National Healthcare Quality and Disparities Report
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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 29 Research Studies DisplayedPerl J, Fuller DS, Boudville N
Optimizing peritoneal dialysis-associated peritonitis prevention in the United States: from standardized peritoneal dialysis-associated peritonitis reporting and beyond.
Peritoneal dialysis (PD)-associated peritonitis is the leading cause of permanent transition to hemodialysis among patients receiving PD. Optimizing the prevention of peritonitis in the United States will first require standardization of peritonitis definitions, key data elements, and outcomes in an effort to facilitate nationwide reporting. In this paper, the investigators highlighted considerations and challenges in developing standardized definitions and implementation of national reporting of peritonitis rates by PD facilities.
AHRQ-funded; HS025756.
Citation: Perl J, Fuller DS, Boudville N .
Optimizing peritoneal dialysis-associated peritonitis prevention in the United States: from standardized peritoneal dialysis-associated peritonitis reporting and beyond.
Clin J Am Soc Nephrol 2020 Dec 31;16(1):154-61. doi: 10.2215/cjn.11280919..
Keywords: Kidney Disease and Health, Quality Improvement, Quality of Care
Bakre S, Hollingsworth JM, Yan PL
Accountable care organizations and spending for patients undergoing long-term dialysis.
This study analyzed Medicare data to examine time trends in long-term dialysis beneficiary alignment to Accountable Care Organizations (ACOs) and differences in spending for those who were Accountable Care Organization aligned versus nonaligned. Beneficiaries on long-term dialysis between 2009 and 2016 were identified using a 20% random sample of Medicare beneficiaries. Trends in alignment to an ACO alignment were compared with alignment of the general Medicare population. The cohort included 135,152 beneficiaries during the study period. Alignment to an ACO of long-term dialysis beneficiaries increased from 6% to 23% from 2012 to 2016. In the time series analysis, ACO spending was $143 less per beneficiary-quarter than spending for non-aligned beneficiaries. This savings was limited to care by a primary care physician.
AHRQ-funded; HS024525; HS026908; HS024728.
Citation: Bakre S, Hollingsworth JM, Yan PL .
Accountable care organizations and spending for patients undergoing long-term dialysis.
Clin J Am Soc Nephrol 2020 Dec 7;15(12):1777-84. doi: 10.2215/cjn.02150220..
Keywords: Healthcare Costs, Dialysis, Kidney Disease and Health, Medicare
Edwards GC, Shipe ME, Smith L
Exploring patient willingness to accept hepatitis C-infected kidneys for transplantation.
The objective of this study was to explore patient willingness to accept a kidney from Hepatitis C virus-infected donors compared to donors with active intravenous drug use and donors with longstanding diabetes and hypertension. Using electronic surveys, results showed that utilization of kidneys from Hepatitis C virus-infected donors to expand the donor pool appeared to be an acceptable option to patients.
AHRQ-funded; HS026122.
Citation: Edwards GC, Shipe ME, Smith L .
Exploring patient willingness to accept hepatitis C-infected kidneys for transplantation.
BMC Nephrol 2020 Nov 10;21(1):473. doi: 10.1186/s12882-020-02114-y..
Keywords: Hepatitis, Kidney Disease and Health, Transplantation
Sloan CE, Zhong J, Mohottige D
Fragmentation of care as a barrier to optimal ESKD management.
This article describes the role of care fragmentation in the delivery of optimal ESKD care and identifies research gaps in the evidence across the continuum of care. The authors consider the impact of care fragmentation on ESKD care from the patient and health system perspectives and explore opportunities for system-level interventions aimed at improving care for patients with ESKD.
AHRQ-funded.
Citation: Sloan CE, Zhong J, Mohottige D .
Fragmentation of care as a barrier to optimal ESKD management.
Semin Dial 2020 Nov;33(6):440-48. doi: 10.1111/sdi.12929..
Keywords: Kidney Disease and Health, Care Management, Healthcare Delivery, Quality of Care
Qian JZ, McAdams-DeMarco M, Ng DK
Arteriovenous fistula placement, maturation, and patency loss in older patients initiating hemodialysis.
