Pub Date : 2024-09-12DOI: 10.1016/j.xkme.2024.100901
Avi G. Aronov , Milda R. Saunders , Jesse Y. Hsu , Daohang Sha , Martha Daviglus , Michael J. Fischer , Lawrence J. Appel , James Sondheimer , Jiang He , Hernan Rincon-Choles , Edward J. Horwitz , Tanika N. Kelly , Ana C. Ricardo , James P. Lash
<div><h3>Rationale & Objective</h3><div>In the general population, neighborhood socioeconomic status (SES) has been found to be associated with cardiovascular risk, but this relationship has not been well studied among patients with chronic kidney disease (CKD). This study seeked to evaluate the association between neighborhood SES and cardiovascular outcomes in a CKD cohort.</div></div><div><h3>Study Design</h3><div>Multicenter prospective cohort.</div></div><div><h3>Setting & Participants</h3><div>In total, 3,197 participants in the Chronic Renal Insufficiency Cohort Study without cardiovascular disease at baseline.</div></div><div><h3>Exposure</h3><div>Neighborhood SES quartiles using a validated neighborhood-level SES summary measure for 6 census-derived variables.</div></div><div><h3>Outcome</h3><div>Incident heart failure, myocardial infarction, and all-cause death.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazards.</div></div><div><h3>Results</h3><div>During median follow-up of 8.8 years, there were 465 incident heart failure events, 297 myocardial infarctions, and 891 deaths. In a fully adjusted model, among individuals with estimated glomerular filtration rate<!--> <!-->≥45<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>, lowest neighborhood SES quartile was associated with higher risk of heart failure (HR, 1.96 [95% CI, 1.04-3.67]) compared with the highest quartile. This association was not significant among those with estimated glomerular filtration rate<!--> <!--><45<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> (<em>P</em> for interaction<!--> <!--><<!--> <!-->0.1). There was no association between neighborhood SES and myocardial infarction; however, in the same multivariable-adjusted model, less than high school education was associated with higher risk of myocardial infarction (HR, 1.52 [95% CI, 1.06-2.17]). Among those aged greater than 60 years, there was a significant association between the lowest neighborhood SES quartile and death (HR, 1.72 [95% CI, 1.06-2.78]), but this association was not significant among those aged 60 years and younger (<em>P</em> for interaction<!--> <!--><<!--> <!-->0.05).</div></div><div><h3>Limitations</h3><div>Findings are subject to residual confounding and bias.</div></div><div><h3>Conclusions</h3><div>In a CKD cohort, neighborhood-level SES was associated with incident heart failure among individuals with more preserved kidney function and death in those younger than 60 years. Policies and public health and health system interventions are needed to address individual- and neighborhood-level SES factors to improve outcomes for patients with CKD residing in disadvantaged communities.</div></div><div><h3>Plain-Language Summary</h3><div>Because patients with chronic kidney disease (CKD) experience high rates of cardiovascular complications, we evaluated the relationship between neighborhood-level socioeconomic status (SES) and cardiovascular outcomes using data
{"title":"Neighborhood Socioeconomic Status and Cardiovascular Events in Adults With CKD: The CRIC Study","authors":"Avi G. Aronov , Milda R. Saunders , Jesse Y. Hsu , Daohang Sha , Martha Daviglus , Michael J. Fischer , Lawrence J. Appel , James Sondheimer , Jiang He , Hernan Rincon-Choles , Edward J. Horwitz , Tanika N. Kelly , Ana C. Ricardo , James P. Lash","doi":"10.1016/j.xkme.2024.100901","DOIUrl":"10.1016/j.xkme.2024.100901","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>In the general population, neighborhood socioeconomic status (SES) has been found to be associated with cardiovascular risk, but this relationship has not been well studied among patients with chronic kidney disease (CKD). This study seeked to evaluate the association between neighborhood SES and cardiovascular outcomes in a CKD cohort.</div></div><div><h3>Study Design</h3><div>Multicenter prospective cohort.</div></div><div><h3>Setting & Participants</h3><div>In total, 3,197 participants in the Chronic Renal Insufficiency Cohort Study without cardiovascular disease at baseline.</div></div><div><h3>Exposure</h3><div>Neighborhood SES quartiles using a validated neighborhood-level SES summary measure for 6 census-derived variables.</div></div><div><h3>Outcome</h3><div>Incident heart failure, myocardial infarction, and all-cause death.