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Liddell TS, Henry-Okafor Q, Umeukeje EM. Hypertension management in chronic kidney disease: A guide for NPs. Nurse Pract 2024; 49:13-20. [PMID: 38915144 DOI: 10.1097/01.npr.0000000000000201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
ABSTRACT This article offers a guide for NPs for managing hypertension (HTN) in adults in the setting of chronic kidney disease (CKD). It outlines evidence-based strategies, including lifestyle modifications, pharmacologic interventions, and patient education measures, that can be used in patients with CKD to optimize BP control. Special considerations, such as comorbid mental health conditions and individualized treatment plans, are also addressed. NPs play a pivotal role in improving outcomes by fostering patient engagement and adherence. By embracing this holistic approach, NPs are poised to enhance the quality of care and well-being of patients with CKD and HTN.
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Torres C, Muldrow RA, Naranjo AR, Cotten SW, Pierre CC, Greene DN. Development and validation of an LC-MSMS method to quantify creatinine from dried blood spots. J Mass Spectrom Adv Clin Lab 2024; 32:50-59. [PMID: 38511102 PMCID: PMC10950697 DOI: 10.1016/j.jmsacl.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/16/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Screening for chronic kidney disease relies on accurate and precise creatinine measurements. Traditionally, creatinine is measured in serum or plasma using high-throughput chemistry analyzers. However, dried blood spots (DBS) can also be utilized to improve testing access. Methods Samples were obtained from a 6 mm DBS punch, which was reconstituted in water before undergoing an acetonitrile crash. The resulting supernatant was diluted using an 80:20 acetonitrile: water before injection. Creatinine was identified using an isocratic gradient, and detected using an API 4000 triple quadrupole mass analyzer. Quantification relied on matrix-matched calibrators, with values harmonized to the Roche Cobas enzymatic assay. Validation studies assessing method performance included precision, linearity, accuracy, method comparison, stability, interference, and matrix effects. Results The LC-MSMS assay was linear from 0.3 to 20 mg/dL (y = 1.02x-0.11; R2 = 0.996). Precision ranged from 5.2 to 8.1 % using matrix-matched controls (n = 4) that spanned the analytical measurement range. LC-MSMS results corresponded to the enzymatic assay (Roche) with a fitted line equation of y = 0.956x-0.07 (R2 = 0.995; n = 173). The Siemens and Roche enzymatic assays demonstrated higher accuracy in correlating to the DBS creatinine concentration (n = 40 paired venous/DBS collections) compared to the Beckman Jaffe assay (-2.5 % and -0.8 % versus -6.3 % and -4.1 %, respectively) or the iSTAT (-28.4 % and -27.1 %, respectively). Accuracy was unaffected by hematocrit, blood spot volume, excess IgG or IgA, or hypertriglyceridemia. No matrix effects were observed, and both extraction and processing efficiency were robust.Ambient stability extended to at least 10 days, and exposure to extreme temperature did not affect the creatinine results. Conclusion We successfully developed an accurate and precise LC-MSMS method for quantifying creatinine in DBS.
