National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (2)
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Cardiovascular Conditions (1)
- Children/Adolescents (1)
- Chronic Conditions (3)
- Clinical Decision Support (CDS) (1)
- Communication (1)
- Disparities (5)
- Education: Patient and Caregiver (1)
- Genetics (1)
- Healthcare Costs (1)
- Healthcare Delivery (1)
- Healthcare Utilization (1)
- Health Literacy (1)
- Health Services Research (HSR) (1)
- Heart Disease and Health (1)
- (-) Kidney Disease and Health (21)
- Low-Income (1)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medicare (1)
- Medication (2)
- Mortality (2)
- Obesity (1)
- Obesity: Weight Management (1)
- Outcomes (5)
- Patient-Centered Outcomes Research (3)
- Policy (4)
- Prevention (1)
- Racial and Ethnic Minorities (2)
- Registries (1)
- Risk (2)
- Sex Factors (1)
- Shared Decision Making (3)
- Surgery (3)
- (-) Transplantation (21)
- Women (1)
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 21 of 21 Research Studies DisplayedMontgomery JR, Waits SA, Dimick JB
Risks of bariatric surgery among patients with end-stage renal disease.
Pretransplant morbid obesity among patients with end-stage renal disease (ESRD) is a significant predictor of delayed access to transplant and inferior posttransplant patient and kidney allograft outcomes. In this study, the authors performed an analysis of perioperative safety of bariatric surgery in obese patients with ESRD using a national registry capturing greater than 95% of bariatric operations.
AHRQ-funded; HS025778.
Citation: Montgomery JR, Waits SA, Dimick JB .
Risks of bariatric surgery among patients with end-stage renal disease.
JAMA Surg 2019 Dec;154(12):1160-62. doi: 10.1001/jamasurg.2019.2824..
Keywords: Surgery, Obesity, Obesity: Weight Management, Kidney Disease and Health, Transplantation, Risk, Chronic Conditions
Purnell TS, Luo X, Crews DC
Neighborhood poverty and sex differences in live donor kidney transplant outcomes in the United States.
Neighborhood poverty has been associated with worse outcomes after live donor kidney transplantation (LDKT), and prior work suggests that women with kidney disease may be more susceptible to the negative influence of poverty than men. As such, our goal was to examine whether poverty differentially affects women in influencing LDKT outcomes. The investigators concluded that given their findings that poverty was more strongly associated with graft loss in women, targeted efforts are needed to specifically address mechanisms driving these disparities in LDKT outcomes.
AHRQ-funded; HS024600.
Citation: Purnell TS, Luo X, Crews DC .
Neighborhood poverty and sex differences in live donor kidney transplant outcomes in the United States.
Transplantation 2019 Oct;103(10):2183-89. doi: 10.1097/tp.0000000000002654.
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Keywords: Transplantation, Kidney Disease and Health, Patient-Centered Outcomes Research, Disparities, Women, Sex Factors, Low-Income, Outcomes
Stepkowski SM, Mierzejewska B, Fumo D
The 6-year clinical outcomes for patients registered in a multiregional United States Kidney Paired Donation program - a retrospective study.
This retrospective study examined 6-year clinical outcomes for patients registered in a multiregional US Kidney Paired Donation (KPF) program. A total of 1121 end-stage renal disease patients who registered with their willing/incompatible living donors for kidney exchange were followed. Out of the 1121, 65% were transplanted with 37% of them in kidney paired donations, 10% with compatible live donors, and 18% with deceased donors. The remaining patients withdrew due to illness or death, or were still waiting (20%). There were similar survival rates with the different donor methods.
AHRQ-funded; HS020610.
Citation: Stepkowski SM, Mierzejewska B, Fumo D .
The 6-year clinical outcomes for patients registered in a multiregional United States Kidney Paired Donation program - a retrospective study.
Transpl Int 2019 Aug;32(8):839-53. doi: 10.1111/tri.13423..
Keywords: Kidney Disease and Health, Mortality, Outcomes, Transplantation
Yanik MV, Seifert ME MV, Seifert ME, Locke JE
CYP3A5 genotype affects time to therapeutic tacrolimus level in pediatric kidney transplant recipients.
Optimal management of immunosuppression in kidney transplantation requires a delicate balance of efficacy and toxicity. Tacrolimus (TAC) dose requirements are significantly impacted by genetic variation in CYP3A5 polymorphisms, however the impact that genotype has on clinical outcomes in the pediatric kidney transplant population remains unclear. In this study, the investigators evaluated a retrospective cohort of 98 pediatric kidney transplant recipients. In this paper, they report on their findings.
AHRQ-funded; HS013852.
Citation: Yanik MV, Seifert ME MV, Seifert ME, Locke JE .
