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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 200 Research Studies DisplayedAklilu AM, Kumar S, Nugent J
COVID-19-associated acute kidney injury and longitudinal kidney outcomes.
This retrospective longitudinal multicenter cohort study’s objective was to assess long-term kidney outcomes of patient who had COVID-19-associated acute kidney injury (AKI). This study was conducted in a large hospital system using electronic health records data on adult hospitalized patients with AKI and COVID-19 or other illnesses. Included patients were those 1) who were hospitalized during the COVID-19 pandemic (March 2020-June 2022), were screened for SARS-CoV-2, had AKI, and survived to discharge, or 2) had been hospitalized during the 5 years before the pandemic (October 2016-January 2020), had a positive influenza A or B test result, had AKI, and survived to discharge. The study cohort included 9624 hospitalized patients (mean age, 69.0 years; 4955 females) with AKI, including 987 patients with COVID-AKI, 276 with influenza-associated AKI, and 8361 with AKI associated with other illnesses (other-AKI). When compared with the other 2 groups, patients with COVID-19-associated AKI were slightly younger in age, had a higher baseline eGFR, worse baseline comorbidity scores, higher markers of illness severity, and longer hospital stay. Compared with the other-AKI group, the COVID-AKI group had lower major adverse kidney events (MAKE) (adjusted hazard ratio [aHR], 0.67) due to lower all-cause mortality (aHR, 0.31) and lower rates of worsened kidney function.
AHRQ-funded; HS027626.
Citation: Aklilu AM, Kumar S, Nugent J .
COVID-19-associated acute kidney injury and longitudinal kidney outcomes.
JAMA Intern Med 2024 Apr; 18(4):414-23. doi: 10.1001/jamainternmed.2023.8225..
Keywords: COVID-19, Kidney Disease and Health, Outcomes
Watnick S, Blake PG, Mehrotra R
System-level strategies to improve home dialysis: policy levers and quality initiatives.
This article discusses trends in home dialysis use, reviews the evolving understanding of what constitutes high quality care for the home dialysis population (as well as how this can be measured), and discusses policy and advocacy efforts that continue to shape the care of US patients, and compares with experiences in other countries. The authors conclude by discussing future directions for quality and advocacy efforts.
AHRQ-funded; HS028684.
Citation: Watnick S, Blake PG, Mehrotra R .
System-level strategies to improve home dialysis: policy levers and quality initiatives.
Clin J Am Soc Nephrol 2023 Dec; 18(12):1616-25. doi: 10.2215/cjn.0000000000000299..
Keywords: Home Healthcare, Kidney Disease and Health, Policy, Quality Improvement, Quality of Care
Charkviani M, Barreto EF, Pearson KK
Development and implementation of an acute kidney injury remote patient monitoring program: research letter.
This paper describes the development and preliminary feasibility of an acute kidney injury remote patient monitoring (AKI RPM) program launched in October 2021 to help improve quality and efficiency of care. Enrolled patients were those who experienced AKI during a hospitalization and underwent nephrology consultation. Those patients were provided with home monitoring technology and underwent weekly laboratory assessments. Nurses evaluated the data daily and used prespecified protocols for management and escalation of care if needed. Twenty patients enrolled in the first 5 months, with a median duration of program participation of 36 days. Eight patients experienced an unplanned readmission or emergency department visit, half of which were attributed to AKI and related circumstances. Of the 9 patients who provided postgraduation surveys, all were satisfied with the RPM program and 89% would recommend RPM to other patients with similar health conditions.
AHRQ-funded; HS028060-01.
Citation: Charkviani M, Barreto EF, Pearson KK .
Development and implementation of an acute kidney injury remote patient monitoring program: research letter.
Can J Kidney Health Dis 2023 Jan-Dec; 10:20543581231192746. doi: 10.1177/20543581231192746..
Keywords: Kidney Disease and Health, Telehealth, Health Information Technology (HIT)
Aklilu AM, Kumar S, Yamamoto Y
Outcomes associated with sodium-glucose cotransporter-2 inhibitor use in acute heart failure hospitalizations complicated by AKI.
