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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results1 to 25 of 189 Research Studies Displayed
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.
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.
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
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.
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.
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
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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
Miano TA, Hennessy S, Yang W
Association of vancomycin plus piperacillin-tazobactam with early changes in creatinine versus cystatin C in critically ill adults: a prospective cohort study.
The purpose of this study was to test the hypothesis that the association between vancomycin + piperacillin-tazobactam and increased acute kidney injury (AKI) risk by contrasting changes in creatinine concentration after antibiotic initiation with changes in cystatin C concentration. The researchers included patients enrolled in the Molecular Epidemiology of SepsiS in the ICU (MESSI) prospective cohort who were treated for greater than or equal to 48 h with vancomycin + piperacillin-tazobactam or vancomycin + cefepime. The kidney function biomarkers of blood urea nitrogen (BUN), creatinine, and cystatin C were measured before antibiotic treatment and again on day two after initiation. Creatinine-defined AKI and dialysis were evaluated through day14, and mortality was assessed through day 30. The study found that in the 739 patients vancomycin + piperacillin-tazobactam was associated with a higher percentage increase of creatinine at day-two and a higher incidence of creatinine-defined AKI: rate ratio. Vancomycin + piperacillin-tazobactam was not associated with change in alternative biomarkers. The researchers concluded that the study supports the hypothesis that vancomycin + piperacillin-tazobactam effects on creatinine represent pseudotoxicity.
Citation: Miano TA, Hennessy S, Yang W . Association of vancomycin plus piperacillin-tazobactam with early changes in creatinine versus cystatin C in critically ill adults: a prospective cohort study. Intensive Care Med 2022 Sep;48(9):1144-55. doi: 10.1007/s00134-022-06811-0..
Keywords: Critical Care, Medication, Kidney Disease and Health, Adverse Drug Events (ADE), Adverse Events
Roddy MK, Mayberry LS, Nair D
Exploring mHealth potential to improve kidney function: secondary analysis of a randomized trial of diabetes self-care in diverse adults.
This study examined whether REACH, a text message-delivered self-management support intervention, which focuses on medication adherence, diet, and exercise can significantly improve glycemic control in 506 chronic kidney disease (CKD) patients with Type 2 Diabetes (T2D). The authors used data from the trial to explore the intervention’s effect on change in estimated glomerular filtration rate (eGR) at 12 months in a subsample of 271 patients. Patients with proteinuria at baseline who received REACH had less worsening of eGFR.
Citation: Roddy MK, Mayberry LS, Nair D . Exploring mHealth potential to improve kidney function: secondary analysis of a randomized trial of diabetes self-care in diverse adults. BMC Nephrol 2022 Aug 10;23(1):280. doi: 10.1186/s12882-022-02885-6..
Keywords: Telehealth, Health Information Technology (HIT), Patient Self-Management, Diabetes, Chronic Conditions, Kidney Disease and Health, Patient Adherence/Compliance
Nair D, Hall RK
Clin-Star corner: what is new at the interface of geriatrics and nephrology?
In this article, the authors highlight key findings of three recent original investigations in nephrology and describe each study, the relevance to the care of older adults, and current areas of uncertainty that warrant further investigation. The three articles relate to removal of the race adjustment in the estimation of kidney function, the use of novel therapeutics to halt chronic kidney disease progression and improve cardiovascular outcomes, and medication management for short-term pain control in chronic kidney disease.
Citation: Nair D, Hall RK . Clin-Star corner: what is new at the interface of geriatrics and nephrology? J Am Geriatr Soc 2022 Aug;70(8):2219-24. doi: 10.1111/jgs.17942..
Keywords: Elderly, Kidney Disease and Health, Chronic Conditions
Wang HS, Panagides J, Cahill D
Dietary risk factors for pediatric kidney stones: a case-control study.
This study’s objective was to perform a case-control study of the association of dietary nutrients with pediatric urolithiasis. Researchers obtained dietary information from pediatric urolithiasis patients and healthy controls; survey results were converted to standard nutrient intakes. Findings showed that higher dietary intake of calcium, sodium, and beta carotene, and lower potassium intake were associated with pediatric urolithiasis.
Citation: Wang HS, Panagides J, Cahill D . Dietary risk factors for pediatric kidney stones: a case-control study. J Urol 2022 Aug;208(2):434-40. doi: 10.1097/ju.0000000000002687..
Keywords: Children/Adolescents, Nutrition, Kidney Disease and Health, Risk
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.
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
May HP, Krauter AK, Finnie DM
Optimising transitions of care for acute kidney injury survivors: protocol for a mixed-methods study of nephrologist and primary care provider recommendations.
Gaps in proper kidney care after acute kidney injury (AKI) in hospital patients can contribute to long term complications for those individuals. The purpose of this study is to provide an in-depth assessment of nephrologists’ and primary care providers’ approaches to follow-up care after in-hospital acute kidney injury (AKI). The researchers will utilize a mixed-methods study to assess provider recommendations and decision-making for post-AKI care.