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Affiliation(s)
| | | | | | - Steven W. Cotten
- Department of Pathology and Laboratory Medicine, Chapel Hill, NC, USA
| | - Christina C. Pierre
- Department of Pathology and Laboratory Medicine, Penn Medicine Lancaster General Hospital, Lancaster, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dina N. Greene
- LetsGetCheked, Monrovia, CA, USA
- University of Washington Seattle, Department of Laboratory Medicine and Pathology, Seattle, WA, USA
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3
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Burch AE, Lee E, Bolin LP, Shackelford P, Bolin P. Health Screening Among a Rural, Hourly Workforce: North Carolina SERVIRE Project. Am J Prev Med 2024; 66:730-734. [PMID: 37972798 DOI: 10.1016/j.amepre.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION This study demonstrates the feasibility of a novel, business-partnered, and worksite-based approach to healthcare access to facilitate chronic disease screening and diagnosis among rural hourly workers. The prevalence of undiagnosed and untreated diabetes and hypertension among screening participants was determined. METHODS From February 2021 to June 2023, investigators partnered with 29 businesses to screen 1,114 workers. Health screenings included a demographic questionnaire, A1c testing for prediabetes (A1c of 5.7-6.4) and diabetes (A1c≥6.5), hypertension (Stage 1: systolic blood pressure of 130-139 mmHg; Stage 2: systolic blood pressure ≥140 mmHg), kidney disease (estimated glomerular filtration rate <60; urine protein ≥1+), and questionnaire assessment of stroke (CHA2DS2-VASc) and sleep apnea (STOP-bang) risk. RESULTS Of the 1,114 individuals screened (n=632, 56.7% male; n=497, 44.6% Black)), 388 (36%) screened positive for prediabetes or diabetes. Diabetes was previously undiagnosed in 273 (70.4%) of these participants. More than half of the participants (n=680, 62.4%) had an elevated blood pressure reading during the screening, and the majority of these participants (n=445, 65.4%) had not been previously diagnosed with hypertension. In addition, 241 (21.6%) participants were at an increased risk of stroke (CHA2DS2-VASc≥2), and 182 (23.7%) had a STOP-Bang score ≥4, indicating an increased risk of obstructive sleep apnea. CONCLUSIONS By partnering with local businesses to deliver worksite-based health screenings, high rates of undiagnosed and uncontrolled diabetes and hypertension were identified among the rural, hourly workforce. This worksite-based approach to healthcare access could facilitate early detection of chronic disease, improve patient engagement in the healthcare system, and ultimately yield better long-term public health outcomes.
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Affiliation(s)
- Ashley E Burch
- Department of Health Services & Information Management, East Carolina University, Greenville, North Carolina; Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina.
| | - Elisabeth Lee
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Linda P Bolin
- Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina
| | - Paul Shackelford
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Paul Bolin
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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4
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Mohottige D. Paving a Path to Equity in Cardiorenal Care. Semin Nephrol 2024; 44:151519. [PMID: 38960842 DOI: 10.1016/j.semnephrol.2024.151519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Cardiorenal syndrome encompasses a dynamic interplay between cardiovascular and kidney disease, and its prevention requires careful examination of multiple predisposing underlying conditions. The unequal distribution of diabetes, heart failure, hypertension, and kidney disease requires special attention because of the influence of these conditions on cardiorenal disease. Despite growing evidence regarding the benefits of disease-modifying agents (e.g., sodium-glucose cotransporter 2 inhibitors) for cardiovascular, kidney, and metabolic (CKM) disease, significant disparities remain in access to and utilization of these essential therapeutics. Multilevel barriers impeding their use require multisector interventions that address patient, provider, and health system-tailored strategies. Burgeoning literature also describes the critical role of unequal social determinants of health, or the sociopolitical contexts in which people live and work, in cardiorenal risk factors, including heart failure, diabetes, and chronic kidney disease. This review outlines (i) inequality in the burden and treatment of hypertension, type 2 diabetes, and heart failure; (ii) disparities in the use of key disease-modifying therapies for CKM diseases; and (iii) multilevel barriers and solutions to achieve greater pharmacoequity in the use of disease-modifying therapies. In addition, this review provides summative evidence regarding the role of unequal social determinants of health in cardiorenal health disparities, further outlining potential considerations for future research and intervention. As proposed in the 2023 American Heart Association presidential advisory on CKM health, a paradigm shift will be needed to achieve cardiorenal health equity. Through a deeper understanding of CKM health and a commitment to equity in the prevention, detection, and treatment of CKM disease, we can achieve this critical goal.
