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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 25 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
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
Bae S, Johnson M, Massie AB
Mortality and access to kidney transplantation in patients with sickle cell disease-associated kidney failure.
Patients with sickle cell disease-associated kidney failure have high mortality, which might be lowered by kidney transplantation. However, because they show higher post-transplant mortality compared with patients with other kidney failure etiologies, kidney transplantation remains controversial in this population. In this study, the investigators aimed to quantify the decrease in mortality associated with transplantation in this population and determine the chance of receiving transplantation with sickle cell disease as the cause of kidney failure as compared with other etiologies of kidney failure.
AHRQ-funded; HS024600.
Citation: Bae S, Johnson M, Massie AB .
Mortality and access to kidney transplantation in patients with sickle cell disease-associated kidney failure.
Clin J Am Soc Nephrol 2021 Mar 8;16(3):407-14. doi: 10.2215/cjn.02720320..
Keywords: Transplantation, Access to Care, Kidney Disease and Health, Mortality
Davies SJ, Zhao Morgenstern, H Davies SJ, Zhao J, Morgenstern H
Low serum potassium levels and clinical outcomes in peritoneal dialysis-international results from PDOPPS.
Characteristics/treatments associated with hypokalemia included protein-energy wasting indicators, lower urine volume, lower blood pressure, higher dialysis dose, greater diuretic use and not being prescribed a renin-angiotensin system inhibitor. Persistent hypokalemia was associated with 80% higher subsequent peritonitis rates and 40% higher mortality.
AHRQ-funded; HS025756.
Citation: Davies SJ, Zhao Morgenstern, H Davies SJ, Zhao J, Morgenstern H .
Low serum potassium levels and clinical outcomes in peritoneal dialysis-international results from PDOPPS.
Kidney Int Rep 2021 Feb;6(2):313-24. doi: 10.1016/j.ekir.2020.11.021..
Keywords: Dialysis, Kidney Disease and Health, Mortality, Outcomes
Li K, Ferguson T, Embil J
Risk of kidney failure, death, and cardiovascular events after lower limb complications in patients with CKD.
Investigators sought to determine how interim lower limb complications modify the subsequent risk of progression to kidney failure, all-cause mortality before kidney failure, and cardiovascular events in a cohort of patients with chronic kidney disease (CKD) stages G3 to G5. Patient-level data obtained from several administrative databases from Manitoba, Canada, were analyzed. They found that interim lower limb complications were associated with an increased risk of kidney failure, all-cause mortality before kidney failure, and cardiovascular-related hospitalization. They stated that clinical trials of screening and treatment strategies for patients with CKD at risk for lower limb complications may help determine optimal strategies to manage this risk.
AHRQ-funded; HS018574.
Citation: Li K, Ferguson T, Embil J .
Risk of kidney failure, death, and cardiovascular events after lower limb complications in patients with CKD.
Kidney Int Rep 2021 Feb;6(2):381-88. doi: 10.1016/j.ekir.2020.11.010..
Keywords: Kidney Disease and Health, Cardiovascular Conditions, Chronic Conditions, Risk, Adverse Events, Mortality, Outcomes
Thorsteinsdottir B, Hickson LJ, Giblon R
Validation of prognostic indices for short term mortality in an incident dialysis population of older adults >75.
Prognosis provides critical knowledge for shared decision making between patients and clinicians. While several prognostic indices for mortality in dialysis patients have been developed, their performance among elderly patients initiating dialysis is unknown, despite great need for reliable prognostication in that context. The purpose of this study was to assess the performance of 6 previously validated prognostic indices to predict 3 and/or 6 months mortality in a cohort of elderly incident dialysis patients.
AHRQ-funded; HS025517; HS025164; HS025402.
Citation: Thorsteinsdottir B, Hickson LJ, Giblon R .
Validation of prognostic indices for short term mortality in an incident dialysis population of older adults >75.
PLoS One 2021 Jan 20;16(1):e0244081. doi: 10.1371/journal.pone.0244081..
Keywords: Elderly, Dialysis, Kidney Disease and Health, Mortality, Shared Decision Making
Ke C, Kim SJ, Shah BR
AHRQ Author: Bierman AS
Impact of socioeconomic status on incidence of end-stage renal disease and mortality after dialysis in adults with diabetes.
The purpose of this study was to determine whether low socioeconomic status (SES), with or without universal drug coverage, predicts end-stage renal disease (ESRD) and survival after dialysis in patients with diabetes. Results showed that low SES was inversely associated with ESRD outcomes in individuals with diabetes, and this disparity was reduced in those age 65 and older who universally received prescription drug coverage. Low SES was associated with a higher mortality after dialysis, largely explained by lower kidney transplantation rates in poorer populations.
AHRQ-authored.