This retrospective study examined the association of sodium-glucose cotransporter-2 inhibitor (SGLT2i) use with patients who have KDIGO-defined acute kidney injury (AKI) during acute heart failure (AHF) hospitalizations and their kidney function recovery at 14 days and 30 days using time-varying multivariable Cox-regression analyses. The study looked at 3305 adults hospitalized across 5 Yale New Haven Health Systems between January 2020 and May 2022 with AHF complicated by KDIGO-defined AKI. Of those individuals hospitalized with AHF and AKI, 356 received SGLT2i following AKI diagnosis either as initiation or continuation. The rate of renal recovery was not significantly different among those exposed and unexposed to SGLT2i following AKI (adjusted HR 0.94). SGLT2i exposure was associated with lower risk of 30-day mortality (adjusted HR 0.45). Rates of renal recovery were similar between the exposed and nonexposed cohorts regardless of the proximity of SGLT2i exposure to AKI diagnosis.
AHRQ-funded; HS027626.
Citation: Aklilu AM, Kumar S, Yamamoto Y .
Outcomes associated with sodium-glucose cotransporter-2 inhibitor use in acute heart failure hospitalizations complicated by AKI.
Kidney360 2023 Oct; 4(10):1371-81. doi: 10.34067/kid.0000000000000250..
Keywords: Kidney Disease and Health, Heart Disease and Health, Cardiovascular Conditions, Inpatient Care, Medication, Outcomes
Giles C, Novakovic M, Hopman W
The quality of discharge summaries after acute kidney injury.
The objectives of this retrospective chart review were to determine the quality of discharge summaries in acute kidney injury (AKI) patients and to identify predictors for higher quality summaries. Researchers examined the discharge summaries for 300 randomly selected adult patients who survived a hospitalization with AKI at a tertiary care hospital in Ontario. Results showed that most discharge summaries were missing key AKI elements, even for patients with severe AKI. The researchers concluded that these gaps indicated opportunities for improving discharge summary communication following AKI.
AHRQ-funded; HS028060.
Citation: Giles C, Novakovic M, Hopman W .
The quality of discharge summaries after acute kidney injury.
Can J Kidney Health Dis 2023 Jan-Dec; 10:20543581231199018. doi: 10.1177/20543581231199018..
Keywords: Kidney Disease and Health, Injuries and Wounds, Hospital Discharge
Menez S, Coca Moledina, Moledina DG
Evaluation of plasma biomarkers to predict major adverse kidney events in hospitalized patients with COVID-19.
There is an increased risk for major adverse kidney events (MAKE) in patients hospitalized with COVID-19. The purpose of this prospective cohort study was to identify plasma biomarkers predictive of MAKE in patients hospitalized with COVID-19. The study found that in total, 95 patients (16%) experienced MAKE. Each 1 SD increase in soluble tumor necrosis factor receptor 1 (sTNFR1) and sTNFR2 was significantly associated with an increased risk of MAKE. A limitation of the study was a lack of control group of hospitalized patients without COVID-19.
AHRQ-funded; HS027626.
Citation: Menez S, Coca Moledina, Moledina DG .
Evaluation of plasma biomarkers to predict major adverse kidney events in hospitalized patients with COVID-19.
Am J Kidney Dis 2023 Sep; 82(3):322-32.e1. doi: 10.1053/j.ajkd.2023.03.010..
Keywords: COVID-19, Kidney Disease and Health, Inpatient Care
Kim D, Swaminathan S, Lee Y
Racial and ethnic disparities in excess deaths after COVID-19 vaccine deployment among persons with kidney failure.
COVID-19 resulted in clear racial/ethnic disparities in excess deaths among persons with kidney failure. It is not clear whether or how these disparities changed throughout the pandemic, especially after the deployment of COVID-19 vaccines. The purpose of this study was to examine disparities in excess mortality for the Medicare population with kidney failure from March 2020, through December 2021. The study found that there were 686,719 patients with kidney failure in January 2020. Researchers reported an increase in excess deaths beginning March 1, 2020, with a peak in January 2021. From March 1, 2020, through January 30, 2021, and there were substantial disparities in excess deaths across racial/ethnic groups. The number of excess deaths was 5582, 4303, and 2679 for non-Hispanic White, non-Hispanic Black, and Hispanic patients, respectively. The percent excess deaths was 31.9% for Hispanic patients, 27.5% for non-Hispanic Black patients, and 16.4% for non-Hispanic White patients. After the wide distribution of COVID-19 vaccines since the end of January 2021, the lowest percent excess deaths was observed among Hispanic patients, followed by Black patients, and White patients.
AHRQ-funded; HS028285.
Citation: Kim D, Swaminathan S, Lee Y .