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Affiliation(s)
- Dinushika Mohottige
- Institute for Health Equity Research, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, NY; Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
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5
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Owokuhaisa J, Abaasa CN, Muhindo R, Musinguzi P, Rukundo GZ. Barriers and Facilitators to Screening for Kidney Disease Among Older Adults with Hypertension and Diabetes in Mbarara Southwestern Uganda: Healthcare Providers' Perspective. J Multidiscip Healthc 2024; 17:855-865. [PMID: 38476253 PMCID: PMC10928919 DOI: 10.2147/jmdh.s451533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/09/2024] [Indexed: 03/14/2024] Open
Abstract
Background Screening for kidney disease (KD) among high-risk patients (patients with hypertension or diabetes) allows early diagnosis, intervention and delayed progression of the disease. In low- and middle-income countries (LMIC), KD screening is still sub-optimal. This study explored the healthcare providers' perceived barriers and facilitators to KD screening among older adults with hypertension and diabetes in Mbarara southwestern Uganda. Methods This was a descriptive qualitative study among healthcare providers caring for older adults with diabetes mellitus and hypertension at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. In-depth interviews were conducted using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed to develop themes of barriers and facilitators. Results We conducted 30 in-depth interviews among healthcare providers. Barriers to screening for kidney disease included patient related factors according to healthcare providers (financial hardships, poor health seeking behavior, limited knowledge and awareness), healthcare factors (work overload, ineffective patient healthcare provider communication) and system/policy related factors (lack of laboratory supplies, lack of guidelines and poor medical record keeping and documentation). With respect to facilitators, we found formation of peer support groups, effective team, and continuous medical education (CME). Conclusion Healthcare providers encounter substantial but modifiable barriers in screening older adults for KD. The identification of barriers and facilitators in timely KD detection gives us an outlook of the problem in Uganda and leads for proposals of action. Interventions that address these barriers and promote facilitators may improve the healthcare provider's effectiveness and capacity to care including screening for patients at risk of KD.
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Affiliation(s)
- Judith Owokuhaisa
- Faculty of Medicine, Department of Physiotherapy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Catherine N Abaasa
- Faculty of Medicine, Department of Medical Laboratory Sciences, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rose Muhindo
- Faculty of Medicine, Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Pius Musinguzi
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey Zari Rukundo
- Faculty of Medicine, Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
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6
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Lang-Lindsey K, Jenkins P. Enhancing Quality of Life in African American Patients with Chronic Kidney Disease: An Evidence-Based Intervention. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:184-198. [PMID: 38390708 DOI: 10.1080/19371918.2024.2321299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
This study aimed to assess the effectiveness of achronic kidney disease (CKD) peer coach's educational intervention on the quality of life of African-American individuals with CKD. This study employed an experimental research design to assess a peer coaching educational intervention for African-American individuals with CKD. The theoretical underpinning was grounded in social learning theory, emphasizing observational learning, imitation, and modeling. 165 patients were randomly assigned to either the intervention group (n = 81) or the control group (n = 84). Pre- and post-intervention analyses showed no significant differences in most health measures between the two groups. However, the intervention group demonstrated significant improvement in the energy/fatigue subscale, witha16-point difference supporting the intervention group (p = .003). Additionally, the intervention group showed increased scores in the pain subscale (p = .015), while the control group did not. The CKD educational intervention highlighted cultural considerations and provided cost-effective strategies for social workers. It emphasizes the importance of targeted educational interventions and calls for further research and interventions to address the comprehensive needs of CKD patients and improve their quality of life.
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Affiliation(s)
| | - Patrice Jenkins
- School of Social Work, Jackson State University, Jackson, Mississippi, USA
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Fuller TJ, Lambert DN, DiClemente RJ, Wingood GM. Reach and Capacity of Black Protestant Health Ministries as Sites of Community-Wide Health Promotion: A Qualitative Social Ecological Model Examination. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01926-0. [PMID: 38319551 DOI: 10.1007/s40615-024-01926-0] [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: 07/31/2023] [Revised: 12/29/2023] [Accepted: 01/31/2024] [Indexed: 02/07/2024]
Abstract
Black communities in the Southeast United States experience a disproportionate burden of illness and disease. To address this inequity, public health practitioners are partnering with Black Protestant churches to deliver health promotion interventions. Yet, the reach of these programs beyond the organizational level of the Social Ecological Model (SEM) is not well defined. Thus, the aim of this study is to understand Black Protestant church leaders' and members' perceptions about the capacity of their ministries to reach into their communities, beyond their congregations, as providers or hosts of health education or promotion interventions. From 20 Black Protestant churches in Atlanta, GA, 92 church leaders and members participated in semi-structured interviews. Grounded theory guided data analysis and a diverse team coded the interviews. Most participating churches had health ministries. Participants saw the boundaries between their churches at the organizational level of the SEM and the broader Black community to be porous. Those who described their "community" as being broader than their congregation also tended to describe community-wide health promotion their church engaged in. They described church-based health fairs as a strategy to promote engagement in their communities. Some participants, particularly those in a health-related profession, discussed visions of how to utilize their church as a site for community-wide health promotion. We suggest these participants may be boundary leaders who can build relationships between public health professionals, pastors, and congregants. Based on the findings, we suggest that church-based health fairs may be effective sites of community-wide health promotion.