Citation: Ke C, Kim SJ, Shah BR .
Impact of socioeconomic status on incidence of end-stage renal disease and mortality after dialysis in adults with diabetes.
Can J Diabetes 2019 Oct;43(7):483-89.e4. doi: 10.1016/j.jcjd.2019.04.006..
Keywords: Diabetes, Kidney Disease and Health, Mortality, Social Determinants of Health
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
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
Nguyen OK, Vazquez MA, Charles MA
Association of scheduled vs emergency-only dialysis with health outcomes and costs in undocumented immigrants with end-stage renal disease.
This paper discusses costs and mortality associated with undocumented immigrants with end-stage renal disease (ESRD). If the patient has insurance, the costs and mortality rates are much lower than those who receive emergency-only dialysis.
AHRQ-funded; HS022418.
Citation: Nguyen OK, Vazquez MA, Charles MA .
Association of scheduled vs emergency-only dialysis with health outcomes and costs in undocumented immigrants with end-stage renal disease.
JAMA Intern Med 2019 Feb;179(2):175-83. doi: 10.1001/jamainternmed.2018.5866..
Keywords: Dialysis, Kidney Disease and Health, Healthcare Costs, Mortality, Patient-Centered Outcomes Research
Yuo TH, Wallace JR, Fish L
Editor's choice - comparison of outcomes after open surgical and endovascular lower extremity revascularisation among end stage renal disease patients on dialysis.
This study compared outcomes of different revascularization surgeries among end stage renal disease (ESRD) patients with peripheral arterial disease (PAD). There is a high risk of complications for this surgery. Outcomes of endovascular revascularization (ER) and open surgical revascularisation (OSR) were compared. Outcomes measured included mortality and major amputation. There is a lower mortality risk for ER versus OSR. OSR has better 30-day limb salvage although there are similar long-term outcomes.
AHRQ-funded; HS019486.
Citation: Yuo TH, Wallace JR, Fish L .
Editor's choice - comparison of outcomes after open surgical and endovascular lower extremity revascularisation among end stage renal disease patients on dialysis.
Eur J Vasc Endovasc Surg 2019 Feb;57(2):248-57. doi: 10.1016/j.ejvs.2018.09.008..
Keywords: Adverse Events, Cardiovascular Conditions, Comparative Effectiveness, Dialysis, Evidence-Based Practice, Kidney Disease and Health, Mortality, Outcomes, Patient-Centered Outcomes Research, Risk, Surgery
Charytan DM, Skali H, Shah NR
Coronary flow reserve is predictive of the risk of cardiovascular death regardless of chronic kidney disease stage.
Microvascular rarefaction is found in experimental uremia, but data from patients with chronic kidney disease (CKD) are limited. The investigators, therefore, quantified absolute myocardial blood flow and coronary flow reserve (the ratio of peak to resting flow) from myocardial perfusion positron emission tomography scans at a single institution and classified individuals into standard CKD categories based on the estimated glomerular filtration rate.
AHRQ-funded; HS022998.
Citation: Charytan DM, Skali H, Shah NR .
Coronary flow reserve is predictive of the risk of cardiovascular death regardless of chronic kidney disease stage.
Kidney Int 2018 Feb;93(2):501-09. doi: 10.1016/j.kint.2017.07.025..
Keywords: Cardiovascular Conditions, Kidney Disease and Health, Mortality
Platinga LC, King L, Patzer RE
Early hospital readmission among hemodialysis patients in the United States is associated with subsequent mortality.
The researchers examined the timing of readmissions of hemodialysis patients in the United States and its association with mortality among 285,795 prevalent adult Medicare-primary hemodialysis patients from a national registry. They concluded that regardless of timing, patients with readmissions had a higher risk of death within one year, compared to those with no readmissions.
AHRQ-funded; HS025018.
Citation: Platinga LC, King L, Patzer RE .
Early hospital readmission among hemodialysis patients in the United States is associated with subsequent mortality.
Kidney Int 2017 Oct;92(4):934-41. doi: 10.1016/j.kint.2017.03.025.
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Keywords: Kidney Disease and Health, Hospital Readmissions, Mortality
McMahon BJ, Bruden D, Townsend-Bulson L
Infection with hepatitis C virus genotype 3 is an independent risk factor for end-stage liver disease, hepatocellular carcinoma, and liver-related death.
The researchers examined the association of 11 risk factors with adverse outcomes in a population-based prospective cohort observational study of Alaska Native/American Indian persons with chronic infection. They found those infected with HCV genotype 3 to be at high risk for end-stage liver disease, hepatocellular carcinoma, and liver-related death.
AHRQ-funded; HS000046.
Citation: McMahon BJ, Bruden D, Townsend-Bulson L .