</div></div><div><h3>Analytical Approach</h3><div>Cox proportional hazards.</div></div><div><h3>Results</h3><div>During median follow-up of 8.8 years, there were 465 incident heart failure events, 297 myocardial infarctions, and 891 deaths. In a fully adjusted model, among individuals with estimated glomerular filtration rate<!--> <!-->≥45<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>, lowest neighborhood SES quartile was associated with higher risk of heart failure (HR, 1.96 [95% CI, 1.04-3.67]) compared with the highest quartile. This association was not significant among those with estimated glomerular filtration rate<!--> <!--><45<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> (<em>P</em> for interaction<!--> <!--><<!--> <!-->0.1). There was no association between neighborhood SES and myocardial infarction; however, in the same multivariable-adjusted model, less than high school education was associated with higher risk of myocardial infarction (HR, 1.52 [95% CI, 1.06-2.17]). Among those aged greater than 60 years, there was a significant association between the lowest neighborhood SES quartile and death (HR, 1.72 [95% CI, 1.06-2.78]), but this association was not significant among those aged 60 years and younger (<em>P</em> for interaction<!--> <!--><<!--> <!-->0.05).</div></div><div><h3>Limitations</h3><div>Findings are subject to residual confounding and bias.</div></div><div><h3>Conclusions</h3><div>In a CKD cohort, neighborhood-level SES was associated with incident heart failure among individuals with more preserved kidney function and death in those younger than 60 years. Policies and public health and health system interventions are needed to address individual- and neighborhood-level SES factors to improve outcomes for patients with CKD residing in disadvantaged communities.</div></div><div><h3>Plain-Language Summary</h3><div>Because patients with chronic kidney disease (CKD) experience high rates of cardiovascular complications, we evaluated the relationship between neighborhood-level socioeconomic status (SES) and cardiovascular outcomes using data ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100901"},"PeriodicalIF":3.2,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1016/j.xkme.2024.100900
Jeffrey Thompson , Jennifer Kammerer , Tasha Boshears , Juliana Oliveira , Kirsten L. Johansen , Anna Kovar , Lulu Lee , Gil Yosipovitch
<div><h3>Rationale & Objective</h3><div>Chronic kidney disease-associated pruritus (CKD-aP) is a common, underrecognized condition in patients with chronic kidney disease (CKD), especially those receiving hemodialysis (HD). The present study analyzed the clinical treatment journey and overall burden of pruritus among patients with CKD-aP.</div></div><div><h3>Study Design</h3><div>Cross-sectional, patient-reported online survey.</div></div><div><h3>Setting & Participants</h3><div>Data from adult patients undergoing HD (December 2021–May 2022) in the United States.</div></div><div><h3>Exposure</h3><div>Patients participated in an online survey and responded to questions on validated patient-reported outcome instruments related to CKD-aP.</div></div><div><h3>Outcomes</h3><div>Self-reported measures analyzed at the end of this survey include itch characteristics; symptom management; health care provider (HCP) engagement; and effect on HD, quality of life (QoL), sleep, and work productivity.</div></div><div><h3>Analytical Approach</h3><div>Bivariate analysis assessed the association of itch severity with CKD-specific QoL.</div></div><div><h3>Results</h3><div>Overall, 354 patients with CKD-aP were included in analyses, of which 49% and 30% had moderate and severe itch, respectively (22% were mild). Around 68% reported symptoms to HCPs, most commonly a nephrologist or primary care provider, and 55% received a treatment recommendation. The most common treatments were topical lotions/moisturizers (75%) and corticosteroids (48%); use of oral prescriptions was low (20%), with limited satisfaction with treatments. Overall, 23% of patients reported shortening and 17% reported missing HD sessions because of itch. In bivariate analysis, patients with more severe CKD-aP reported significantly worse disease and function scores (kidney disease score, cognitive function, quality of social interaction, sleep [all, <em>P</em> <!--><<!--> <!-->0.001], and sexual function [<em>P</em> <!--><<!--> <!-->0.05]), suggesting a direct effect of CKD-aP on QoL.</div></div><div><h3>Limitations</h3><div>Possible recall bias, especially for questions with longer recall periods.