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Affiliation(s)
- Tyler J Fuller
- Graduate Program in Religion, Boston University, Boston, MA, USA.
| | - Danielle N Lambert
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | - Ralph J DiClemente
- Department of Social and Behavioral Sciences, New York University, New York, NY, USA
| | - Gina M Wingood
- Department of Sociomedical Sciences, Columbia University, New York, NY, USA
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8
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Raja M, Radhakrishnan S, Milan RA, Hurse D, Dean C. Assessing Chronic Kidney Disease Knowledge, Beliefs, and Risk among Detroit Residents. AMERICAN JOURNAL OF HEALTH EDUCATION 2023. [DOI: 10.1080/19325037.2022.2163006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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9
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Crews DC, Patzer RE, Cervantes L, Knight R, Purnell TS, Powe NR, Edwards DP, Norris KC. Designing Interventions Addressing Structural Racism to Reduce Kidney Health Disparities: A Report from a National Institute of Diabetes and Digestive and Kidney Diseases Workshop. J Am Soc Nephrol 2022; 33:2141-2152. [PMID: 36261301 PMCID: PMC9731627 DOI: 10.1681/asn.2022080890] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Structural racism embodies the many ways in which society fosters racial discrimination through "mutually reinforcing inequitable systems" that limit access to resources and opportunities that can promote health and well being among marginalized communities. To achieve health equity, and kidney health equity more specifically, structural racism must be eliminated. In February 2022, the National Institute of Diabetes and Digestive and Kidney Diseases convened the "Designing Interventions that Address Structural Racism to Reduce Kidney Health Disparities" workshop, which was aimed at describing the mechanisms through which structural racism contributes to health and health care disparities for people along the continuum of kidney disease and identifying actionable opportunities for interventional research focused on dismantling or addressing the effects of structural racism. Participants identified six domains as key targets for interventions and future research: (1) apply an antiracism lens, (2) promote structural interventions, (3) target multiple levels, (4) promote effective community and stakeholder engagement, (5) improve data collection, and (6) advance health equity through new health care models. There is an urgent need for research to develop, implement, and evaluate interventions that address the unjust systems, policies, and laws that generate and perpetuate inequities in kidney health.
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Affiliation(s)
- Deidra C. Crews
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel E. Patzer
- Department of Epidemiology, Rollins School of Public Health and School of Medicine, Emory University, Atlanta, Georgia
- Department of Surgery, School of Medicine, Emory University, Atlanta, Georgia
| | - Lilia Cervantes
- Division of Hospital Medicine and General Internal Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - Richard Knight
- American Association of Kidney Patients, Tampa, Florida
- College of Business, Bowie State University, Bowie, Maryland
| | - Tanjala S. Purnell
- Departments of Epidemiology and Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Neil R. Powe
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California
| | | | - Keith C. Norris
- Department of Medicine, University of California Los Angeles, Los Angeles, California
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10
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Shah KM, Hsiao LL. Leveraging Resources Effectively at the Community Level: Lessons Learned from the Kidney Disease Screening and Awareness Program. Kidney Int Rep 2022; 7:2551-2554. [PMID: 36506230 PMCID: PMC9727510 DOI: 10.1016/j.ekir.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Kavya M. Shah
- Renal Division, Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachussets, USA
| | - Li-Li Hsiao
- Renal Division, Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachussets, USA,Correspondence: Li-Li Hsiao, 221 Longwood Avenue, BLI449, Boston, Massachusetts 02115, USA.