The current clinical guidelines for vascular access do not have specific recommendations for older hemodialysis patients. This retrospective cohort study aimed to determine the association of age with arteriovenous fistula (AVF) placement, maturation, and primary and secondary patency loss among older hemodialysis recipients. The authors conclude that the likelihood of AVF maturation is an important consideration for vascular access planning.
AHRQ-funded; HS022931.
Citation: Qian JZ, McAdams-DeMarco M, Ng DK .
Arteriovenous fistula placement, maturation, and patency loss in older patients initiating hemodialysis.
Am J Kidney Dis 2020 Oct;76(4):480-89.e1. doi: 10.1053/j.ajkd.2020.02.449..
Keywords: Elderly, Dialysis, Kidney Disease and Health, Surgery
Yao X, Inselman JW, Ross JS
Comparative effectiveness and safety of oral anticoagulants across kidney function in patients with atrial fibrillation.
Patients with atrial fibrillation and severely decreased kidney function were excluded from the pivotal non-vitamin K antagonist oral anticoagulants (NOAC) trials, thereby raising questions about comparative safety and effectiveness in patients with reduced kidney function. This study aimed to compare oral anticoagulants across the range of kidney function in patients with atrial fibrillation.
AHRQ-funded; HS025517; HS025164; HS025402; HS022882; HS024075.
Citation: Yao X, Inselman JW, Ross JS .
Comparative effectiveness and safety of oral anticoagulants across kidney function in patients with atrial fibrillation.
Circ Cardiovasc Qual Outcomes 2020 Oct;13(10):e006515. doi: 10.1161/circoutcomes.120.006515..
Keywords: Kidney Disease and Health, Cardiovascular Conditions, Blood Thinners, Medication, Medication: Safety, Patient Safety, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Martinez DA, Levin SR, Klein EY
Early prediction of acute kidney injury in the emergency department with machine-learning methods applied to electronic health record data.
Researchers analyzed routinely collected emergency department (ED) data and developed prediction models with capacity for early identification of ED patients at high risk for acute kidney injury. They found that machine learning applied to routinely-collected ED data identified ED patients at high risk for acute kidney injury up to 72 hours before they met diagnostic criteria. They recommended further prospective evaluation.
AHRQ-funded; HS027793.
Citation: Martinez DA, Levin SR, Klein EY .
Early prediction of acute kidney injury in the emergency department with machine-learning methods applied to electronic health record data.
Ann Emerg Med 2020 Oct;76(4):501-14. doi: 10.1016/j.annemergmed.2020.05.026..
Keywords: Kidney Disease and Health, Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT)
Lee H, Caldwell JT, Maene C
Racial/ethnic inequities in access to high-quality dialysis treatment in Chicago: does neighborhood racial/ethnic composition matter?
Investigators examined whether neighborhood racial composition contributes to racial/ethnic inequities in access to high-quality dialysis care in Chicago. Data from the United States Renal Data System was merged with the ESRD Quality Incentive Program file and the American Community Survey (2005-2009) for facility and neighborhood characteristics. The investigators concluded that expanding opportunities for Blacks and Hispanics to gain access to racially integrated and minority neighborhoods may help alleviate racial/ethnic inequities in access to quality care among kidney disease patients.
AHRQ-funded; HS00078.
Citation: Lee H, Caldwell JT, Maene C .
Racial/ethnic inequities in access to high-quality dialysis treatment in Chicago: does neighborhood racial/ethnic composition matter?
J Racial Ethn Health Disparities 2020 Oct;7(5):854-64. doi: 10.1007/s40615-020-00708-8..
Keywords: Racial and Ethnic Minorities, Access to Care, Urban Health, Dialysis, Disparities, Quality of Care, Kidney Disease and Health
Crews DC, Purnell TS
COVID-19, racism, and racial disparities in kidney disease: galvanizing the kidney community response.
This article and associated podcast discussed racial disparities in kidney disease and COVID-19, including Geronimus’ weathering hypothesis, structural racism, and the role of nephrologists.
AHRQ-funded; HS024600.
Citation: Crews DC, Purnell TS .
COVID-19, racism, and racial disparities in kidney disease: galvanizing the kidney community response.