</div></div><div><h3>Conclusions</h3><div>CKD-aP is often inadequately treated and disruptive of dialysis treatment, even among patients who report itch to HCPs. Worse itch severity is associated with poorer QoL, sleep quality, and functional/work impairment.</div></div><div><h3>Plain-Language Summary</h3><div>Chronic kidney disease-associated pruritus (CKD-aP) is a common problem in patients with kidney disease, especially in those who are receiving dialysis. There are few approved treatment options for CKD-aP. Understanding how CKD-related itch affects patients may help identify ways to improve CKD-aP symptoms/signs. This patient-reported survey assessed itch characteristics, symptom management attempts and effectiveness, and burdens caused by itch in patients with CKD-aP. Although<!--> <!-->
{"title":"Chronic Kidney Disease-Associated Pruritus Burden: A Patient Survey Study","authors":"Jeffrey Thompson , Jennifer Kammerer , Tasha Boshears , Juliana Oliveira , Kirsten L. Johansen , Anna Kovar , Lulu Lee , Gil Yosipovitch","doi":"10.1016/j.xkme.2024.100900","DOIUrl":"10.1016/j.xkme.2024.100900","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Chronic kidney disease-associated pruritus (CKD-aP) is a common, underrecognized condition in patients with chronic kidney disease (CKD), especially those receiving hemodialysis (HD). The present study analyzed the clinical treatment journey and overall burden of pruritus among patients with CKD-aP.</div></div><div><h3>Study Design</h3><div>Cross-sectional, patient-reported online survey.</div></div><div><h3>Setting & Participants</h3><div>Data from adult patients undergoing HD (December 2021–May 2022) in the United States.</div></div><div><h3>Exposure</h3><div>Patients participated in an online survey and responded to questions on validated patient-reported outcome instruments related to CKD-aP.</div></div><div><h3>Outcomes</h3><div>Self-reported measures analyzed at the end of this survey include itch characteristics; symptom management; health care provider (HCP) engagement; and effect on HD, quality of life (QoL), sleep, and work productivity.</div></div><div><h3>Analytical Approach</h3><div>Bivariate analysis assessed the association of itch severity with CKD-specific QoL.</div></div><div><h3>Results</h3><div>Overall, 354 patients with CKD-aP were included in analyses, of which 49% and 30% had moderate and severe itch, respectively (22% were mild). Around 68% reported symptoms to HCPs, most commonly a nephrologist or primary care provider, and 55% received a treatment recommendation. The most common treatments were topical lotions/moisturizers (75%) and corticosteroids (48%); use of oral prescriptions was low (20%), with limited satisfaction with treatments. Overall, 23% of patients reported shortening and 17% reported missing HD sessions because of itch. In bivariate analysis, patients with more severe CKD-aP reported significantly worse disease and function scores (kidney disease score, cognitive function, quality of social interaction, sleep [all, <em>P</em> <!--><<!--> <!-->0.001], and sexual function [<em>P</em> <!--><<!--> <!-->0.05]), suggesting a direct effect of CKD-aP on QoL.</div></div><div><h3>Limitations</h3><div>Possible recall bias, especially for questions with longer recall periods.</div></div><div><h3>Conclusions</h3><div>CKD-aP is often inadequately treated and disruptive of dialysis treatment, even among patients who report itch to HCPs. Worse itch severity is associated with poorer QoL, sleep quality, and functional/work impairment.</div></div><div><h3>Plain-Language Summary</h3><div>Chronic kidney disease-associated pruritus (CKD-aP) is a common problem in patients with kidney disease, especially in those who are receiving dialysis. There are few approved treatment options for CKD-aP. Understanding how CKD-related itch affects patients may help identify ways to improve CKD-aP symptoms/signs. This patient-reported survey assessed itch characteristics, symptom management attempts and effectiveness, and burdens caused by itch in patients with CKD-aP. Although<!--> <!-->","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100900"},"PeriodicalIF":3.2,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142418757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1016/j.xkme.2024.100899
Samira S. Farouk , Matthew A. Sparks , Jessica Joseph
