and Risk of End-Stage Renal Disease among US Adults with Chronic Kidney Disease. Am J Nephrol 2018; 47:174-181. [PMID: 29525790 PMCID: PMC5906156 DOI: 10.1159/000487715] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/11/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Dietary acid load (DAL) contributes to the risk of CKD and CKD progression. We sought to determine the relation of DAL to racial/ethnic differences in the risk of end-stage renal disease (ESRD) among persons with CKD. METHODS Among 1,123 non-Hispanic black (NHB) and non-Hispanic white (NHW) National Health and Nutrition Examination Survey III participants with estimated glomerular filtration rate 15-59 mL/min/1.73 m2, DAL was estimated using the Remer and Manz net acid excretion (NAEes) formula and 24-h dietary recall. ESRD events were ascertained via linkage with Medicare. A competing risk model (accounting for death) was used to estimate the hazard ratio (HR) for treated ESRD, comparing NHBs with NHWs, adjusting for demographic, clinical and nutritional factors (body surface area, total caloric intake, serum bicarbonate, protein intake), and NAEes. Additionally, whether the relation of NAEes with ESRD risk varied by race/ethnicity was tested. RESULTS At baseline, NHBs had greater NAEes (50.9 vs. 44.2 mEq/day) than NHWs. It was found that 22% developed ESRD over a median of 7.5 years. The unadjusted HR comparing NHBs to NHWs was 3.35 (95% CI 2.51-4.48) and adjusted HR (for factors above) was 1.68 (95% CI 1.18-2.38). A stronger association of NAE with risk of ESRD was observed among NHBs (adjusted HR per mEq/day increase in NAE 1.21, 95% CI 1.12-1.31) than that among NHWs (HR 1.08, 95% CI 0.96-1.20), p interaction for race/ethnicity × NAEes = 0.004. CONCLUSIONS Among US adults with CKD, the association of DAL with progression to ESRD is stronger among NHBs than NHWs. DAL is worthy of further investigation for its contribution to kidney outcomes across race/ethnic groups.
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Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Johns Hopkins Center for Health Equity, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Tanushree Banerjee
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | - Donald E Wesson
- Diabetes Health and Wellness Institute, Baylor Scott and White Health, Dallas, Texas, USA
| | - Hal Morgenstern
- Departments of Epidemiology and Environmental Health Sciences, School of Public Health, and Department of Urology, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Rajiv Saran
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nilka Ríos Burrows
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Desmond E Williams
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Neil R Powe
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, California, USA
- Department of Medicine, San Francisco General Hospital, San Francisco, California, USA
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Perceived Barriers and Potential Strategies to Improve Self-Management Among Adults with Type 2 Diabetes: A Community-Engaged Research Approach. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 9:349-58. [PMID: 26939674 DOI: 10.1007/s40271-016-0162-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Type 2 diabetes (T2D) is a leading cause of morbidity and mortality that disproportionately affects adults living in urban areas in the USA. Our goal was to actively engage community members in research to identify strategies to improve T2D self-management in an urban community in Baltimore, MD. METHODS We partnered with the Johns Hopkins Community Research Advisory Council to establish our stakeholder advisory board-the Diabetes Action Board (DAB). In response to input from DAB members regarding the best approaches for conducting community-centered T2D research, we conducted three 90-min focus groups of local adults living with T2D to identify ways to improve self-management. DAB members were involved in each stage of the research, including development of the protocol and materials, participant recruitment, and interpretation and dissemination of findings. RESULTS In total, 24 adults with self-reported T2D (75 % participation rate; 79 % female) residing in the local area participated in focus groups. Participants reported that barriers within their daily home and work environments, inadequate neighborhood resources, and suboptimal healthcare quality hindered their self-management. Reported strategies that may help to improve self-management included social support from family members, providers, and community members; improved access to healthy food; and wide availability of free or low-cost T2D educational materials and classes within the local area. CONCLUSION Our study demonstrates a successful mechanism for engaging community members in the design, implementation, and dissemination of T2D research. This research approach was beneficial for building a sustainable partnership to support future work in the local community.
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Parkinson J, Tang W, Johansson CC, Boulton DW, Hamrén B. Comparison of the exposure-response relationship of dapagliflozin in adult and paediatric patients with type 2 diabetes mellitus. Diabetes Obes Metab 2016; 18:685-92. [PMID: 27299483 DOI: 10.1111/dom.12647] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 12/31/2015] [Accepted: 02/11/2016] [Indexed: 12/19/2022]
Abstract
AIMS To quantitatively compare the exposure-response relationship of dapagliflozin in adult and paediatric patients with type 2 diabetes mellitus (T2DM) and to assess the potential impact of covariate effects. METHODS Data from three clinical studies of single-dose (2.5, 5 and 10 mg), orally administered dapagliflozin in adult (NCT00162305, NCT00538174) and paediatric (NCT01525238) patients with T2DM were analysed to examine the relationship between dapagliflozin exposure (area under concentration-time curve) and response [24-h urinary glucose excretion (UGE)] using a sigmoidal maximum effect model. Baseline fasting plasma glucose (FPG), estimated glomerular filtration rate (eGFR), baseline 24-h UGE, sex and race were evaluated as covariates. RESULTS Data from 63 predominantly white or Asian (92.4%) adult and 20 paediatric (45.8% white; 45.8% black) patients were included. The model appeared robust, with predictions fitting well with observed data. Baseline eGFR, FPG and sex were significant covariates in both populations; race was a significant covariate in the paediatric population only. Model-predicted UGE response was higher in paediatric (47.4, 67.5 and 85.9 g/24 h for 2.5, 5 and 10 mg) than in adult (31.2, 43.5 and 54.3 g/24 h for 2.5, 5 and 10 mg) patients, which may be associated with the higher eGFR values in paediatric patients. CONCLUSIONS After a single oral dose of dapagliflozin, adult and paediatric patients with T2DM had similar exposure-response relationships after accounting for significant covariates. These results support the planned dosage strategy for a phase III dapagliflozin safety and efficacy study in paediatric patients with T2DM, for whom treatment options are currently limited.