J Am Soc Nephrol 2020 Aug;31(8):1-3. doi: 10.1681/asn.2020060809..
Keywords: COVID-19, Disparities, Racial and Ethnic Minorities, Kidney Disease and Health
Purnell TS, Bae S, Luo X
National trends in the association of race and ethnicity with predialysis nephrology care in the United States From 2005 to 2015.
Predialysis nephrology care is associated with better survival among patients with end-stage kidney disease. The purpose of this study was to examine national trends in racial/ethnic disparities in receipt of predialysis nephrology care at least 1 year before dialysis initiation in the United States from 2005 to 2015. The study findings suggested that national strategies to address racial/ethnic disparities in predialysis nephrology care are needed.
AHRQ-funded; HS024600.
Citation: Purnell TS, Bae S, Luo X .
National trends in the association of race and ethnicity with predialysis nephrology care in the United States From 2005 to 2015.
JAMA Netw Open 2020 Aug;3(8):e2015003. doi: 10.1001/jamanetworkopen.2020.15003..
Keywords: Kidney Disease and Health, Dialysis, Racial and Ethnic Minorities, Chronic Conditions, Disparities
Assimon MM, Wang L, Pun PH
Use of QT prolonging medications by hemodialysis patients and individuals without end-stage kidney disease.
Investigators characterized the extent and patterns of QT-interval prolonging medication use by adult hemodialysis patients and individuals without end-stage kidney disease annually from 2012 to 2016. They found that hemodialysis patients used QT prolonging medications with known torsades de pointes risk more extensively than individuals without end-stage kidney disease. They recommended future studies evaluating the cardiac safety of these drugs in the hemodialysis population.
AHRQ-funded; HS026801.
Citation: Assimon MM, Wang L, Pun PH .
Use of QT prolonging medications by hemodialysis patients and individuals without end-stage kidney disease.
J Am Heart Assoc 2020 Jul 7;9(13):e015969. doi: 10.1161/jaha.120.015969..
Keywords: Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Kidney Disease and Health, Risk
Hirayama A, Goto T, Hasegawa K
Association of acute kidney injury with readmissions after hospitalization for acute exacerbation of chronic obstructive pulmonary disease: a population-based study.
This study examined the association between acute kidney injury (AKI) and readmission with hospitalization for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Retrospective, population-based cohort data was used from the HCUP State Inpatient Databases from seven states (Arkansas, California, Florida, Iowa, Nebraska, New York, and Utah) from 2010 through 2013. A total of 356,990 patients were identified as hospitalized for AECOPD. Median age was 71 years and 41.9% were male. Of those 7% had a concurrent diagnosis of AKI. Patients with AKI were found to have a significantly higher risk of 30-day all-cause readmission compared to those without AKI as well as a significantly higher risk of 90-day all-cause readmission, particularly for non-respiratory reasons. These reasons included sepsis, acute renal failure, and congestive heart failure.
AHRQ-funded; HS023305.
Citation: Hirayama A, Goto T, Hasegawa K .
Association of acute kidney injury with readmissions after hospitalization for acute exacerbation of chronic obstructive pulmonary disease: a population-based study.
BMC Nephrol 2020 Apr 3;21(1):116. doi: 10.1186/s12882-020-01780-2..
Keywords: Healthcare Cost and Utilization Project (HCUP), Respiratory Conditions, Chronic Conditions, Hospital Readmissions, Hospitalization, Kidney Disease and Health
Kurani S, Jeffery MM, Thorsteinsdottir B
Use of potentially nephrotoxic medications by U.S. adults with chronic kidney disease: NHANES, 2011-2016.
This study looked at the prevalence of potentially inappropriate medication (PIM) use by US adults by chronic kidney disease (CKD) stage and self-reported CKD awareness. A cross-sectional analysis of National Health and Nutrition Examination Surveys, 2011-2016 was conducted using a cohort of non-pregnant CKD adults with stages 3a, 3b, or 4-5 CKD. Analyses were adjusted for sex, age, race/ethnicity, education, comorbidities, and insurance type. More than 50% of US adults were taking PIM(s) for all CKD stages and awareness categories, but rates were highest among CKD-unaware patients with stages 4-5 CKD. Proton pump inhibitors, opioids, metformin, sulfonylureas, and NSAIDS were used frequently in all CKD stages. NSAIDS were used less frequently when the patient was CKD-aware.