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11
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Griffith DM, Umeukeje EM. Navigating to Kidney Health Equity. J Am Soc Nephrol 2022; 33:1242-1244. [PMID: 35728885 PMCID: PMC9257807 DOI: 10.1681/asn.2022040421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Derek M Griffith
- Racial Justice Institute and Departments of Health Systems Administration and Oncology, Georgetown University, Washington, DC
| | - Ebele M Umeukeje
- Vanderbilt Center for Kidney Disease and Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee
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12
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Gray J, Hillman LA, Vivian E, St. Peter WL. Pharmacist's Role in Reducing
Medication‐Related
Racial Disparities in African American Patients with Chronic Kidney Disease. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Julie Gray
- University of Minnesota College of Pharmacy Minneapolis Minnesota
| | - Lisa A. Hillman
- University of Minnesota College of Pharmacy Minneapolis Minnesota
| | - Eva Vivian
- University of Wisconsin‐Madison School of Pharmacy Madison Wisconsin
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Umeukeje EM, Washington JT, Nicholas SB. Etiopathogenesis of kidney disease in minority populations and an updated special focus on treatment in diabetes and hypertension. J Natl Med Assoc 2022; 114:S3-S9. [PMID: 35589418 DOI: 10.1016/j.jnma.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Diabetes and hypertension are the most common causes of chronic kidney disease (CKD) in the general population as well as in the Black and African American population, who also suffer from high rates of CKD and CKD progression compared to the White population. Progression of CKD can lead to kidney failure, and patients with progressive kidney disease have a high risk of premature mortality, particularly from cardiovascular disease. Screening for early detection of CKD is important as it facilitates the initiation of medications that have been shown to delay the progression of diabetes-related as well as non-diabetes-related CKD, and reduce rates of death from both kidney and cardiovascular disease. The potential adverse effects from use of some of the newer reno- and cardio-protective glucose-lowering medications, such as the sodium glucose cotransporter-2 inhibitors, may be effectively avoided with detailed patient education and monitoring by the healthcare provider. It is important to note that lifestyle modification including regular exercise, diet, and smoking cessation are first-line in the management of diabetes and hypertension. When CKD occurs, co-management by providers using a comprehensive strategy may avert early complications and facilitate appropriate early referral for nephrology specialty care.
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Affiliation(s)
- Ebele M Umeukeje
- Division of Nephrology, Vanderbilt University Medical Center, Vanderbilt Center for Kidney Disease, United States
| | | | - Susanne B Nicholas
- David Geffen School of Medicine at University of California, 7-155 Factor Bldg. 10833 LeConte Blvd, Los Angeles, CA 90095, United States.
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14
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Ozieh MN, Egede LE. Delay Early CKD with Lifestyle Intervention in African Americans with Diabetic Kidney Disease (DELAY DKD): A Pre-Post Pilot Study (Preprint). JMIR Form Res 2021; 6:e34029. [PMID: 35289751 PMCID: PMC8965678 DOI: 10.2196/34029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/23/2021] [Accepted: 01/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background Behavioral factors, such as lifestyle, have been shown to explain approximately 24% of the excess risk of chronic kidney disease (CKD) among African Americans. However, there are limited intervention studies culturally tailored to African Americans with type 2 diabetes mellitus and CKD. Objective The main objective of this study was to examine the feasibility and preliminary efficacy of a culturally tailored lifestyle intervention among African Americans with type 2 diabetes mellitus and CKD. Methods A pre-post design was used to test the feasibility of a lifestyle intervention in 30 African American adults recruited from the Medical University of South Carolina between January 2017 and February 2017. A research nurse delivered the manualized study intervention weekly for 6 weeks. Clinical outcomes (hemoglobin A1c, blood pressure, and estimated glomerular filtration rate [eGFR]) were measured at baseline and postintervention. Disease knowledge, self-care, and behavior outcomes were also measured using validated structured questionnaires at baseline and postintervention. Descriptive statistics and effect sizes were calculated to determine clinically important changes from baseline. Results Significant pre-post mean differences and decreases were observed for hemoglobin A1c (mean 0.75%, 95% CI 0.16-1.34; P=.01), total cholesterol (mean 16.38 mg/dL, 95% CI 5.82-26.94; P=.004), low-density lipoprotein (mean 13.73 mg/dL, 95% CI 3.91-23.54; P=.008), and eGFR (mean 6.73 mL/min/1.73m2, 95% CI 0.97-12.48; P=.02). Significant pre-post mean differences and increases were observed for CKD self-efficacy (mean −11.15, 95% CI −21.55 to −0.75; P=.03), CKD knowledge (mean −2.62, 95% CI −3.98 to −1.25; P<.001), exercise behavior (mean −1.21, 95% CI −1.96 to −0.46; P=.003), and blood sugar testing (mean −2.15, 95% CI −3.47 to −0.83; P=.003). Conclusions This study provides preliminary data for a large-scale appropriately powered randomized controlled trial to examine a culturally tailored lifestyle intervention in African Americans with type 2 diabetes mellitus and CKD in order to improve clinical, knowledge, self-care, and behavior outcomes in this population.