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Affiliation(s)
| | - W Tang
- AstraZeneca, Gaithersburg, MD, USA
| | | | | | - B Hamrén
- AstraZeneca Gothenburg, Mölndal, Sweden
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Pollack AH, Backonja U, Miller AD, Mishra SR, Khelifi M, Kendall L, Pratt W. Closing the Gap: Supporting Patients' Transition to Self-Management after Hospitalization. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2016; 2016:5324-5336. [PMID: 27500285 DOI: 10.1145/2858036.2858240] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patients going home after a hospitalization face many challenges. This transition period exposes patients to unnecessary risks related to inadequate preparation prior to leaving the hospital, potentially leading to errors and patient harm. Although patients engaging in self-management have better health outcomes and increased self-efficacy, little is known about the processes in place to support and develop these skills for patients leaving the hospital. Through qualitative interviews and observations of 28 patients during and after their hospitalizations, we explore the challenges they face transitioning from hospital care to self-management. We identify three key elements in this process: knowledge, resources, and self-efficacy. We describe how both system and individual factors contribute to breakdowns leading to ineffective patient management. This work expands our understanding of the unique challenges faced by patients during this difficult transition and uncovers important design opportunities for supporting crucial yet unmet patient needs.
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Affiliation(s)
- Ari H Pollack
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA; Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - Uba Backonja
- Biomedical and Health Informatics, University of Washington, Seattle, WA, USA
| | - Andrew D Miller
- Biomedical and Health Informatics, University of Washington, Seattle, WA, USA
| | - Sonali R Mishra
- The Information School, University of Washington, Seattle, WA, USA
| | - Maher Khelifi
- Biomedical and Health Informatics, University of Washington, Seattle, WA, USA
| | - Logan Kendall
- Biomedical and Health Informatics, University of Washington, Seattle, WA, USA
| | - Wanda Pratt
- The Information School, University of Washington, Seattle, WA, USA
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Tamrat R, Peralta CA, Tajuddin SM, Evans MK, Zonderman AB, Crews DC. Apolipoprotein L1, income and early kidney damage. BMC Nephrol 2015; 16:14. [PMID: 25884165 PMCID: PMC4361142 DOI: 10.1186/s12882-015-0008-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 01/27/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The degree to which genetic or environmental factors are associated with early kidney damage among African Americans (AAs) is unknown. METHODS Among 462 AAs in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, we examined the cross-sectional association between apolipoprotein L1 (APOL1) risk variants and income with: 1) mildly reduced eGFR (<75 mL/min/1.73 m(2), creatinine-cystatin C equation) and 2) elevated urine albumin-to-creatinine ratio (ACR) (≥17 in men and ≥25 mg/g in women). High risk APOL1 status was defined by 2 copies of high-risk variants; low risk if 0 or 1 copy. Income groups were dichotomized as < $14,000/year (lowest income group) or ≥ $14,000/year. Logistic regression models were adjusted for age, sex, and % European ancestry. RESULTS Overall, participants' mean age was 47 years and 16% (n = 73) had high risk APOL1 status. Mean eGFR was 99 mL/min/1.73 m(2). Mildly reduced eGFR was prevalent among 11% (n = 51). The lowest income group had higher adjusted odds (aOR) of mildly reduced eGFR than the higher income group (aOR 1.8, 95% CI 1.2-2.7). High-risk APOL1 was not significantly associated with reduced eGFR (aOR 1.5, 95% CI 0.9-2.5). Among 301 participants with ACR data, 7% (n = 21) had elevated ACR. Compared to low-risk, persons with high-risk APOL1 had higher odds of elevated ACR (aOR 3.8, 95% CI 2.0-7.3). Income was not significantly associated with elevated ACR (aOR 1.8, 95% CI 0.7-4.5). There were no significant interactions between APOL1 and income. CONCLUSIONS Both genetic and socioeconomic factors may be important determinants of early kidney damage among AAs.
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Affiliation(s)
- Ruth Tamrat
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Carmen A Peralta
- Department of Medicine, University of California, San Francisco, CA, USA. .,San Francisco VA Medical Center, San Francisco, CA, USA.
| | - Salman M Tajuddin
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA.
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA.
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA.
| | - Deidra C Crews
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA. .,Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA. .,Division of Nephrology, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, 301 Mason F. Lord Drive, Suite 2500, Baltimore, MD, 21224, USA.
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