National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 25 of 40 Research Studies DisplayedChu CD, Xia F, Du Y
Estimated prevalence and testing for albuminuria in US adults at risk for chronic kidney disease.
The purpose of this cohort study was to assess the extent of albuminuria underdetection from lack of testing and examine its association with CKD treatment. Researchers examined records of adults with hypertension or diabetes, utilizing data from the 2007 to 2018 National Health and Nutrition Examination Surveys (NHANES) and the Optum deidentified electronic health record (EHR) data set of US health care organizations. The total EHR study population included 192,108 patients; 96.6% with hypertension, and 26.2% with diabetes. The study found that 17.5% of patients had albuminuria testing; of whom 34.3% had albuminuria. Among 158,479 patients who were untested, the estimated albuminuria prevalence rate was 13.4%. Thus, only 35.2% of the projected population with albuminuria had been tested. Albuminuria testing was associated with higher adjusted odds of receiving ACEi or ARB treatment, SGLT2i treatment, and having blood pressure controlled to less than 140/90 mm Hg. The researchers concluded that approximately two-thirds of patients with albuminuria were undetected due to lack of testing.
AHRQ-funded; HS026383.
Citation: Chu CD, Xia F, Du Y .
Estimated prevalence and testing for albuminuria in US adults at risk for chronic kidney disease.
JAMA Netw Open 2023 Jul; 6(7):e2326230. doi: 10.1001/jamanetworkopen.2023.26230..
Keywords: Kidney Disease and Health, Chronic Conditions, Diabetes, Blood Pressure, Evidence-Based Practice
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.
AHRQ-funded; HS026128.
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
Fissell RB, Wysocki M, Bonnet K
Patient perspectives on peritoneal dialysis (PD) and the PD catheter: strategies and solutions.
This study examined patient perspectives on strategies for living with peritoneal dialysis (PD) and strategies for living and using a PD catheter. It is hoped that these perspectives may inform efforts to reduce PD catheter complications, increase individual patient PD modality persistence, and thus increase overall home dialysis prevalence. The authors interviewed 32 adult PD patients in Nashville, Tennessee. Qualitative analyses of these interviews included: (1) isolation of themes, (2) development of a coding system and (3) creation of a conceptual framework using an inductive-deductive approach. Patients identified important challenges including drain pain, difficulty eating and sleeping, and fear of peritonitis. Their coping strategies included repositioning while draining, adjusting eating patterns, and development of PD patient and helper knowledge and confidence, especially at home after initial training. These strategies were found by a trial-and-error iterative process with input from multiple sources, which led to individualized solutions.
AHRQ-funded; HS026395.
Citation: Fissell RB, Wysocki M, Bonnet K .
Patient perspectives on peritoneal dialysis (PD) and the PD catheter: strategies and solutions.
Perit Dial Int 2023 May; 43(3):231-40. doi: 10.1177/08968608231152063..
Keywords: Kidney Disease and Health, Chronic Conditions
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.
AHRQ-funded; HS023434
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
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.
AHRQ-funded; HS026122.
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).
AHRQ-funded; HS028672.
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.
AHRQ-funded; HS026128.
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
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.
AHRQ-funded; HS026395.
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.
AHRQ-funded; HS026395.
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
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
Remigio RV, Turpin R, Raimann JG, et al.
Assessing proximate intermediates between ambient temperature, hospital admissions, and mortality in hemodialysis patients.
This study investigated whether pre-dialysis systolic blood pressure (preSBP) and interdialytic weight gain (IDWG) in individuals with end-stage kidney disease (ESKD) can independently mediate the association between ambient temperature, all-cause hospital admissions (ACHA), and all-cause mortality (ACM). The study population consisted of 1981 ESKD patients receiving hemodialysis treatments at Fresenius Medical Care facilities in Philadelphia County, PA, from 2011 to 2019. Within a time-to-event framework, the authors estimated the association between daily maximum dry-bulb temperature (TMAX) and, as separate models, ACHA and ACM during warmer calendar months. Based on Lag 2- Lag 1 temporal ordering, and a 1 °C increase in daily maximum dry-bulb temperature (TMAX), the authors found an increased hazard of ACHA by 1.4% and ACM 7.5%. Short-term lag exposures to 1 °C increase in temperature predicted mean reductions in IDWG and preSBP by 0.013-0.015% and 0.168-0.229 mmHg.