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Affiliation(s)
- Mukoso N Ozieh
- Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Leonard E Egede
- Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI, United States
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15
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Castilla-Puentes R, Pesa J, Brethenoux C, Furey P, Gil Valletta L, Falcone T. Applying the Health Belief Model to Characterize Racial/Ethnic Differences in Digital Conversations Related to Depression Pre– and Mid–COVID-19 (Preprint). JMIR Form Res 2021; 6:e33637. [PMID: 35275834 PMCID: PMC9217151 DOI: 10.2196/33637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/25/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Ruby Castilla-Puentes
- Janssen Research & Development, LLC, Titusville, NJ, United States
- Center for Public Health Practice, Drexel University, Philadelphia, PA, United States
- Hispanic Organization for Leadership and Advancement, Johnson & Johnson, Employee Resource Group, New Brunswick, NJ, United States
| | - Jacqueline Pesa
- Janssen Scientific Affairs, LLC, Titusville, NJ, United States
| | | | | | | | - Tatiana Falcone
- Department of Psychiatry and Psychology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, United States
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Mohottige D, Diamantidis CJ, Norris KC, Boulware LE. Racism and Kidney Health: Turning Equity Into a Reality. Am J Kidney Dis 2021; 77:951-962. [PMID: 33639186 DOI: 10.1053/j.ajkd.2021.01.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/15/2021] [Indexed: 12/12/2022]
Abstract
Kidney disease continues to manifest stark racial inequities in the United States, revealing the entrenchment of racism and bias within multiple facets of society, including in our institutions, practices, norms, and beliefs. In this perspective, we synthesize theory and evidence to describe why an understanding of race and racism is integral to kidney care, providing examples of how kidney health disparities manifest interpersonal and structural racism. We then describe racialized medicine and "colorblind" approaches as well as their pitfalls, offering in their place suggestions to embed antiracism and an "equity lens" into our practice. We propose examples of how we can enhance kidney health equity by enhancing our structural competency, using equity-focused race consciousness, and centering investigation and solutions around the needs of the most marginalized. To achieve equitable outcomes for all, our medical institutions must embed antiracism and equity into all aspects of advocacy, policy, patient/community engagement, educational efforts, and clinical care processes. Organizations engaged in kidney care should commit to promoting structural equity and eliminating potential sources of bias across referral practices, guidelines, research agendas, and clinical care. Kidney care providers should reaffirm our commitment to structurally competent patient care and educational endeavors in which empathy and continuous self-education about social drivers of health and inequity, racism, and bias are integral. We envision a future in which kidney health equity is a reality for all. Through bold collective and sustained investment, we can achieve this critical goal.