<div><h3>Background</h3><div>Despite concerted efforts by the nephrology community to increase the quality of nephrology education via a plethora of free open access medical education tools and efforts by national nephrology societies, interest in nephrology has mostly remained stagnant.</div></div><div><h3>Methods</h3><div>A 6-month virtual learning and mentoring program (NephSIM Nephrons) was launched in January 2021 to increase interest in nephrology careers among medical students and residents. Trainees were assigned one faculty mentor and a small group with faculty and other trainees. Learning opportunities consisted of both live and virtual sessions and an asynchronous curriculum. Feedback was collected from trainees at the end of the program each year through an online, anonymous survey. For trainees in the 2021 and 2022 cohort, residency/fellowship status for the July 2024-2025 academic year was assessed by survey.</div></div><div><h3>Results</h3><div>Of 319 and 315 eligible applications received for the 2021 and 2022 programs, 111 and 108 trainees were accepted, respectively; 31 participants in the 2023 cohort completed the exit survey (response rate: 31/84, 37%) and rated the mean overall NephSIM Nephrons experience as 4.7 of 5. All respondents were very likely or somewhat likely to recommend the experience to other trainees. In the 2021 and 2022 cohorts, 37 of 49 (77%) and 29 of 38 (76%) trainees, respectively, who were eligible to match into adult or pediatric nephrology fellowships by July 2024 successfully matched. Similarly, among the 2021 and 2022 cohorts, 11 of 19 (58%) and 21 of 23 (91%), respectively, who could be internal medicine or pediatrics residents in July 2024 successfully matched.</div></div><div><h3>Limitations</h3><div>Low survey response rate.</div></div><div><h3>Conclusions</h3><div>Early outcome analysis of the NephSIM Nephrons program shows promising results, and individuals who participated had high rates of enrollment in nephrology pipeline residencies and nephrology fellowships. More work is needed to first continue rigorous follow-up of program participants, obtain qualitative program feedback, and improve participant and mentor engagement.</div></div><div><h3>Plain-Language Summary</h3><div>Despite concerted efforts by the nephrology community to increase the quality of nephrology education via a plethora of free, open access medical education tools and efforts by national nephrology societies, interest in nephrology has mostly remained stagnant. A 6-month virtual learning and mentoring program (NephSIM Nephrons) was launched in January 2021 to increase interest in nephrology careers among medical students and residents. Early outcome analysis of the NephSIM Nephrons program shows promising results, and individuals who participated had high rates of enrollment in nephrology pipeline residencies and nephrology fellowships. More work is needed to continue rigorous follow-up of program participants, obtain qual
{"title":"Preliminary Outcomes of NephSIM Nephrons: A Virtual Mentorship Program to Foster Interest in Nephrology","authors":"Samira S. Farouk , Matthew A. Sparks , Jessica Joseph","doi":"10.1016/j.xkme.2024.100899","DOIUrl":"10.1016/j.xkme.2024.100899","url":null,"abstract":"<div><h3>Background</h3><div>Despite concerted efforts by the nephrology community to increase the quality of nephrology education via a plethora of free open access medical education tools and efforts by national nephrology societies, interest in nephrology has mostly remained stagnant.</div></div><div><h3>Methods</h3><div>A 6-month virtual learning and mentoring program (NephSIM Nephrons) was launched in January 2021 to increase interest in nephrology careers among medical students and residents. Trainees were assigned one faculty mentor and a small group with faculty and other trainees. Learning opportunities consisted of both live and virtual sessions and an asynchronous curriculum. Feedback was collected from trainees at the end of the program each year through an online, anonymous survey. For trainees in the 2021 and 2022 cohort, residency/fellowship status for the July 2024-2025 academic year was assessed by survey.</div></div><div><h3>Results</h3><div>Of 319 and 315 eligible applications received for the 2021 and 2022 programs, 111 and 108 trainees were accepted, respectively; 31 participants in the 2023 cohort completed the exit survey (response rate: 31/84, 37%) and rated the mean overall NephSIM Nephrons experience as 4.7 of 5. All respondents were very likely or somewhat likely to recommend the experience to other trainees. In the 2021 and 2022 cohorts, 37 of 49 (77%) and 29 of 38 (76%) trainees, respectively, who were eligible to match into adult or pediatric nephrology fellowships by July 2024 successfully matched. Similarly, among the 2021 and 2022 cohorts, 11 of 19 (58%) and 21 of 23 (91%), respectively, who could be internal medicine or pediatrics residents in July 2024 successfully matched.