CYP3A5 genotype affects time to therapeutic tacrolimus level in pediatric kidney transplant recipients.
Pediatr Transplant 2019 Aug;23(5):e13494. doi: 10.1111/petr.13494..
Keywords: Children/Adolescents, Transplantation, Kidney Disease and Health, Genetics
Chang SH, Wang M, Liu X
Racial/ethnic disparities in access and outcomes of simultaneous liver-kidney transplant among liver transplant candidates with renal dysfunction in the United States.
Since the Model for End-stage Liver Disease (MELD) allocation system was implemented, the proportion of simultaneous liver-kidney transplantation (SLKT) has increased significantly. The investigators study whether racial/ethnic disparities exist in access to SLKT and post-SLKT survival. The investigators concluded that in the MELD era, racial/ethnic differences exist in access and survival of SLKT for patients with renal dysfunction at listing for LT.
AHRQ-funded; HS022330.
Citation: Chang SH, Wang M, Liu X .
Racial/ethnic disparities in access and outcomes of simultaneous liver-kidney transplant among liver transplant candidates with renal dysfunction in the United States.
Transplantation 2019 Aug;103(8):1663-74. doi: 10.1097/tp.0000000000002574..
Keywords: Access to Care, Disparities, Kidney Disease and Health, Outcomes, Policy, Transplantation
Hart A, Gustafson SK, Wey A
The association between loss of Medicare, immunosuppressive medication use, and kidney transplant outcomes.
The purpose of this study was to determine the association between the timing of Medicare loss and immunosuppressive medication fills and kidney allograft loss. Findings indicated that the medication possession ratio (MPR) was lower for recipients with early or late Medicare loss compared with no coverage loss for all immunosuppressive medication types. When recipients were matched by age, posttransplant timing of Medicare loss, and donor risk, the hazard of allograft loss was significantly higher after Medicare loss, with no difference in the hazard for on-time Medicare loss.
AHRQ-funded; HS024527.
Citation: Hart A, Gustafson SK, Wey A .
The association between loss of Medicare, immunosuppressive medication use, and kidney transplant outcomes.
Am J Transplant 2019 Jul;19(7):1964-71. doi: 10.1111/ajt.15293..
Keywords: Kidney Disease and Health, Medicare, Medication, Outcomes, Patient-Centered Outcomes Research, Transplantation
Kilambi V, Bui K, Hazen GB
Evaluation of accepting kidneys of varying quality for transplantation or expedited placement with decision trees.
This article introduces a decision-tree methodology that analyzes a patient's dilemma: to accept a kidney offer now or reject it. The methodology calculates the survival benefit of accepting a kidney given a certain quality now and the survival benefit of rejecting it. The decision-tree tool presented could aid personalized transplant decision-making in the future by providing patients with calculated, individualized survival benefits between accepting and rejecting a kidney offer.
AHRQ-funded; HS024840.
Citation: Kilambi V, Bui K, Hazen GB .
Evaluation of accepting kidneys of varying quality for transplantation or expedited placement with decision trees.
Transplantation 2019 May;103(5):980-89. doi: 10.1097/tp.0000000000002585..
Keywords: Transplantation, Kidney Disease and Health, Shared Decision Making
Warsame F, Haugen CE, Ying H
Limited health literacy and adverse outcomes among kidney transplant candidates.
More than one-third of US adults have limited health literacy, putting them at risk of adverse clinical outcomes. In this study the investigators evaluated the prevalence of limited health literacy among 1578 adult kidney transplant (KT) candidates (May 2014-November 2017) and examined its association with listing for transplant and waitlist mortality in this pilot study. The investigators concluded that limited health literacy may be a salient mechanism in access to KT; programs to aid candidates with limited health literacy may improve outcomes and reduce disparities.
AHRQ-funded; HS024600.
Citation: Warsame F, Haugen CE, Ying H .
Limited health literacy and adverse outcomes among kidney transplant candidates.
Am J Transplant 2019 Feb;19(2):457-65. doi: 10.1111/ajt.14994..
Keywords: Health Literacy, Transplantation, Adverse Events, Patient-Centered Outcomes Research, Outcomes, Surgery, Mortality, Kidney Disease and Health
Dunn T, Saeed MJ, Shpigel A
The association of preoperative cardiac stress testing with 30-day death and myocardial infarction among patients undergoing kidney transplantation.
This study examined whether the use of preoperative cardiac stress testing of patients undergoing kidney transplantation reduced 30-day- death and myocardial infarction post-transplantation. ESRD patients 40 years or older with primary Medicare insurance between 2006 and 2013 were identified using the United States Renal Data System. In a matched cohort of 17,304 patients, there was little difference in 30-day post-transplantation mortality and myocardial infarction between those receiving a stress test and those who did not.