AHRQ-funded; HS027716.
Citation: Remigio RV, Turpin R, Raimann JG, et al..
Assessing proximate intermediates between ambient temperature, hospital admissions, and mortality in hemodialysis patients.
Environ Res 2022 Mar;204(Pt B):112127. doi: 10.1016/j.envres.2021.112127..
Keywords: Kidney Disease and Health, Chronic Conditions, Hospitalization
Gianaris K, Vargas GB, Johnson M
Perceived susceptibility to chronic kidney disease and hypertension self-management among Black and White live kidney donors.
This study examines the theory whether Black kidney donors are more likely than White donors to develop hypertension (HTN) and chronic kidney disease after donation. The authors ascertained electronic medical records and phone survey data from live donors enrolled in the multi-center Wellness and Health Outcomes of LivE Donors (WHOLE-Donor) Hypertension Care Study between May 2013 and April 2020. The study cohort included 318 US-based live kidney donors who developed post-donation HTN with 57.6% female, 78.9% White, 18.6% Black, and a mean age of 46.7 years. Donors with diabetes or who were older than 50 years reported being moderately or strongly concerned about kidney disease. A large majority (87%) reported taking at least one action to help control blood pressure, with no significant differences by sociodemographic factors. They found no substantial differences in perceived susceptibility to kidney disease among Black and White donors, despite published evidence that Black donors may experience greater risk of developing kidney disease than White donors.
AHRQ-funded; HS024600.
Citation: Gianaris K, Vargas GB, Johnson M .
Perceived susceptibility to chronic kidney disease and hypertension self-management among Black and White live kidney donors.
Ethn Dis 2022 Spring;32(2):101-08. doi: 10.18865/ed.32.2.101..
Keywords: Kidney Disease and Health, Chronic Conditions, Racial and Ethnic Minorities, Transplantation, Patient Self-Management, Blood Pressure
Boehmer KR, Pine KH, Whitman S
Do patients with high versus low treatment and illness burden have different needs? A mixed-methods study of patients living on dialysis.
The authors sought to understand the differences that exist between patients with end-stage kidney disease reporting high versus low treatment and illness burden. They found that patients on dialysis reporting the greatest illness and treatment burden have difficulties that their low-burden counterparts do not report, which may be amenable to intervention.
AHRQ-funded; HS026379.
Citation: Boehmer KR, Pine KH, Whitman S .
Do patients with high versus low treatment and illness burden have different needs? A mixed-methods study of patients living on dialysis.
PLoS One 2021 Dec 28;16(12):e0260914. doi: 10.1371/journal.pone.0260914..
Keywords: Dialysis, Kidney Disease and Health, Chronic Conditions
Kilgallon JL, Gannon M, Burns Z
Multicomponent intervention to improve blood pressure management in chronic kidney disease: a protocol for a pragmatic clinical trial.
This study’s objective is to develop an intervention for the primary care management of uncontrolled hypertension (HTN) in chronic kidney disease (CKD) utilizing user-centered design principles and behavioral economic principles, test the effectiveness of that intervention, and collect implementation data that will facilitate the application of the intervention in other practice settings. One hundred and eighty-four eligible clinical physicians from 15 practices of The Brigham and Women's Practice -Based Research Network are enrolled in the study. The researchers will use the Reach Effectiveness Adoption Implementation Maintenance framework to assess the intervention’s effectiveness in impacting a change in mean systolic blood pressure between baseline and 6 months.
AHRQ-funded; 233201500020I; HS026506; HS028127.
Citation: Kilgallon JL, Gannon M, Burns Z .
Multicomponent intervention to improve blood pressure management in chronic kidney disease: a protocol for a pragmatic clinical trial.
BMJ Open 2021 Dec 22;11(12):e054065. doi: 10.1136/bmjopen-2021-054065..
Keywords: Blood Pressure, Kidney Disease and Health, Chronic Conditions, Clinical Decision Support (CDS), Health Information Technology (HIT)
Nair D, Cukor D, Taylor WD
Applying a biopsychosocial framework to achieve durable behavior change in kidney disease.