Racial and ethnic disparities in excess deaths after COVID-19 vaccine deployment among persons with kidney failure.
Clin J Am Soc Nephrol 2023 Sep; 18(9):1207-09. doi: 10.2215/cjn.0000000000000226..
Keywords: COVID-19, Racial and Ethnic Minorities, Disparities, Vaccination, Kidney Disease and Health, Mortality
Tummalapalli SL, Struthers SA, White D
Optimal care for kidney health: development of a Merit-based Incentive Payment System (MIPS) value pathway.
This article detailed the iterative consensus-building process used by the American Society of Nephrology Quality Committee to develop the Optimal Care for Kidney Health Merit-based Incentive Payment System (MIPS) Value Pathway (MVP). The Optimal Care for Kidney Health MVP, published in the 2023 Medicare Physician Fee Schedule Final Rule, included measures related to angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use, hypertension control, readmissions, acute kidney injury requiring dialysis, and advance care planning. The MVP nephrology’s goal was to streamline measure selection in MIPS and served as a case study of collaborative policymaking between one professional organization and national regulatory agencies.
AHRQ-funded; HS028684.
Citation: Tummalapalli SL, Struthers SA, White D .
Optimal care for kidney health: development of a Merit-based Incentive Payment System (MIPS) value pathway.
J Am Soc Nephrol 2023 Aug; 34(8):1315-28. doi: 10.1681/asn.0000000000000163..
Keywords: Kidney Disease and Health, Payment, Healthcare Costs, Medicare
Kaufmann MB, Tan JC, Chertow GM
Deceased donor kidney transplantation for older transplant candidates: a new microsimulation model for determining risks and benefits.
This study examined what potential health gains could be made by increasing kidney transplant access to older candidates from the use of a deceased donor kidney through developing and calibrating a microsimulation model of the transplantation process and long-term outcomes. The authors estimated risk equations for transplant outcomes using the Scientific Registry of Transplant Recipients (SRTR), which contains data on all US transplants (2010-2019). They calibrated the model to key transplant outcomes and used acceptance sampling, retaining the best-fitting 100 parameter sets. They then examined life expectancy gains from allocating kidneys even of lower quality across patient subgroups defined by age and designated race/ethnicity. The best-fitting 100 parameter sets (among 4,000,000 sampled) enabled their model to closely match key transplant outcomes. They found clear survival benefits for older transplant candidates who receive deceased kidney donors, even lower quality ones, compared with remaining on the waitlist.
AHRQ-funded; HS026128.
Citation: Kaufmann MB, Tan JC, Chertow GM .
Deceased donor kidney transplantation for older transplant candidates: a new microsimulation model for determining risks and benefits.
Med Decis Making 2023 Jul; 43(5):576-86. doi: 10.1177/0272989x231172169..
Keywords: Kidney Disease and Health, Transplantation
Chu CD, Xia F, Du Y
Estimated prevalence and testing for albuminuria in US adults at risk for chronic kidney disease.
The purpose of this cohort study was to assess the extent of albuminuria underdetection from lack of testing and examine its association with CKD treatment. Researchers examined records of adults with hypertension or diabetes, utilizing data from the 2007 to 2018 National Health and Nutrition Examination Surveys (NHANES) and the Optum deidentified electronic health record (EHR) data set of US health care organizations. The total EHR study population included 192,108 patients; 96.6% with hypertension, and 26.2% with diabetes. The study found that 17.5% of patients had albuminuria testing; of whom 34.3% had albuminuria. Among 158,479 patients who were untested, the estimated albuminuria prevalence rate was 13.4%. Thus, only 35.2% of the projected population with albuminuria had been tested. Albuminuria testing was associated with higher adjusted odds of receiving ACEi or ARB treatment, SGLT2i treatment, and having blood pressure controlled to less than 140/90 mm Hg. The researchers concluded that approximately two-thirds of patients with albuminuria were undetected due to lack of testing.
AHRQ-funded; HS026383.
Citation: Chu CD, Xia F, Du Y .
Estimated prevalence and testing for albuminuria in US adults at risk for chronic kidney disease.
JAMA Netw Open 2023 Jul; 6(7):e2326230. doi: 10.1001/jamanetworkopen.2023.26230..
Keywords: Kidney Disease and Health, Chronic Conditions, Diabetes, Blood Pressure, Evidence-Based Practice
Cron DC, Tsai TC, Patzer RE
The association of dialysis facility payer mix with access to kidney transplantation.