AHRQ-funded; HS025164; HS025402; HS025517.
Citation: Kurani S, Jeffery MM, Thorsteinsdottir B .
Use of potentially nephrotoxic medications by U.S. adults with chronic kidney disease: NHANES, 2011-2016.
J Gen Intern Med 2020 Apr;35(4):1092-101. doi: 10.1007/s11606-019-05557-8..
Keywords: Medication: Safety, Medication, Adverse Drug Events (ADE), Adverse Events, Kidney Disease and Health, Chronic Conditions, Patient Safety
Pokorney SD, Black-Maier E, Hellkamp AS
Oral anticoagulation and cardiovascular outcomes in patients with atrial fibrillation and end-stage renal disease.
The objective of this study was to describe patterns of oral anticoagulant (OAC) use in end-stage renal disease (ESRD) patients with atrial fibrillation (AF) and their associations with cardiovascular outcomes. Medicare fee-for-service 5% claims data from 2007 to 2013 was analyzed in a cohort of patients with ESRD and AF. A cohort of 8,410 patients with AF and ESRD was identified, with a total of 3,043 (36.2%) patients treated with OAC during the study period. Treatment with OAC was not associated with hospitalization for stroke, or death but was associated with increased hospitalization for bleeding and intracranial hemorrhage.
AHRQ-funded; HS021092.
Citation: Pokorney SD, Black-Maier E, Hellkamp AS .
Oral anticoagulation and cardiovascular outcomes in patients with atrial fibrillation and end-stage renal disease.
J Am Coll Cardiol 2020 Mar 24;75(11):1299-308. doi: 10.1016/j.jacc.2020.01.019..
Keywords: Blood Thinners, Medication, Heart Disease and Health, Cardiovascular Conditions, Kidney Disease and Health, Chronic Conditions, Outcomes
Muzaale AD, Massie AB, Al Ammary F
Donor-recipient relationship and risk of ESKD in live kidney donors of varied racial groups.
Risk factors for kidney failure are the basis of live kidney donor candidate evaluation. In this retrospective cohort study, the investigators quantified risk for end-stage kidney disease (ESKD) by the biological relationship of the donor to the recipient, a risk factor that is not addressed by current clinical practice guidelines. The investigators found that marked differences in risk for ESKD across types of donor-recipient relationship were observed for Asian, black, and white donors.
AHRQ-funded; HS024600.
Citation: Muzaale AD, Massie AB, Al Ammary F .
Donor-recipient relationship and risk of ESKD in live kidney donors of varied racial groups.
Am J Kidney Dis 2020 Mar;75(3):333-41. doi: 10.1053/j.ajkd.2019.08.020..
Keywords: Transplantation, Kidney Disease and Health, Racial and Ethnic Minorities, Risk, Registries
Butler AM, Layton JB, Dharnidharka VR
Comparative effectiveness of high-dose versus standard-dose influenza vaccine among patients receiving maintenance hemodialysis.
This study compared outcomes of routine dialysis patients who received either the standard dose vaccine (SDV) for influenza or a high-dose vaccine (HDV). Out of 22,215 influenza patient-seasons among adults 65 years and older, 97.4% received SDV and 2.6% received HDV. There did not seem to be any additional protection provided by the HDV for all-cause mortality or influenza-related outcomes.
AHRQ-funded; HS019455.
Citation: Butler AM, Layton JB, Dharnidharka VR .
Comparative effectiveness of high-dose versus standard-dose influenza vaccine among patients receiving maintenance hemodialysis.
Am J Kidney Dis 2020 Jan;75(1):72-83. doi: 10.1053/j.ajkd.2019.05.018..
Keywords: Vaccination, Influenza, Comparative Effectiveness, Dialysis, Kidney Disease and Health, Hospitalization, Outcomes
Amin AP, McNeely C, Spertus JA
Incremental cost of acute kidney injury after percutaneous coronary intervention in the United States.