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Affiliation(s)
- Dinushika Mohottige
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC; Center for Community and Population Health Improvement, Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC.
| | - Clarissa J Diamantidis
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC; Center for Community and Population Health Improvement, Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC; Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Keith C Norris
- Divisions of Nephrology and General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - L Ebony Boulware
- Center for Community and Population Health Improvement, Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC; Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
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Bruno Santos Ferreira R, de Camargo CL. Vulnerabilidade da população negra brasileira frente à evolução da pandemia por COVID-19. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introdução: Devido as iniquidades históricas, o contexto pandêmico do COVID-19 tem impactado de maneira distinta os segmentos sociais, exigindo um acompanhamento especial às minorias étnico-raciais que vivem em situação de vulnerabilidade. Nesse sentido, o estudo tem como objetivo analisar a vulnerabilidade da população negra brasileira frente à evolução da pandemia por COVID-19. Materiais e Métodos: Trata-se de um estudo documental, descritivo, quantitativo, realizada a partir dos boletins epidemiológicos coronavírus publicados pelo Ministério da Saúde do Brasil. Foram avaliadas duas variáveis dos boletins epidemiológicos coronavírus a partir da raça/cor: hospitalizações por síndrome respiratória aguda grave e óbito por Covid-19. Resultados: Entre os boletins nº 9 e nº 18 evidenciou-se o aumento sustentado nas taxas de internação por síndrome respiratória aguda grave (de 23,9% para 54,7%) e óbito (de 34,3% para 61,3%) entre pessoas de raça/cor negra e redução constante na hospitalização (de 73% para 43,3%) e óbito (de 62,9% para 36,5%) entre pessoas brancas. Constata-se que pessoas negras têm maiores chances de internação por SRAG e morte por COVID-19 no Brasil, o que implica maior situação de vulnerabilidade. Discussão: Acredita-se que esse cenário desfavorável entre pessoas negras se deve a dificuldade ou impossibilidade de realização de isolamento social, à prevalência de comorbidades que precipitam quadros graves do COVID-19, as dificuldades no acesso aos serviços de saúde e ao racismo institucional. Conclusão: faz-se necessário a implementação de uma rede de proteção social a esse grupo racial, com o objetivo de reduzir o acometimento da doença e a letalidade do vírus.
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Zhuo M, Jiang MY, Song R, Mothi SS, Bellou S, Polding LC, Li J, Cho A, Hsiao LL. High Prevalence and Low Awareness of Albuminuria in the Community Setting in the KDSAP. Kidney Int Rep 2020; 5:475-484. [PMID: 32280843 PMCID: PMC7136433 DOI: 10.1016/j.ekir.2019.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 11/26/2019] [Accepted: 12/16/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Albuminuria is a sign of kidney disease and associated with adverse outcomes. However, most individuals with albuminuria are unaware of it. The Kidney Disease Screening and Awareness Program (KDSAP) aims for early detection and raising awareness of albuminuria, targeting underserved populations in communities. This study will assess the prevalence and awareness of albuminuria and identify associated risk factors among KDSAP participants. METHODS KDSAP participants ≥18 years old without a history of dialysis or kidney transplant were included. Albuminuria was identified by dipstick urinalysis. Individuals with albuminuria who answered yes to either of the following 2 questions were defined as being aware: (i) Have you ever had protein in the urine? (ii) Do you have kidney disease? RESULTS Among 2304 participants, 461 (20.0%) had albuminuria: 16.3% with trace or 1+ (low degree) and 3.7% with 2+ or more (high degree). Correlating factors of albuminuria included young age, male sex, African American descent, self-reported diabetes, hypertension, family history of kidney disease, and smoking. Overall albuminuria awareness was 15.8%, but awareness inversely correlated to younger age groups: 7.0% for ages 18-39 years, 13.5% for ages 40-59 years, and 24.0% for ages ≥60 years (P < 0.001). A high degree of albuminuria (vs. low, odds ratio: 5.04, P < 0.001) and concurrent hematuria (odds ratio: 2.12, P=0.024) were both associated with higher awareness; conversely, risk factors for low awareness included African American and better self-assessments of health. CONCLUSIONS There was a high albuminuria prevalence among KDSAP participants, yet low awareness. KDSAP can potentially be a useful model for detecting albuminuria and raising awareness in communities.