The purpose of this retrospective population-based cohort study was to evaluate the relationships between insurance status, facility-level payer mix, and 1-year incidence of wait-listing for access to kidney transplantation. The researchers utilized data from the United States Renal Data System from 2013 to 2018, and included patients aged 18 to 75 years initiating chronic dialysis between 2013 and 2017, excluding patients with a prior kidney transplant or with major contraindications to kidney transplant. The primary study outcome was patients added to a waiting list for kidney transplant within 1 year of dialysis initiation. The study found that a total of 233, 003 patients across 6565 facilities met the study inclusion criteria. Of 6565 dialysis facilities, the mean commercial payer mix was 21.2% with a standard deviation of 15.6 percentage points. Patient-level commercial insurance was related with an increased incidence of wait-listing. At the facility-level, greater commercial payer mix was related with increased wait-listing. However, after statistical adjustment, including adjusting for patient-level insurance status, commercial payer mix was not significantly associated with outcome.
AHRQ-funded; HS028476.
Citation: Cron DC, Tsai TC, Patzer RE .
The association of dialysis facility payer mix with access to kidney transplantation.
JAMA Netw Open 2023 Jul; 6(7):e2322803. doi: 10.1001/jamanetworkopen.2023.22803..
Keywords: Kidney Disease and Health, Access to Care, Transplantation
Cusick MM, Tisdale RL, Chertow GM
Population-wide screening for chronic kidney disease : a cost-effectiveness analysis.
The purpose of this study was to assess the cost-effectiveness of adding population-wide screening for chronic kidney disease (CKD), specifically; screening for albuminuria with and without adding Sodium-glucose cotransporter-2 (SGLT2) inhibitors to the current standard of care for CKD. The study found that one-time CKD screening at the age 55 years had an ICER of $86,300 per QALY gained by increasing costs from $249,800 to $259,000 and increasing QALYs from 12.61 to 12.72; this result was accompanied by a decrease in the incidence of kidney failure requiring dialysis or kidney transplant of 0.29 percentage points and an increase in life expectancy from 17.29 to 17.45 years. In the group aged 35 to 75 years, screening one time prevented dialysis or transplant in 398, 000 people and screening every 10 years until age the age of 75 years cost less than $100,000 per QALY gained. The study’s sensitivity analysis found that when SGLT2 inhibitors were 30% less effective, screening every 10 years during ages 35 to 75 years cost between $145,400 and $182,600 per QALY gained, and decreases in the price would be necessary for screening to be cost-effective.
AHRQ-funded; HS026128.
Citation: Cusick MM, Tisdale RL, Chertow GM .
Population-wide screening for chronic kidney disease : a cost-effectiveness analysis.
Ann Intern Med 2023 Jun; 176(6):788-97. doi: 10.7326/m22-3228..
Keywords: Kidney Disease and Health, Screening, Healthcare Costs, Chronic Conditions
May HP, Griffin JM, Herges JR
Comprehensive acute kidney injury survivor care: protocol for the Randomized Acute Kidney Injury in Care Transitions Pilot trial.
The researchers developed the multidisciplinary acute kidney injury (AKI) in Care Transitions (ACT) program, which incorporates post-AKI care in patients' primary care clinic. The purpose of this pilot trial, which received funding from the Agency for Health Care Research and Quality on April 21, 2021, and was approved by the Institutional Review Board on December 14, 2021, is to test the feasibility and acceptability of the ACT program and related study protocol, including recruitment and retention, procedures, and outcome measures. The study will include individuals who have stage 3 AKI during hospitalization, do not need dialysis upon discharge, have a local primary care provider, and are discharged to their home. Recipients of any transplant within 100 days of enrollment are excluded. As of March 14, 2023, seventeen participants each have been enrolled in the intervention and usual care groups. Patients who provide consent are randomized to receive the ACT program intervention or usual care. The ACT program includes predischarge kidney health education and coordinated postdischarge laboratory monitoring and follow-up with a primary care provider and pharmacist within 14 days. The usual care group receives no study-related intervention. This study includes qualitative interviews and surveys with patients and staff and will explore the feasibility of the ACT program. Notes of clinical encounters will be reviewed for dialogue and care plans related to kidney health. Quantitative measures of the feasibility and acceptability of ACT will be summarized via descriptive analyses.
