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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 18 of 18 Research Studies DisplayedKim 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
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
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
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
Alvarado F, Cervantes CE, Crews DC
Examining post-donation outcomes in Hispanic/Latinx living kidney donors in the United States: a systematic review.
The purpose of this systematic qualitative review was to evaluate outcomes in Hispanic donors and examine how Hispanic ethnicity was presented. In October 2021, the researchers reviewed PubMed, EMBASE, and Scopus for studies, with 18 meeting the inclusion criteria. Across the studies, Hispanic donors ranged between 6% and 21% of the donor populations. The study found that Hispanic donors were not at increased risk for end-stage kidney disease, cardiovascular disease, non-pregnancy-related hospitalizations, overall perioperative surgical complications or post-donation mortality compared to non-Hispanic White donors. Also compared to non-Hispanic White donors, most studies showed Hispanic donors were at higher risk for diabetes mellitus following nephrectomy; however, mixed findings were observed regarding the risk for post-donation chronic kidney disease and hypertension. The researchers concluded that future studies should explain variation in health outcomes by considering and assessing differences within the Hispanic donor population.
AHRQ-funded; HS024600.
Citation: Alvarado F, Cervantes CE, Crews DC .
Examining post-donation outcomes in Hispanic/Latinx living kidney donors in the United States: a systematic review.
Am J Transplant 2022 Jul;22(7):1737-53. doi: 10.1111/ajt.17017..
Keywords: Transplantation, Kidney Disease and Health, Chronic Conditions, Racial and Ethnic Minorities, Disparities
Krissberg JR, Kaufmann MB, Gupta A
Racial disparities in pediatric kidney transplantation under the new Kidney Allocation System in the United States.
This study aimed to assess how implementation of the 2014 Kidney Allocation System (KAS) affected racial and ethnic disparities in pediatric kidney transplantation access and related outcomes. The authors performed a retrospective cohort study of children <18 years of age active on the kidney transplant list from 2008 to 2019 using the Scientific Registry of Transplant Recipients. Results found that all children experienced longer wait times from activation to transplantation post-KAS. Although they found that Black and Hispanic children and other children of color experienced longer times from activation to transplant compared with White children in both eras; this finding was largely attenuated after multivariable analysis. Multivariable analysis also showed that racial and ethnic disparities in time from dialysis initiation to transplantation in the pre-KAS era were lessened in the post-KAS era. No disparities were found in odds of delayed graft function, however Black and Hispanic children experienced longer times with a functioning graft in the post-KAS era.
AHRQ-funded; HS026128.
Citation: Krissberg JR, Kaufmann MB, Gupta A .
Racial disparities in pediatric kidney transplantation under the new Kidney Allocation System in the United States.
Clin J Am Soc Nephrol 2021 Dec; 16(12):1862-71. doi: 10.2215/cjn.06740521..
Keywords: Disparities, Racial and Ethnic Minorities, Kidney Disease and Health, Transplantation
Nguyen KH, Thorsness R, Hayes S
Evaluation of racial, ethnic, and socioeconomic disparities in initiation of kidney failure treatment during the first 4 months of the COVID-19 pandemic.
This study examined the impact of COVID-19 on initiation of kidney failure treatment during the first 4 months of the pandemic with a focus on racial, ethnic, and socioeconomic disparities. The study population included 127,149 patients with incident kidney failure between January 2018 and June 2020. The mean age of patients was 62.8 years, and were 41.7% female, 25.9% non-Hispanic Black and 15.6% Hispanic/Latino. There were significant decreases in the proportion of patients with incident kidney failure receiving preemptive transplantation and initiating hemodialysis treatment with an arteriovenous fistula during the first 4 months of the pandemic compared to the pre-COVID-19 period. These decreases were most significant among non-Hispanic Black patients. There were also significant decreases in patients residing in counties in the highest quintile of COVID-19 mortality rates, but not for patients residing in other counties. Treatment initiation was approximately 30% lower than projected in April 2020.
AHRQ-funded; HS028285.
Citation: Nguyen KH, Thorsness R, Hayes S .
Evaluation of racial, ethnic, and socioeconomic disparities in initiation of kidney failure treatment during the first 4 months of the COVID-19 pandemic.
JAMA Netw Open 2021 Oct;4(10):e2127369. doi: 10.1001/jamanetworkopen.2021.27369..
Keywords: COVID-19, Kidney Disease and Health, Racial and Ethnic Minorities, Disparities
Kim D, Lee Y, Thorsness R
Racial and ethnic disparities in excess deaths among persons with kidney failure during the COVID-19 pandemic, March-July 2020.
This national study estimated excess deaths for the kidney failure population by race and ethnicity from March 1 through August 1, 2020. Findings showed that, among the US kidney failure population, the number of excess deaths was 16% higher than expected, similar to reports for the general population. However, results showed that the relative increase in deaths among Black and Hispanic patients was more than 4-fold higher than that observed among White patients. The magnitude of these disparities was larger than corresponding relative ratios reported among COVID-19–associated deaths in the general population.
AHRQ-funded; HS028285.
Citation: Kim D, Lee Y, Thorsness R .
Racial and ethnic disparities in excess deaths among persons with kidney failure during the COVID-19 pandemic, March-July 2020.
Am J Kidney Dis 2021 May;77(5):827-29. doi: 10.1053/j.ajkd.2021.02.003..
Keywords: COVID-19, Racial and Ethnic Minorities, Disparities, Mortality, Kidney Disease and Health, Chronic Conditions, Social Determinants of Health
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
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
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
Lee T, Qian J, Thamer M
Gender disparities in vascular access surgical outcomes in elderly hemodialysis patients.
In this study, the investigators assessed clinically relevant arteriovenous fistulas (AVF) and arteriovenous grafts (AVG) surgical outcomes in elderly male and female patients initiating hemodialysis with a central venous catheter (CVC). The investigators concluded that while AVFs should be considered the preferred vascular access in most circumstances, clinical AVF surgical outcomes were uniformly worse in females. They suggest that clinicians should also consider AVGs as a viable alternative in elderly female patients initiating hemodialysis with a CVC to avoid extended CVC dependence.
AHRQ-funded; HS022931; HS021229.
Citation: Lee T, Qian J, Thamer M .
Gender disparities in vascular access surgical outcomes in elderly hemodialysis patients.
Am J Nephrol 2019;49(1):11-19. doi: 10.1159/000495261..
Keywords: Elderly, Sex Factors, Surgery, Kidney Disease and Health, Disparities, Outcomes, Patient-Centered Outcomes Research
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
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
Traino HM, Nonterah CW, Cyrus JW
Disparities in the completion of steps to kidney transplantation: protocol for a systematic review.
This review will catalogue disparities in the steps to transplantation as well as the barriers and facilitators to completion of each step identified in the extant literature. The results of the review will be used to generate recommendations for future research to improve equity in access to kidney transplantation.
AHRQ-funded; HS018113.
Citation: Traino HM, Nonterah CW, Cyrus JW .
Disparities in the completion of steps to kidney transplantation: protocol for a systematic review.
BMJ Open 2015 Sep 08;5(9):e008677. doi: 10.1136/bmjopen-2015-008677.
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Keywords: Disparities, Transplantation, Kidney Disease and Health, Access to Care, Guidelines
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