</div></div><div><h3>Limitations</h3><div>Low survey response rate.</div></div><div><h3>Conclusions</h3><div>Early outcome analysis of the NephSIM Nephrons program shows promising results, and individuals who participated had high rates of enrollment in nephrology pipeline residencies and nephrology fellowships. More work is needed to first continue rigorous follow-up of program participants, obtain qualitative program feedback, and improve participant and mentor engagement.</div></div><div><h3>Plain-Language Summary</h3><div>Despite concerted efforts by the nephrology community to increase the quality of nephrology education via a plethora of free, open access medical education tools and efforts by national nephrology societies, interest in nephrology has mostly remained stagnant. A 6-month virtual learning and mentoring program (NephSIM Nephrons) was launched in January 2021 to increase interest in nephrology careers among medical students and residents. Early outcome analysis of the NephSIM Nephrons program shows promising results, and individuals who participated had high rates of enrollment in nephrology pipeline residencies and nephrology fellowships. More work is needed to continue rigorous follow-up of program participants, obtain qual","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100899"},"PeriodicalIF":3.2,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.1016/j.xkme.2024.100898
Declan (Shiyu) Lu , Mishal Akhtar , Lisa Dubrofsky , Bourne L. Auguste
<div><h3>Rationale & Objective</h3><div>Investigating the effect of a quality improvement intervention aimed at enhancing the choice of home dialysis among patients through improved educational sessions on dialysis modalities.</div></div><div><h3>Study Design</h3><div>A new referral protocol initiated on September 15, 2022, sought to direct patients with advanced kidney disease to modality education sessions. This protocol involved an updated referral form and process, requiring nephrologists to refer patients with an estimated glomerular filtration rate below 15<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> or specified Kidney Failure Risk Equation scores to modality educators for education. The impact was measured by the uptake of the education and the choice of home dialysis by patients.</div></div><div><h3>Setting & Participants</h3><div>The study took place at Sunnybrook Health Sciences Centre in Toronto, Canada, involving 532 patients across 1,723 clinical encounters from October 2019 to June 2023.</div></div><div><h3>Predictor</h3><div>The intervention was predicted to lead to an increase in both the number of patients receiving modality education and those choosing home dialysis.</div></div><div><h3>Outcomes</h3><div>The primary outcome measured was the selection of home dialysis following modality education, with a secondary focus on the proportion of patients educated post intervention.</div></div><div><h3>Analytical Approach</h3><div>Statistical process charts were used for monitoring changes in education uptake and home dialysis selection rates following the intervention.</div></div><div><h3>Results</h3><div>After implementing the standardized referral system, the proportion of patients receiving modality education increased from 27.1%-56.7%. However, the rate of selecting home dialysis remained constant at 50.9%. Overall home dialysis prevalence at our center averaged 19.6%, remaining lower than the provincial average of 24.4% by the end of the study period.</div></div><div><h3>Limitations</h3><div>The study was limited to 1 center, without evaluating patient satisfaction or dissecting the complexity of educational content and delivery.</div></div><div><h3>Conclusions</h3><div>We succeeded in boosting education rates but failed to achieve higher home dialysis choice rates, possibly owing to the complexity involved in modality choices. We plan to further investigate the factors influencing patient choices during modality education to better promote home dialysis selection.</div></div><div><h3>Plain-Language Summary</h3><div>The study focused on whether teaching patients more about their dialysis options would encourage them to choose home dialysis. A new system was introduced at an academic hospital in Toronto, requiring doctors to refer patients with advanced kidney disease to educational sessions. The aim was to see if patients who learned more about dialysis would be more likely to manage their treatment at home. The result