AHRQ-funded; HS028060.
Citation: May HP, Griffin JM, Herges JR .
Comprehensive acute kidney injury survivor care: protocol for the Randomized Acute Kidney Injury in Care Transitions Pilot trial.
JMIR Res Protoc 2023 May 22; 12:e48109. doi: 10.2196/48109..
Keywords: Kidney Disease and Health, Transitions of Care
Fissell RB, Wysocki M, Bonnet K
Patient perspectives on peritoneal dialysis (PD) and the PD catheter: strategies and solutions.
This study examined patient perspectives on strategies for living with peritoneal dialysis (PD) and strategies for living and using a PD catheter. It is hoped that these perspectives may inform efforts to reduce PD catheter complications, increase individual patient PD modality persistence, and thus increase overall home dialysis prevalence. The authors interviewed 32 adult PD patients in Nashville, Tennessee. Qualitative analyses of these interviews included: (1) isolation of themes, (2) development of a coding system and (3) creation of a conceptual framework using an inductive-deductive approach. Patients identified important challenges including drain pain, difficulty eating and sleeping, and fear of peritonitis. Their coping strategies included repositioning while draining, adjusting eating patterns, and development of PD patient and helper knowledge and confidence, especially at home after initial training. These strategies were found by a trial-and-error iterative process with input from multiple sources, which led to individualized solutions.
AHRQ-funded; HS026395.
Citation: Fissell RB, Wysocki M, Bonnet K .
Patient perspectives on peritoneal dialysis (PD) and the PD catheter: strategies and solutions.
Perit Dial Int 2023 May; 43(3):231-40. doi: 10.1177/08968608231152063..
Keywords: Kidney Disease and Health, Chronic Conditions
Herges JR, May HP, Meade L
Pharmacist-provider collaborative visits after hospital discharge in a comprehensive acute kidney injury survivor model.
This pilot study’s objective was to describe pharmacist contributions to a comprehensive postdischarge acute kidney injury (AKI) survivorship program in primary care (the AKI in Care Transitions [ACT] program). The program was piloted from May to December of 2021 at Mayo Clinic as a bundled care strategy for patients who survived an episode of AKI and were discharged home without the need for hemodialysis. Predischarge patients received education and care coordination from nurses and later completed postdischarge laboratory assessment and clinician follow-up in primary care. During follow-up, patients completed a 30-minute comprehensive medication management visit with a pharmacist focusing on AKI survivorship considerations. Pharmacists made 28 medication therapy recommendations (median 3 per patient) and identified 14 medication discrepancies for the 11 patients who completed the pilot program, with 86% of the medication therapy recommendations being acted on by the PCP within 7 days. Six recommendations were made to initiate renoprotective medications, and 5 were acted on.
AHRQ-funded; HS028060.
Citation: Herges JR, May HP, Meade L .
Pharmacist-provider collaborative visits after hospital discharge in a comprehensive acute kidney injury survivor model.
J Am Pharm Assoc 2023 May-Jun; 63(3):909-14. doi: 10.1016/j.japh.2022.12.029..
Keywords: Provider: Pharmacist, Kidney Disease and Health, Hospital Discharge
Eneanya ND, Adingwupu OM, Kostelanetz S
Social determinants of health and their impact on the Black race coefficient in serum creatinine-based estimation of GFR: secondary analysis of MDRD and CRIC studies.
The rationale behind the disparity in blood creatinine levels between Black and non-Black individuals factored into previous GFR prediction formulas remains unclear. The purpose of this study was to investigate if social health determinants could explain this gap. The researchers conducted a secondary examination of the initial data from the Modification of Diet in Renal Disease and Chronic Renal Insufficiency Cohort investigations. Data from these cohorts were divided based on racial characteristics (Black versus non-Black). The study initially assessed the degree to which the Black race coefficient in the GFR estimation from creatinine is influenced by the interrelation of race with social health determinants and non-GFR creatinine determinants. Researchers then assessed whether the discrepancy in adjusted mean creatinine between racial groups could be attributed to social health determinants and non-GFR creatinine determinants. The study found that in models that associated measured GFR with creatinine, age, sex, and race, the Black race coefficient was 21% in the Modification of Diet in Renal Disease study and 13% in the Chronic Renal Insufficiency Cohort, and was not weakened by the inclusion of social health determinants, either singularly or in combination. In both studies, the Black race coefficient was more pronounced at lower income levels as compared to higher ones. In models associating creatinine with measured GFR, age, and sex, average creatinine was elevated in Black participants in comparison with non-Black participants in both studies, with social health determinants having no impact.