This scoping review uses the biopsychological model of health to identify individual, interpersonal, and systems-level drivers of kidney disease self-management behaviors. The authors also highlight factors that may serve as novel, impactful targets of theory-based behavioral interventions to understand and sustain behavior change in kidney disease.
AHRQ-funded; HS026395.
Citation: Nair D, Cukor D, Taylor WD .
Applying a biopsychosocial framework to achieve durable behavior change in kidney disease.
Semin Nephrol 2021 Nov;41(6):487-504. doi: 10.1016/j.semnephrol.2021.10.002..
Keywords: Kidney Disease and Health, Chronic Conditions, Patient Self-Management
Montgomery JR, Waits SA, Dimick JB
Perioperative risks of sleeve gastrectomy versus roux-en-Y gastric bypass among patients with chronic kidney disease: a review of the MBSAQIP database.
The purpose of this study was to determine whether patients with chronic kidney disease experienced higher rates of perioperative complications after roux-en-Y gastric bypass (RYGB) compared to sleeve gastrectomy. The investigators concluded that among well-matched cohorts of RYGB and sleeve gastrectomy patients, incidence of primary outcomes were similar. Among secondary outcomes, only acute kidney injury was statistically-significantly higher among RYGB patients; however, the E-value for this difference was small and relatively weak confounder(s) could abrogate the statistical difference.
AHRQ-funded; HS025778.
Citation: Montgomery JR, Waits SA, Dimick JB .
Perioperative risks of sleeve gastrectomy versus roux-en-Y gastric bypass among patients with chronic kidney disease: a review of the MBSAQIP database.
Ann Surg 2021 Oct 1;274(4):e328-e35. doi: 10.1097/sla.0000000000003627..
Keywords: Surgery, Obesity, Kidney Disease and Health, Risk, Chronic Conditions
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
Gregg LP, Hedayati SS, Yang H
Association of blood pressure variability and diuretics with cardiovascular events in patients with chronic kidney disease stages 1-5.
This study looked at whether blood pressure variability (BPV) is associated with cardiovascular outcomes and end-stage kidney disease (ESKD) in patients with chronic kidney disease. The authors studied US veterans with nondialysis chronic kidney disease stages 1-5 and hypertension on nondiuretic antihypertensive monotherapy. This case-control study compared veterans on only one antihypertensive prescription with those who were prescribed a second antihypertensive prescription. Each group had 31,394 participants. BPV was associated with composite cardiovascular events. It was associated with cardiovascular events and death but not ESKD in patients with chronic kidney disease.
AHRQ-funded; HS022418.
Citation: Gregg LP, Hedayati SS, Yang H .
Association of blood pressure variability and diuretics with cardiovascular events in patients with chronic kidney disease stages 1-5.
Hypertension 2021 Mar 3;77(3):948-59. doi: 10.1161/hypertensionaha.120.16117..
Keywords: Kidney Disease and Health, Blood Pressure, Cardiovascular Conditions, Chronic Conditions
Nair D, Malhotra S, Lupu D
Challenges in communication, prognostication and dialysis decision-making in the COVID-19 pandemic: implications for interdisciplinary care during crisis settings.
This paper uses case vignettes to highlight challenges in communication, prognostication, and medical decision-making that have been exacerbated by the COVD-19 pandemic for patients with kidney disease. The authors include best practice recommendations to mitigate those issues and conclude with implications for interdisciplinary models of care in crisis settings. Concerns about certain biomarkers, demographics, and medical comorbidities that can predict an increased risk for mortality among patients with COVID-19 and kidney disease are discussed, because there may be communication barriers related to physical exposure and conservation of personal protective equipment with those at-risk patients.
AHRQ-funded; HS026395.
Citation: Nair D, Malhotra S, Lupu D .
Challenges in communication, prognostication and dialysis decision-making in the COVID-19 pandemic: implications for interdisciplinary care during crisis settings.
Curr Opin Nephrol Hypertens 2021 Mar 1;30(2):190-97. doi: 10.1097/mnh.0000000000000689..