This study examined incremental costs of acute kidney injury (AKI) complications from percutaneous coronary intervention (PCI), which is a common and severe complication. Out of a sample of over 1.4 million PCI patients at 518 US hospitals from 2006 to 2015, AKI occurred in 5.73% of PCI patients. Those with AKI had at least double the hospitalization costs and the incremental cost was $9,448. It was also independently associated with an incremental length of stay of 3.6 days. AKI cost burden was extrapolated at 411.3 million US dollars annually.
AHRQ-funded; HS022481.
Citation: Amin AP, McNeely C, Spertus JA .
Incremental cost of acute kidney injury after percutaneous coronary intervention in the United States.
Am J Cardiol 2020 Jan;125(1):29-33. doi: 10.1016/j.amjcard.2019.09.042..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Adverse Events, Healthcare Costs, Kidney Disease and Health, Patient Safety, Registries
Flory JH, Hennessy S, Bailey CJ
Reports of lactic acidosis attributed to metformin, 2015-2018.
This study examined the effects of allowing patients with mild-moderate chronic kidney disease to use metformin. The researchers examined rates of reports of metformin-associated lactic acidosis (MALA) to FDA’s Adverse Event Reporting System (FAERS). Publicly available data from 2015 to 2018 was analyzed. Reports from the US increased from 111 in 2015 to 243 in 2018. However due to a lack of a denominator or control group they could not conclude US MALA rates have increased. The authors also concluded that while the increased reports deserve attention, further study is needed.
AHRQ-funded; HS023898.
Citation: Flory JH, Hennessy S, Bailey CJ .
Reports of lactic acidosis attributed to metformin, 2015-2018.
Diabetes Care 2020 Jan;43(1):244-46. doi: 10.2337/dc19-0923.
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Keywords: Kidney Disease and Health, Medication, Medication: Safety, Patient Safety, Adverse Drug Events (ADE), Adverse Events
Clark-Cutaia MN, Jarrin OF, Thomas-Hawkins C
The perfect storm: stakeholder perspectives on factors contributing to hospital admissions for patients undergoing maintenance hemodialysis.
This study examined reasons why end stage renal disease (ESRD) patients undergoing hemodialysis experience frequent complications and hospitalizations. Interviews and focus groups were conducted with 21 patients living with ESRD, 10 caregivers, and three focus groups with health care professionals. There were four main themes that came out of the discussions: graft site/catheter/access issues, low resistance, breathing problems, and “The perfect storm”. The goal of these interviews were to promote more research to improve transitional care and care delivery for hemodialysis patients.
AHRQ-funded; HS022406.
Citation: Clark-Cutaia MN, Jarrin OF, Thomas-Hawkins C .
The perfect storm: stakeholder perspectives on factors contributing to hospital admissions for patients undergoing maintenance hemodialysis.
Nephrol Nurs J 2020 Jan-Feb;47(1):11-20..
Keywords: Kidney Disease and Health, Dialysis, Adverse Events, Hospitalization, Patient Safety
Banerjee T, Kim SJ, Astor B
Vascular access type, inflammatory markers, and mortality in incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) study.
The researchers investigated the association between access type and inflammatory marker levels in 583 dialysis patients. They found that central venous catheters, compared with arteriovenous fistulas, are associated with a greater state of inflammation and the association of catheter use and mortality may be mediated by access-induced inflammation.
AHRQ-funded; HS008365
Citation: Banerjee T, Kim SJ, Astor B .
Vascular access type, inflammatory markers, and mortality in incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) study.
Am J Kidney Dis. 2014 Dec;64(6):954-61. doi: 10.1053/j.ajkd.2014.07.010..
Keywords: Kidney Disease and Health, Mortality, Comparative Effectiveness
Mold JW, Aspy CB, Smith PD
Leveraging practice-based research networks to accelerate implementation and diffusion of chronic kidney disease guidelines in primary care practices: a prospective cohort study.