AHRQ-funded; HS026122.
Citation: Eneanya ND, Adingwupu OM, Kostelanetz S .
Social determinants of health and their impact on the Black race coefficient in serum creatinine-based estimation of GFR: secondary analysis of MDRD and CRIC studies.
Clin J Am Soc Nephrol 2023 Apr; 18(4):446-54. doi: 10.2215/cjn.0000000000000109..
Keywords: Social Determinants of Health, Racial and Ethnic Minorities, Kidney Disease and Health, Disparities
Solano QP, Thumma JR, Mullens C
Variation of ventral and incisional hernia repairs in kidney transplant recipients.
Researchers sought to evaluate hospital-level variation of ventral or incisional hernia repair (VIHR) among the kidney transplant population by performing a retrospective review of inpatient Medicare claims to identify patients who underwent kidney transplant, 2007-18. Their findings showed that the overall cumulative incidence of hernia repair varied substantially across hospital tertiles; patient and hospital characteristics also varied across tertile, most notably with diabetes and obesity. They concluded that future research will be needed to understand if program and surgeon level factors contribute to the observed variation in treatment.
AHRQ-funded; HS025778.
Citation: Solano QP, Thumma JR, Mullens C .
Variation of ventral and incisional hernia repairs in kidney transplant recipients.
Surg Endosc 2023 Apr; 37(4):3173-79. doi: 10.1007/s00464-022-09505-2..
Keywords: Kidney Disease and Health, Surgery, Transplantation
Brown T, Brody R, Sackey J
Dietary intake correlated to waist-to-hip ratio in patients on maintenance hemodialysis.
Patients with end-stage renal disease (ESRD) undergoing regular hemodialysis (RHD) are susceptible to protein-energy malnutrition (PEM). Insufficient dietary consumption and changes in body measurements are among the diagnostic criteria for PEM. The purpose of this study was to measure the adherence of ESRD patients on RHD to the 2020 National Kidney Foundation Kidney Disease Outcome Quality Initiative (NKF-KDOQI) recommendations for nutritional sufficiency during a dialysis day (DD) and analyze the association between dietary energy (DEI) and protein (DPI) intake and body measurements. The study utilized a secondary review of clinical and demographic data from 142 adults in the Rutgers Nutrition and Kidney Disease database. The correlations between DEI, DPI, and body measurements such as body mass index (BMI), BMI classification, waist circumference, and waist-to-hip ratio (WHR) were evaluated. The study found that the median age of the participants was 55.7 years, with 58% being male and 83.8% identifying as Black/African American. The median time spent on dialysis was 42.0 months (approximately 3.5 years). Seventy-five percent of the participants were classified as overweight or obese. The WHR was 1.0 ± 0.8 cm for males and 0.9 ± 0.1 cm for females. Neither DEI nor DPI on a DD complied with the NKF-KDOQI 2020 recommendations. The median DEI was 17.6 ± 8.4 kcal/kg, and DPI was 0.7 ± 0.4 g/kg. Significant positive correlations were found between DEI and DPI and WHR for the entire sample. In females, a significant positive correlation emerged between DPI and WHR. The researchers concluded that the nutritional consumption of ESRD patients undergoing RHD falls short of the NKF-KDOQI 2020 guidelines on a DD.
AHRQ-funded; HS023434
Citation: Brown T, Brody R, Sackey J .
Dietary intake correlated to waist-to-hip ratio in patients on maintenance hemodialysis.
J Ren Nutr 2023 Mar;33(2):355-62. doi: 10.1053/j.jrn.2022.09.012.
Keywords: Kidney Disease and Health, Nutrition, Chronic Conditions
Ehmann MR, Mitchell J, Levin S
Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis.
The purpose of this retrospective study was to investigate the relationship between intravenous contrast media (CM) administration and persistent acute kidney injury (AKI) in patients with pre-existing AKI. The researchers used propensity-weighted and entropy-balanced observational cohort analysis of consecutive hospitalized patients aged 18 years or older who met the Kidney Disease Improving Global Outcomes (KDIGO) creatinine-based criteria for AKI upon arrival at one of three emergency departments between 7/ 2017 and 6/2021. Patients either received or did not receive intravenous CM. The analysis included 14,449 patient encounters, with 12.8% admitted to the intensive care unit (ICU). The study found that CM was administered in 18.4% of all encounters. AKI resolved before hospital discharge in 69.1% of cases. No association between intravenous CM administration and persistent AKI was found after unadjusted multivariable logistic regression modeling, propensity weighting, and entropy balancing. Similar results were obtained from sub-group analysis of patients admitted to the ICU. Initiation of dialysis within 180 days occurred in 5.4% of the cohort, with no observed association between CM administration and increased risk of dialysis within this timeframe.