Infection with hepatitis C virus genotype 3 is an independent risk factor for end-stage liver disease, hepatocellular carcinoma, and liver-related death.
Clin Gastroenterol Hepatol 2017 Mar;15(3):431-37.e2. doi: 10.1016/j.cgh.2016.10.012.
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Keywords: Hepatitis, Cancer, Kidney Disease and Health, Risk, Mortality
Brown JR, Rezaee ME, Hisey WM
Reduced mortality associated with acute kidney injury requiring dialysis in the United States.
The researchers describe the epidemiology of dialysis-requiring acute kidney injury (AKI-D) as well as associated in-hospital mortality in the US. They found that the incidence rate of AKI-D has increased considerably in the US since 2001. However, in-hospital mortality associated with AKI-D hospital admissions has decreased significantly. AHRQ-funded; HS018443.
AHRQ-funded; HS018443.
Citation: Brown JR, Rezaee ME, Hisey WM .
Reduced mortality associated with acute kidney injury requiring dialysis in the United States.
Am J Nephrol 2016;43(4):261-70. doi: 10.1159/000445846.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Adverse Events, Mortality, Patient Safety, Kidney Disease and Health
Lee T, Thamer M, Zhang Y
Association of peritonitis with hemodialysis catheter dependence after modality switch.
This study characterized vascular access use after switch to hemodialysis and its effect on patient mortality. The researchers found that patients using a permanent vascular access 180 days after switching from peritoneal dialysis to hemodialysis had better adjusted survival during the ensuing year than those using a catheter. They concluded that among patients who switch, prior peritonitis is associated with a higher rate of persistent hemodialysis catheter use, which, in turn, is associated with lower patient survival.
AHRQ-funded; HS022931; HS021229.
Citation: Lee T, Thamer M, Zhang Y .
Association of peritonitis with hemodialysis catheter dependence after modality switch.
Clin J Am Soc Nephrol 2016 Nov 7;11(11):1999-2004. doi: 10.2215/cjn.04970516.
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Keywords: Dialysis, Kidney Disease and Health, Evidence-Based Practice, Mortality, Patient-Centered Healthcare
Lee T, Thamer M, Zhang Q
Reduced cardiovascular mortality associated with early vascular access placement in elderly patients with chronic kidney disease.
This study assessed whether there has been a decrease in cardiovascular comorbidity in elderly chronic kidney disease (CKD) patients undergoing predialysis access surgery, and whether this impacted clinical outcomes after access creation and cardiovascular events after hemodialysis initiation. It concluded that a progressive decrease in cardiovascular comorbidities in elderly CKD patients undergoing predialysis vascular access surgery was associated with a decrease in death before hemodialysis and cardiovascular events after starting hemodialysis.
AHRQ-funded; HS022931.
Citation: Lee T, Thamer M, Zhang Q .
Reduced cardiovascular mortality associated with early vascular access placement in elderly patients with chronic kidney disease.
Am J Nephrol 2016;43(5):334-40. doi: 10.1159/000446159.
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Keywords: Cardiovascular Conditions, Elderly, Kidney Disease and Health, Kidney Disease and Health, Mortality
Brown JR, Rezaee ME, Nichols EL
Incidence and in-hospital mortality of acute kidney injury (AKI) and dialysis-requiring AKI (AKI-D) after cardiac catheterization in the National Inpatient Sample.
This study examined cardiac catheterization or percutaneous coronary intervention (PCI) hospital discharges from the nationally representative National Inpatient Sample to determine annual population incidence rates for AKI and AKI-D in the United States from 2001 to 2011. It found that the incidence of AKI among cardiac catheterization and PCI patients has increased sharply in the United States; however, mortality has significantly declined.
AHRQ-funded; HS018443.
Citation: Brown JR, Rezaee ME, Nichols EL .
Incidence and in-hospital mortality of acute kidney injury (AKI) and dialysis-requiring AKI (AKI-D) after cardiac catheterization in the National Inpatient Sample.
J Am Heart Assoc 2016 Mar 15;5(3):e002739. doi: 10.1161/jaha.115.002739.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Adverse Events, Mortality, Patient Safety, Surgery, Heart Disease and Health, Cardiovascular Conditions, Kidney Disease and Health, Dialysis, Hospitals
Warnock DG, Powell TC, Donnelly JP
Categories of hospital-associated acute kidney injury: time course of changes in serum creatinine values.
The objective of this study was to categorize hospital-associated acute kidney injury (HA-AKI) based on the timing of minimum and peak inpatient serum creatinine (sCr) and describe the association with inpatient mortality. It concluded that risk of short-term inpatient mortality is associated with AKI, and this risk is attenuated with recovery of kidney function in the hospital.
AHRQ-funded; HS013852.
Citation: Warnock DG, Powell TC, Donnelly JP .