Citation: May HP, Krauter AK, Finnie DM . Optimising transitions of care for acute kidney injury survivors: protocol for a mixed-methods study of nephrologist and primary care provider recommendations. BMJ Open 2022 Jun 22;12(6):e058613. doi: 10.1136/bmjopen-2021-058613..
Keywords: Kidney Disease and Health, Transitions of Care
Campbell JI, Dubois MM, Savage TJ
Comorbidities associated with hospitalization and progression among adolescents with symptomatic coronavirus disease 2019.
This study’s objective was to identify subgroups likely to benefit from monoclonal antibody and antiviral therapy to treat COVID-19 by evaluating the relationship between comorbidities and hospitalization among US adolescents aged 12-17 with symptomatic coronavirus disease 2019 (COVID-19). The authors used the Pediatric COVID-19 US registry to identify patients who met their inclusion criteria of comorbidities including obesity, chronic kidney disease (CKD), diabetes, immunosuppressive disease or treatment, sickle cell disease (SCD), heart disease, neurologic disease/neurodevelopmental disorders, and pulmonary disease (excluding patients with mild asthma). Out of 1877 total patients included 284 (15%) were hospitalized within 28 days of their COVID-19 diagnosis. The following comorbidities were associated with increased odds of hospitalization: SCD, immunocompromising condition, obesity, diabetes, neurologic disease, and pulmonary disease (excluding mild asthma).
Citation: Campbell JI, Dubois MM, Savage TJ . Comorbidities associated with hospitalization and progression among adolescents with symptomatic coronavirus disease 2019. J Pediatr 2022 Jun;245:102-10.e2. doi: 10.1016/j.jpeds.2022.02.048..
Keywords: Children/Adolescents, Diabetes, Asthma, Kidney Disease and Health, Hospitalization
Cheetham MS, Zhao J, McCullough K
International peritoneal dialysis training practices and the risk of peritonitis.
In peritoneal dialysis (PD), the impact of training on patient outcomes is not well understood, with a lack of evidence to inform best practices in training. The purpose of this study was to compare international PD training practices and evaluate their association with peritonitis. In this prospective study, a cohort of 1,376 adult patients from 120 facilities across 7 counties were included, all of whom were participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) and were on PD for greater than 3 months. Training characteristics were reported at patient and facility levels and included duration, location, and modality of training, use of individual/ group training, use of written/ oral competency assessments, training of family members, and nurse affiliation. The study found that training was most typically conducted in a one-on-one setting (79%) by facility-affiliated nurses (87%) at the facility (81%). In 5 of 14 United Kingdom facilities, receiving training from both facility and external, third-party nurses was associated with a reduced risk of peritonitis. However, no other training characteristics were significantly associated with risk of peritonitis. The study concluded that in this study, there was no evidence that risk of peritonitis was associate with the assessed characteristics of PD patient training.
Citation: Cheetham MS, Zhao J, McCullough K . International peritoneal dialysis training practices and the risk of peritonitis. Nephrol Dial Transplant 2022 Apr 25;37(5):937-49. doi: 10.1093/ndt/gfab298..
Keywords: Kidney Disease and Health, Adverse Events, Training
Remigio RV., Hel. H, Raimann JG
Combined effects of air pollution and extreme heat events among ESKD patients within the Northeastern United States.
Researchers investigated the impact of air pollution exposure among end-stage kidney disease (ESKD) patients and its potential modifying effect from extreme heat events (EHE). Data on daily all-cause mortality and all-cause hospital admissions was taken from Fresenius Kidney Care records from selected northeastern US counties. Their findings suggested interdependent effects of EHE and air pollution among ESKD patients for all-cause mortality risks. They recommended national level assessments in order to consider the ESKD population as a sensitive population and to inform treatment protocols during extreme heat and degraded pollution episodes.
Citation: Remigio RV., Hel. H, Raimann JG . Combined effects of air pollution and extreme heat events among ESKD patients within the Northeastern United States. Sci Total Environ 2022 Mar 15;812:152481. doi: 10.1016/j.scitotenv.2021.152481..
Keywords: Kidney Disease and Health
Barreto EF, May HP, Schreier DJ
Development and feasibility of a multidisciplinary approach to AKI survivorship in care transitions: research letter.
The purpose of this study was to observe and describe the development and feasibility of a multidisciplinary approach to caring for acute kidney injury (AKI) survivors at care transitions (ACT). The studied population were adults with stage 3 AKI who were not discharging on dialysis and were established with a primary care provider at the authors’ academic medical center in the U.S. Preliminary data indicated that AKI survivors of interest could primarily be identified, educated, and followed up with using the multidisciplinary approach model, which also maximized the unique expertise of each team member. The authors concluded that this multidisciplinary ACT workflow supported by clinical decision support was feasible, scalable, and addressed gaps in existing care transition models.
Citation: Barreto EF, May HP, Schreier DJ . Development and feasibility of a multidisciplinary approach to AKI survivorship in care transitions: research letter. Can J Kidney Health Dis 2022 Mar 6; 9:20543581221081258. doi: 10.1177/20543581221081258..
Keywords: Kidney Disease and Health, Transplantation, Transitions of Care