AHRQ-funded; HS027793; HS02664002.
Citation: Ehmann MR, Mitchell J, Levin S .
Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis.
Intensive Care Med 2023 Feb; 49(2):205-15. doi: 10.1007/s00134-022-06966-w..
Keywords: Kidney Disease and Health, Adverse Drug Events (ADE), Adverse Events, Outcomes
Purnell TS, Bignall ONR, Norris KC
Centering anti-racism and social justice in nephrology education to advance kidney health equity.
This article discusses actions necessary to effectively prepare a new generation of nephrology thought leaders who understand the roles of structural racism and social determinants of health (SDOH) in continuing racial disparities as critical issues in efforts that promote kidney health equity. The authors provide their recommendations for centering antiracism and social justice in nephrology education to advance kidney health equity, including: 1 Acknowledging and adopting evidence-based strategies to address implicit biases and explicit acts of interpersonal racism in healthcare encounters that may perpetuate kidney health disparities; 2) Strive to remove structural racism at the societal and health system levels that systematically introduce inequities in kidney care; 3) incorporate research training inclusive of methodologic and content areas that are vital to health equity; 4) foster role modeling within nephrology education through faculty mentorship and professional networking opportunities. The authors conclude that to effectively advance kidney research and practice, sustainable solutions to eradicate disparities must be developed and a prepared nephrology workforce must be trained, one that centers antiracism and social justice in sustained efforts to advance kidney health equity.
AHRQ-funded; HS024600.
Citation: Purnell TS, Bignall ONR, Norris KC .
Centering anti-racism and social justice in nephrology education to advance kidney health equity.
J Am Soc Nephrol 2022 Nov;33(11):1981-84. doi: 10.1681/asn.2022040432..
Keywords: Racial and Ethnic Minorities, Kidney Disease and Health, Disparities, Education: Continuing Medical Education, Education: Curriculum
Umeukeje EM, Koonce TY, Kusnoor SV
Systematic review of international studies evaluating MDRD and CKD-EPI estimated glomerular filtration rate (eGFR) equations in Black adults.
The authors conducted a systematic review to assess how well estimating glomerular filtration rate (eGFR), with and without race adjustment, estimates measured GFR (mGFR) in Black adults globally. They identified 12 studies which included patients with and without kidney disease from Africa, the United States, Europe, and Brazil. They found that the majority of these studies determined that removal of race adjustment improved bias, accuracy, and precision of eGFR equations for Black adults. They concluded that their systematic review supports the need for future studies to be conducted in diverse populations to assess the possibility of alternative approaches for estimating GFR.
AHRQ-funded; HS026122.
Citation: Umeukeje EM, Koonce TY, Kusnoor SV .
Systematic review of international studies evaluating MDRD and CKD-EPI estimated glomerular filtration rate (eGFR) equations in Black adults.
PLoS One 2022 Oct 18;17(10):e0276252. doi: 10.1371/journal.pone.0276252..
Keywords: Kidney Disease and Health, Chronic Conditions, Racial and Ethnic Minorities, Diagnostic Safety and Quality
Becker NV, Scott JW, Moniz MH
Association of chronic disease with patient financial outcomes among commercially insured adults.