Categories of hospital-associated acute kidney injury: time course of changes in serum creatinine values.
Nephron 2015;131(4):227-36. doi: 10.1159/000441956.
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Keywords: Kidney Disease and Health, Adverse Events, Hospitalization, Mortality
Scialla JJ, Parekh RS, Eustace JA
Race, mineral homeostasis and mortality in patients with end-stage renal disease on dialysis.
In this study, the researchers determined the race-specific relationship between mineral parameters and mortality in patients initiating hemodialysis. They concluded that aberrant phosphorus homeostasis, reflected by higher phosphorus and FGF23, may be a risk factor for mortality in patients initiating hemodialysis, particularly among African Americans.
AHRQ-funded; HS08365.
Citation: Scialla JJ, Parekh RS, Eustace JA .
Race, mineral homeostasis and mortality in patients with end-stage renal disease on dialysis.
Am J Nephrol 2015;42(1):25-34. doi: 10.1159/000438999.
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Keywords: Kidney Disease and Health, Racial and Ethnic Minorities, Mortality, Kidney Disease and Health
Weiss JW, Peters D, Yang X
Systolic BP and mortality in older adults with CKD.
This study sought to determine whether a nonlinear relationship between BP and mortality - as described for the broader chronic kidney disease (CKD) population and for older adults in the general population - is present for older adults with CKD. It found that in a cohort of older adults, a relationship between higher SBP and mortality was present only for younger members of this cohort and not for those older than 70.
AHRQ-funded; HS019456.
Citation: Weiss JW, Peters D, Yang X .
Systolic BP and mortality in older adults with CKD.
Clin J Am Soc Nephrol 2015 Sep 4;10(9):1553-9. doi: 10.2215/cjn.11391114.
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Keywords: Blood Pressure, Mortality, Elderly, Kidney Disease and Health
Shafi T, Meyer TW, Hostetter TH
Free levels of selected organic solutes and cardiovascular morbidity and mortality in hemodialysis patients: results from the Retained Organic Solutes and Clinical Outcomes (ROSCO) investigators.
This study examined the association of baseline free levels of four organic solutes that are secreted in the native kidney —p-cresol sulfate, indoxyl sulfate, hippurate and phenylacetylglutamine—with outcomes in hemodialysis patients. It found that free levels of uremic solutes that are secreted by the native kidney are associated with a higher risk of cardiovascular morbidity and mortality in incident hemodialysis patients.
AHRQ-funded; HS008365.
Citation: Shafi T, Meyer TW, Hostetter TH .
Free levels of selected organic solutes and cardiovascular morbidity and mortality in hemodialysis patients: results from the Retained Organic Solutes and Clinical Outcomes (ROSCO) investigators.
PLoS One 2015 May 4;10(5):e0126048. doi: 10.1371/journal.pone.0126048..
Keywords: Cardiovascular Conditions, Kidney Disease and Health, Mortality
Muntner P, Gutierrez OM, Zhao H
Validation study of medicare claims to identify older US adults with CKD using the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.
The researchers compared characteristics and outcomes for individuals with chronic kidney disease (CKD) defined using laboratory measurements versus claims data from 6,982 study participants who had Medicare fee-for-service coverage. They found that CKD, whether identified using a claims-based algorithm or through estimated glomerular filtration rate or albumin-creatinine ratio measurements, is associated with increased risk for all-cause mortality and end-stage renal disease (ESRD).
AHRQ-funded; HS018517.
Citation: Muntner P, Gutierrez OM, Zhao H .
Validation study of medicare claims to identify older US adults with CKD using the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.
Am J Kidney Dis 2015 Feb;65(2):249-58. doi: 10.1053/j.ajkd.2014.07.012.
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Am J Kidney Dis 2015 Feb;65(2):249-58. doi: 10.1053/j.ajkd.2014.07.012.
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Keywords: Kidney Disease and Health, Outcomes, Comparative Effectiveness, Kidney Disease and Health, Mortality
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
Scialla JJ, Kao WH, Crainceanu C
Biomarkers of vascular calcification and mortality in patients with ESRD.
This study evaluated the association between selected calcification biomarkers and long-term mortality in a large prospective cohort of dialysis patients. It found that factors such as osteoprotegerin and fetuin-A may be risk factors for all-cause and cardiovascular mortality in patients undergoing dialysis, but they do not improve risk prediction.
AHRQ-funded; HS008365
Citation: Scialla JJ, Kao WH, Crainceanu C .
Biomarkers of vascular calcification and mortality in patients with ESRD.
Clin J Am Soc Nephrol. 2014 Apr;9(4):745-55. doi: 10.2215/CJN.05450513..
Keywords: Kidney Disease and Health, Mortality, Chronic Conditions