This study was conducted to determine whether practice-based research networks (PBRNs) could increase dissemination, implementation, and diffusion of evidence-based treatment guidelines for chronic kidney disease by leveraging early adopter practices. After the intervention, the initial four PBRNs increased the use of ACEIs/ARBs, discontinuation of NSAIDs, testing for anemia, and testing and/or treatment for vitamin D deficiency. Most were able to recruit two additional practices, which also increased their use of ACEIs/ARBs and testing and/or treatment of vitamin D deficiency. The researchers concluded that, with some assistance, early adopter practices can facilitate the diffusion of evidence-based approaches to other practices.
AHRQ-funded; HS019945.
Citation: Mold JW, Aspy CB, Smith PD .
Leveraging practice-based research networks to accelerate implementation and diffusion of chronic kidney disease guidelines in primary care practices: a prospective cohort study.
Implement Sci 2014 Nov 23;9:169. doi: 10.1186/s13012-014-0169-x.
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Keywords: Practice-Based Research Network (PBRN), Primary Care, Kidney Disease and Health, Chronic Conditions, Guidelines, Implementation
Scialla JJ, Liu J, Crews DC
An instrumental variable approach finds no associated harm or benefit with early dialysis initiation in the United States.
The estimated glomerular filtration rate (eGFR) at dialysis initiation has been rising. This study described geographic variation in estimated glomerular filtration rate (eGFR) at dialysis initiation and determine its association with mortality. It found no associated harm or benefit with early dialysis initiation in the United States.
AHRQ-funded; 290200500341I.
Citation: Scialla JJ, Liu J, Crews DC .
An instrumental variable approach finds no associated harm or benefit with early dialysis initiation in the United States.
Kidney Int 2014 Oct;86(4):798-809. doi: 10.1038/ki.2014.110..
Keywords: Kidney Disease and Health, Outcomes, Patient Safety, Registries
Zhang Y, Thamer M, Kshirsagar O
Dialysis chains and placement on the waiting list for a cadaveric kidney transplant.
The purpose of this paper is to investigate the effect of dialysis facility chain status on renal transplantation therapy. The researchers concluded that dialysis chain affiliation expands previously observed ownership-related differences in placement on the waiting list, and for-profit ownership of dialysis chain facilities appears to be a significant impediment to access to renal transplants.
AHRQ-funded; HS020243.
Citation: Zhang Y, Thamer M, Kshirsagar O .
Dialysis chains and placement on the waiting list for a cadaveric kidney transplant.
Transplantation 2014 Sep 15;98(5):543-51. doi: 10.1097/tp.0000000000000106.
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Keywords: Kidney Disease and Health, Transplantation, Access to Care
Petrov ME, Kim Y, Lauderdale DS
Objective sleep, a novel risk factor for alterations in kidney function: the CARDIA study.
The investigators determined the association between objectively measured sleep and 10-year changes in estimated glomerular filtration rate. They found that, in this community-based sample, shorter sleep and poorer sleep quality were related to higher kidney filtration rates over 10 years.
AHRQ-funded; HS013852.
Citation: Petrov ME, Kim Y, Lauderdale DS .
Objective sleep, a novel risk factor for alterations in kidney function: the CARDIA study.
Sleep Med 2014 Sep;15(9):1140-6. doi: 10.1016/j.sleep.2014.05.021.
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Keywords: Risk, Sleep Problems, Kidney Disease and Health
Davis AE, Mehrotra S, Kilambi V
The effect of the Statewide Sharing variance on geographic disparity in kidney transplantation in the United States.
This study examined the effect of Statewide Sharing on geographic allocation disparity over time between donor service areas (DSAs) within Tennessee and Florida and compared them with geographic disparity between the DSAs within a state for all states with more than one DSA (California, New York, North Carolina, Ohio, Pennsylvania, Texas, and Wisconsin). Findings suggested that changes which are untested run the risk of unintended consequences, and Statewide Sharing should be further studied and considered.
AHRQ-funded; HS021078.
Citation: Davis AE, Mehrotra S, Kilambi V .
The effect of the Statewide Sharing variance on geographic disparity in kidney transplantation in the United States.
Clin J Am Soc Nephrol 2014 Aug 7;9(8):1449-60. doi: 10.2215/cjn.05350513.
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Keywords: Chronic Conditions, Disparities, Kidney Disease and Health, Policy, Transplantation