This study examined the association between chronic disease and adverse financial outcomes. The authors used claims data for patients enrolled in a preferred provider organization in Michigan. Patients diagnosed with thirteen common chronic conditions (cancer, congestive heart failure, chronic kidney disease, dementia, depression and anxiety, diabetes, hypertension, ischemic heart disease, liver disease, chronic obstructive pulmonary disease and asthma, serious mental illness, stroke, and substance use disorders) were included in the cohort of 2,854,481 adults aged 21 and over. The cohort included 61.4% with no chronic conditions, 17.7% with 1 chronic condition, 14.8% with 2 to 3 chronic conditions, 5.4% with 4 to 6 chronic conditions, and 0.7% with 7 to 13 chronic conditions. Among the cohort, 9.6% had medical debt in collections, 8.3% had nonmedical debt in collections, 16.3% had delinquent debt, 19.3% had a low credit score, and 0.6% had recent bankruptcy. For individuals with 0 vs 7 to 13 chronic conditions, the predicted probabilities of having any medical debt in collections (7.6% vs 32%), any nonmedical debt in collections (7.2% vs 24%), any delinquent debt (14% vs 43%), a low credit score (17% vs 47%) or recent bankruptcy (0.4% vs 1.7%) were all considerably higher for individuals with more chronic conditions and increased with each added chronic condition. Among individuals with medical debt in collections, the estimated amount increased with the number of chronic conditions ($784 for individuals with 0 conditions vs $1252 for individuals with 7-13 conditions).
AHRQ-funded; HS028672.
Citation: Becker NV, Scott JW, Moniz MH .
Association of chronic disease with patient financial outcomes among commercially insured adults.
JAMA Intern Med 2022 Oct;182(10):1044-51. doi: 10.1001/jamainternmed.2022.3687..
Keywords: Chronic Conditions, Healthcare Costs, Cancer, Kidney Disease and Health
Tisdale RL, Cusick MM, Aluri KZ
Cost-effectiveness of dapagliflozin for non-diabetic chronic kidney disease.
The purpose of this study was to determine the cost-effectiveness of adding dapagliflozin to standard management of patients with non-diabetic chronic kidney disease (CKD). Findings showed that adding dapagliflozin to standard care improved life expectancy by 2 years, increased discounted quality-adjusted life years, and reduced the total incidence of both kidney failure on kidney replacement therapy (KRT) and average years on KRT over the lifetime of the cohort. Further, dapagliflozin plus standard care was more effective than standard care alone while increasing lifetime costs.
AHRQ-funded; HS026128.
Citation: Tisdale RL, Cusick MM, Aluri KZ .
Cost-effectiveness of dapagliflozin for non-diabetic chronic kidney disease.
J Gen Intern Med 2022 Oct;37(13):3380-87. doi: 10.1007/s11606-021-07311-5..
Keywords: Kidney Disease and Health, Medication, Chronic Conditions, Healthcare Costs
Butler T, Cummings LS, Purnell TS
The case for prioritizing diversity in the transplantation workforce to advance kidney health equity.
The authors of this article propose a more diverse transplant workforce to address the problem of kidney transplant inequity. Black patients are disproportionately affected by kidney failure and systemic barriers to kidney transplantation such as delayed referrals, which may be due to clinician bias. Workforce diversity would help to alleviate the harm of implicit biases.
AHRQ-funded; HS024600.
Citation: Butler T, Cummings LS, Purnell TS .
The case for prioritizing diversity in the transplantation workforce to advance kidney health equity.
J Am Soc Nephrol 2022 Oct; 33(10):1817-19. doi: 10.1681/asn.2022040429..
Keywords: Kidney Disease and Health, Transplantation, Workforce, Disparities, Racial and Ethnic Minorities
Ramadan OI, Dember LM, Wang GJ
Association between anaesthesia type and arteriovenous fistula maturation.
The purpose of this study was to measure the relationship between anesthesia type and arteriovenous fistula maturation. The researchers conducted a secondary analysis of data from 602 participants of the Hemodialysis Fistula Maturation study, a prospective cohort study of advanced chronic kidney disease patients who underwent single-stage upper extremity fistula creation between 2010 and 2013. The current study found that 55.8% of patients received regional/local anesthesia and 44.2% received general anesthesia. Unassisted maturation took place in 53.1% of patients after regional/local anesthesia vs 40.3% after general anesthesia. After adjustment for patient factors and fistula type, regional/local anesthesia was related with higher odds of unassisted maturation than general anesthesia. However, after further adjustment for clinical center fixed effects, odds of unassisted maturation did not differ by anesthesia type. The researchers concluded that regional/local anesthesia was related with higher odds of fistula maturation when adjusting for patient factors and fistula type, but the relationship association did not endure after adjusting for center fixed effects.
AHRQ-funded; HS026116.
Citation: Ramadan OI, Dember LM, Wang GJ .
Association between anaesthesia type and arteriovenous fistula maturation.
BJA Open 2022 Sep;3. doi: 10.1016/j.bjao.2022.100031..
Keywords: Kidney Disease and Health, Medication