AHRQ-funded; HS019455.
Citation: Dunn T, Saeed MJ, Shpigel A .
The association of preoperative cardiac stress testing with 30-day death and myocardial infarction among patients undergoing kidney transplantation.
PLoS One 2019 Feb;14(2):e0211161. doi: 10.1371/journal.pone.0211161..
Keywords: Transplantation, Kidney Disease and Health, Heart Disease and Health, Cardiovascular Conditions, Chronic Conditions, Risk, Surgery
Novogrodsky E, Yaghoubian A, Connor SE
The role of media in non-directed (altruistic) living kidney donation.
This study sought to characterize how non-directed living kidney donors use media and informational resources over the course of their kidney donation journey. The investigators conducted semi-structured interviews with non-directed donors (NDDs) who initiated kidney transplant chains. The investigators concluded that media and informational resources play an important role in the process of donation for NDDs, including inspiring interest in donation through personal narratives.
AHRQ-funded; HS000029.
Citation: Novogrodsky E, Yaghoubian A, Connor SE .
The role of media in non-directed (altruistic) living kidney donation.
Health Commun 2019 Feb;34(2):259-67. doi: 10.1080/10410236.2017.1405480..
Keywords: Kidney Disease and Health, Transplantation, Shared Decision Making, Communication, Education: Patient and Caregiver
Kumar K, Tonascia JM, Muzaale AD
Racial differences in completion of the living kidney donor evaluation process.
Racial disparities in living donor kidney transplantation (LDKT) persist, but the most effective target to eliminate these disparities remains unknown. The researchers investigated delays during completion of the live donor evaluation process. They concluded that delays may be a manifestation of the transplant candidate's social network and recommended targeted efforts to optimize networks for identification of donor candidates in order to address LDKT disparities.
AHRQ-funded; HS024600.
Citation: Kumar K, Tonascia JM, Muzaale AD .
Racial differences in completion of the living kidney donor evaluation process.
Clin Transplant 2018 Jul;32(7):e13291. doi: 10.1111/ctr.13291..
Keywords: Transplantation, Racial and Ethnic Minorities, Disparities, Kidney Disease and Health
Ashlagi I, Bingaman A, Burq M
Effect of match-run frequencies on the number of transplants and waiting times in kidney exchange.
Many U.S. kidney paired donation (KPD) registries have gradually shifted to high-frequency match-runs, raising the question of whether this harms the number of transplants. The authors conducted simulations and found that longer intervals between match-runs do not increase the total number of transplants, and that prioritizing highly sensitized patients is more effective than waiting longer between match-runs for transplanting these patients. Further, increasing arrival rates of new pairs improves both the fraction of transplanted pairs and waiting times.
AHRQ-funded; HS020610.
Citation: Ashlagi I, Bingaman A, Burq M .
Effect of match-run frequencies on the number of transplants and waiting times in kidney exchange.
Am J Transplant 2018 May;18(5):1177-86. doi: 10.1111/ajt.14566..
Keywords: Transplantation, Kidney Disease and Health, Health Services Research (HSR), Policy, Registries
Wey A, Salkowski N, Kremers WK
A kidney offer acceptance decision tool to inform the decision to accept an offer or wait for a better kidney.
The researchers developed a kidney offer acceptance decision tool to predict the probability of graft survival and patient survival for first-time kidney-alone candidates after an offer is accepted or declined, and they characterized the effect of restricting the donor pool with a maximum acceptable kidney donor profile index (KDPI). Donor pool restrictions were associated with worse 3-year outcomes, especially for candidates with high allocation priority.
AHRQ-funded; HS024527.
Citation: Wey A, Salkowski N, Kremers WK .
A kidney offer acceptance decision tool to inform the decision to accept an offer or wait for a better kidney.
Am J Transplant 2018 Apr;18(4):897-906. doi: 10.1111/ajt.14506.
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Keywords: Clinical Decision Support (CDS), Shared Decision Making, Kidney Disease and Health, Medical Expenditure Panel Survey (MEPS), Transplantation
Ruck JM, Holscher CM, Purnell TS
https://www.ncbi.nlm.nih.gov/pubmed/29068176
Factors associated with perceived donation-related financial burden among living kidney donors.
The perception of living kidney donation-related financial burden affects willingness to donate and the experience of donation, yet no existing tools identify donors who are at higher risk of perceived financial burden. In this study, the investigators sought to identify characteristics that predicted higher risk of perceived financial burden.
AHRQ-funded; HS024600.
Citation: Ruck JM, Holscher CM, Purnell TS .
Factors associated with perceived donation-related financial burden among living kidney donors.