Keywords: COVID-19, Dialysis, Kidney Disease and Health, Decision Making, Clinician-Patient Communication, Communication, Chronic Conditions
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
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
Hirayama A, Goto T, Hasegawa K
Association of acute kidney injury with readmissions after hospitalization for acute exacerbation of chronic obstructive pulmonary disease: a population-based study.
This study examined the association between acute kidney injury (AKI) and readmission with hospitalization for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Retrospective, population-based cohort data was used from the HCUP State Inpatient Databases from seven states (Arkansas, California, Florida, Iowa, Nebraska, New York, and Utah) from 2010 through 2013. A total of 356,990 patients were identified as hospitalized for AECOPD. Median age was 71 years and 41.9% were male. Of those 7% had a concurrent diagnosis of AKI. Patients with AKI were found to have a significantly higher risk of 30-day all-cause readmission compared to those without AKI as well as a significantly higher risk of 90-day all-cause readmission, particularly for non-respiratory reasons. These reasons included sepsis, acute renal failure, and congestive heart failure.
AHRQ-funded; HS023305.
Citation: Hirayama A, Goto T, Hasegawa K .
Association of acute kidney injury with readmissions after hospitalization for acute exacerbation of chronic obstructive pulmonary disease: a population-based study.
BMC Nephrol 2020 Apr 3;21(1):116. doi: 10.1186/s12882-020-01780-2..
Keywords: Healthcare Cost and Utilization Project (HCUP), Respiratory Conditions, Chronic Conditions, Hospital Readmissions, Hospitalization, Kidney Disease and Health
Kurani S, Jeffery MM, Thorsteinsdottir B
Use of potentially nephrotoxic medications by U.S. adults with chronic kidney disease: NHANES, 2011-2016.
This study looked at the prevalence of potentially inappropriate medication (PIM) use by US adults by chronic kidney disease (CKD) stage and self-reported CKD awareness. A cross-sectional analysis of National Health and Nutrition Examination Surveys, 2011-2016 was conducted using a cohort of non-pregnant CKD adults with stages 3a, 3b, or 4-5 CKD. Analyses were adjusted for sex, age, race/ethnicity, education, comorbidities, and insurance type. More than 50% of US adults were taking PIM(s) for all CKD stages and awareness categories, but rates were highest among CKD-unaware patients with stages 4-5 CKD. Proton pump inhibitors, opioids, metformin, sulfonylureas, and NSAIDS were used frequently in all CKD stages. NSAIDS were used less frequently when the patient was CKD-aware.
AHRQ-funded; HS025164; HS025402; HS025517.
Citation: Kurani S, Jeffery MM, Thorsteinsdottir B .
Use of potentially nephrotoxic medications by U.S. adults with chronic kidney disease: NHANES, 2011-2016.
J Gen Intern Med 2020 Apr;35(4):1092-101. doi: 10.1007/s11606-019-05557-8..
Keywords: Medication: Safety, Medication, Adverse Drug Events (ADE), Adverse Events, Kidney Disease and Health, Chronic Conditions, Patient Safety
Pokorney SD, Black-Maier E, Hellkamp AS
Oral anticoagulation and cardiovascular outcomes in patients with atrial fibrillation and end-stage renal disease.
The objective of this study was to describe patterns of oral anticoagulant (OAC) use in end-stage renal disease (ESRD) patients with atrial fibrillation (AF) and their associations with cardiovascular outcomes. Medicare fee-for-service 5% claims data from 2007 to 2013 was analyzed in a cohort of patients with ESRD and AF. A cohort of 8,410 patients with AF and ESRD was identified, with a total of 3,043 (36.2%) patients treated with OAC during the study period. Treatment with OAC was not associated with hospitalization for stroke, or death but was associated with increased hospitalization for bleeding and intracranial hemorrhage.
AHRQ-funded; HS021092.
Citation: Pokorney SD, Black-Maier E, Hellkamp AS .
Oral anticoagulation and cardiovascular outcomes in patients with atrial fibrillation and end-stage renal disease.
J Am Coll Cardiol 2020 Mar 24;75(11):1299-308. doi: 10.1016/j.jacc.2020.01.019..
Keywords: Blood Thinners, Medication, Heart Disease and Health, Cardiovascular Conditions, Kidney Disease and Health, Chronic Conditions, Outcomes
Montgomery 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