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Affiliation(s)
- Min Zhuo
- Renal Division, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Renal Division, Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ming-Yan Jiang
- Renal Division, Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Renal Division, Department of Internal Medicine, Chi Mei Medical Center, Taiwan
| | - Rui Song
- Renal Division, Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Suraj Sarvode Mothi
- Renal Division, Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sirine Bellou
- Renal Division, Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura C. Polding
- Stanford University School of Medicine, Stanford, California, USA
| | - Jiahua Li
- Renal Division, Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Cho
- Renal Division, Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Li-Li Hsiao
- Renal Division, Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Stallings SC, Boyer AP, Joosten YA, Novak LL, Richmond A, Vaughn YC, Wilkins CH. A taxonomy of impacts on clinical and translational research from community stakeholder engagement. Health Expect 2019; 22:731-742. [PMID: 31321849 PMCID: PMC6737764 DOI: 10.1111/hex.12937] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 05/09/2019] [Accepted: 05/31/2019] [Indexed: 01/10/2023] Open
Abstract
Background Community engagement is increasingly recognized as a valuable tool in clinical and translational research; however, the impact of engagement is not fully understood. No standard nomenclature yet exists to clearly define how research changes when community stakeholders are engaged across the research spectrum. This severely limits our ability to assess the value of community engagement in research. To address this gap, we developed a taxonomy for characterizing and classifying changes in research due to community engagement. Methods Using an iterative process, we (a) identified areas of potential impact associated with community engagement from author experience, (b) categorized these in taxonomic bins based on research stages, (c) conducted semi‐structured interviews with researchers and community stakeholders, (d) validated the codebook in a sample dataset and (e) refined the taxonomy based on the validation. Community stakeholders were involved in every step of the process including as members of the primary study team. Results The final taxonomy catalogues changes into eleven domains corresponding to research phases. Each domain includes 2‐4 dimensions depicting concepts within the domain's scope and, within each dimension, 2‐10 elements labelling activities through which community engagement could change research. Conclusions Community engagement has great potential to enhance clinical and translational research. This taxonomy provides a common vocabulary and framework for understanding the impact of community engagement and suggests metrics for assessing the value of community engagement in research.
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Affiliation(s)
- Sarah C Stallings
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alaina P Boyer
- National Health Care for the Homeless Council, Nashville, Tennessee
| | - Yvonne A Joosten
- Department of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laurie L Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Al Richmond
- Community-Campus Partnerships for Health, Raleigh, North Carolina
| | | | - Consuelo H Wilkins
- Vice President for Health Equity, Vanderbilt University Medical Center, Nashville, Tennessee
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Laster M, Shen JI, Norris KC. Kidney Disease Among African Americans: A Population Perspective. Am J Kidney Dis 2018; 72:S3-S7. [PMID: 30343720 PMCID: PMC6200351 DOI: 10.1053/j.ajkd.2018.06.021] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 06/25/2018] [Indexed: 12/21/2022]
Abstract
End-stage kidney disease and earlier stages of chronic kidney disease (CKD) represent one of the most dramatic examples of racial/ethnic disparities in health in our nation. African Americans are 3 times more likely to require renal replacement therapy then their non-Hispanic white counterparts. This article describes CKD-related disparities linked to a variety of clinical, socioeconomic, and cultural factors, as well as to select social determinants of health that are defined by social positioning and often by race within the United States. Our advancing understanding of these issues has led to improvements in patient outcomes and is narrowing the gap in disparities across most aspects of CKD and CKD risk factors. There are also extensive data indicating similar improvements in quality measures for patients on dialysis therapy. This article also reviews the state of CKD in African Americans from a population perspective and provides recommendations for the way forward.
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Affiliation(s)
- Marciana Laster
- Division of Nephrology, Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - Jenny I Shen
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA; Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Keith C Norris
- Division of Nephrology and Hypertension, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA; Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA.
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Tuttle KR. Race in America: What Does It Mean for Diabetes and CKD? Clin J Am Soc Nephrol 2018; 13:829-830. [PMID: 29798886 PMCID: PMC5989669 DOI: 10.2215/cjn.04890418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Katherine R Tuttle
- Providence Health Care, Kidney Research Institute, Nephrology Division and Institute of Translational Health Sciences, University of Washington, Spokane, Washington
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Affiliation(s)
- Keith C Norris
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California
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