Am J Transplant 2018 Mar;18(3):715-19. doi: 10.1111/ajt.14548..
Keywords: Transplantation, Healthcare Costs, Kidney Disease and Health
Bozek DN, Dunn TB, Kuhr CS
Complete chain of the first global kidney exchange transplant and 3-yr follow-up.
While the promise of Global Kidney Exchange (GKE) is significant, it has been met with ethical criticism since its inception in 2015. This paper aims to demonstrate the selection process and provide >3 yr of follow-up on the first GKE donor and recipient from the Philippines. The authors concluded that, although criticisms of GKE highlight concerns for possible exploitation of financially disadvantaged groups, their results demonstrated that these concerns did not come to fruition.
AHRQ-funded; HS020610.
Citation: Bozek DN, Dunn TB, Kuhr CS .
Complete chain of the first global kidney exchange transplant and 3-yr follow-up.
Eur Urol Focus 2018 Mar;4(2):190-97. doi: 10.1016/j.euf.2018.07.021..
Keywords: Kidney Disease and Health, Transplantation
Vranian SC, Covert KL, Mardis CR
Assessment of risk factors for increased resource utilization in kidney transplantation.
The purpose of this study was to identify risk factors for increased health care resource utilization in kidney transplant recipients, based on drug-related problems and self-administered surveys. Adult kidney transplant recipients seen in the transplant clinic were surveyed for self-reported demographics, then assessed for associations between survey results, pharmacist-derived drug-related problems, and health resource utilization over a minimum 6-month follow-up period. The authors conclude that Medicaid insurance, self-rated poor health status, and errors in the medication regimen were significant risk factors for increased health care utilization in kidney transplant recipients. Further research is warranted to validate these potential risk factors.
AHRQ-funded; HS023754.
Citation: Vranian SC, Covert KL, Mardis CR .
Assessment of risk factors for increased resource utilization in kidney transplantation.
J Surg Res 2018 Feb;222:195-202.e2. doi: 10.1016/j.jss.2017.09.037..
Keywords: Healthcare Utilization, Kidney Disease and Health, Transplantation
Purnell TS, Luo X, Cooper LA
Association of race and ethnicity with live donor kidney transplantation in the United States from 1995 to 2014.
This study estimated changes over time in racial/ethnic disparities in live donor kidney transplantation (LDKT) in the United States, accounting for differences in death and deceased donor kidney transplantation. Among adult first-time kidney transplantation candidates in the United States who were added to the deceased donor kidney transplantation waiting list between 1995 and 2014, disparities in the receipt of live donor kidney transplantation increased from 1995-1999 to 2010-2014.
AHRQ-funded; HS024600.
Citation: Purnell TS, Luo X, Cooper LA .
Association of race and ethnicity with live donor kidney transplantation in the United States from 1995 to 2014.
JAMA 2018 Jan 2;319(1):49-61. doi: 10.1001/jama.2017.19152.
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Keywords: Disparities, Kidney Disease and Health, Kidney Disease and Health, Racial and Ethnic Minorities, Transplantation
Melcher ML, Roberts JP, Leichtman AB
Utilization of deceased donor kidneys to initiate living donor chains.
The authors proposed that some deceased donor kidneys be allocated to initiate nonsimultaneous extended altruistic donor chains of living donor kidney transplants. They hypothesized that a pilot program would show a positive impact on patients of all ethnicities and blood types.
AHRQ-funded; HS020610.
Citation: Melcher ML, Roberts JP, Leichtman AB .
Utilization of deceased donor kidneys to initiate living donor chains.
Am J Transplant 2016 May;16(5):1367-70. doi: 10.1111/ajt.13740.
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Keywords: Healthcare Delivery, Kidney Disease and Health, Policy, Transplantation
Santos CA, Brennan DC, Saeed MJ
Pharmacoepidemiology of cytomegalovirus prophylaxis in a large retrospective cohort of kidney transplant recipients with Medicare Part D coverage.
The researchers sought to determine real-world use of cytomegalovirus (CMV) prophylaxis. They found that variability in usage of prophylaxis among transplant centers was greater than variability within transplant centers. They concluded that limiting unnecessary use of CMV prophylaxis may decrease healthcare costs and drug-related harms.
AHRQ-funded; HS019455.
Citation: Santos CA, Brennan DC, Saeed MJ .
Pharmacoepidemiology of cytomegalovirus prophylaxis in a large retrospective cohort of kidney transplant recipients with Medicare Part D coverage.
Clin Transplant 2016 Apr;30(4):435-44. doi: 10.1111/ctr.12706.
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Keywords: Adverse Drug Events (ADE), Kidney Disease and Health, Medication, Prevention, Transplantation
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
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