{"title":"Dialysis Modality Education Timing and Home Dialysis Uptake: A Quality Improvement Study","authors":"Declan (Shiyu) Lu , Mishal Akhtar , Lisa Dubrofsky , Bourne L. Auguste","doi":"10.1016/j.xkme.2024.100898","DOIUrl":"10.1016/j.xkme.2024.100898","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Investigating the effect of a quality improvement intervention aimed at enhancing the choice of home dialysis among patients through improved educational sessions on dialysis modalities.</div></div><div><h3>Study Design</h3><div>A new referral protocol initiated on September 15, 2022, sought to direct patients with advanced kidney disease to modality education sessions. This protocol involved an updated referral form and process, requiring nephrologists to refer patients with an estimated glomerular filtration rate below 15<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> or specified Kidney Failure Risk Equation scores to modality educators for education. The impact was measured by the uptake of the education and the choice of home dialysis by patients.</div></div><div><h3>Setting & Participants</h3><div>The study took place at Sunnybrook Health Sciences Centre in Toronto, Canada, involving 532 patients across 1,723 clinical encounters from October 2019 to June 2023.</div></div><div><h3>Predictor</h3><div>The intervention was predicted to lead to an increase in both the number of patients receiving modality education and those choosing home dialysis.</div></div><div><h3>Outcomes</h3><div>The primary outcome measured was the selection of home dialysis following modality education, with a secondary focus on the proportion of patients educated post intervention.</div></div><div><h3>Analytical Approach</h3><div>Statistical process charts were used for monitoring changes in education uptake and home dialysis selection rates following the intervention.</div></div><div><h3>Results</h3><div>After implementing the standardized referral system, the proportion of patients receiving modality education increased from 27.1%-56.7%. However, the rate of selecting home dialysis remained constant at 50.9%. Overall home dialysis prevalence at our center averaged 19.6%, remaining lower than the provincial average of 24.4% by the end of the study period.</div></div><div><h3>Limitations</h3><div>The study was limited to 1 center, without evaluating patient satisfaction or dissecting the complexity of educational content and delivery.</div></div><div><h3>Conclusions</h3><div>We succeeded in boosting education rates but failed to achieve higher home dialysis choice rates, possibly owing to the complexity involved in modality choices. We plan to further investigate the factors influencing patient choices during modality education to better promote home dialysis selection.</div></div><div><h3>Plain-Language Summary</h3><div>The study focused on whether teaching patients more about their dialysis options would encourage them to choose home dialysis. A new system was introduced at an academic hospital in Toronto, requiring doctors to refer patients with advanced kidney disease to educational sessions. The aim was to see if patients who learned more about dialysis would be more likely to manage their treatment at home. The result","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100898"},"PeriodicalIF":3.2,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142326364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-28DOI: 10.1016/j.xkme.2024.100897
Arjun V. Masurkar MD, PhD , Nisha Bansal MD , David K. Prince PhD , Wolfgang C. Winkelmayer MD, MPH, ScD , Daniela F. Ortiz MPH , Gianna Ramos MD , Qandeel Soomro MD , Alok Vedvyas MS , Ricardo S. Osorio MD , Mark A. Bernard PhD , Ludovic Debure BS , Wajiha Ahmed MD , Allal Boutajangout PhD , Thomas Wisniewski MD , David M. Charytan MD, MSc
{"title":"Alzheimer Disease–Related Biomarkers in Patients on Maintenance Hemodialysis","authors":"Arjun V. Masurkar MD, PhD , Nisha Bansal MD , David K. Prince PhD , Wolfgang C. Winkelmayer MD, MPH, ScD , Daniela F. Ortiz MPH , Gianna Ramos MD , Qandeel Soomro MD , Alok Vedvyas MS , Ricardo S. Osorio MD , Mark A. Bernard PhD , Ludovic Debure BS , Wajiha Ahmed MD , Allal Boutajangout PhD , Thomas Wisniewski MD , David M. Charytan MD, MSc","doi":"10.1016/j.xkme.2024.100897","DOIUrl":"10.1016/j.xkme.2024.100897","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100897"},"PeriodicalIF":3.2,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524001080/pdfft?md5=5702547619a3b75eadb9c4dc0a448e02&pid=1-s2.0-S2590059524001080-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Rationale & Objective</h3><div>Allopurinol and febuxostat, which are xanthine oxidoreductase inhibitors, have been widely used as uric acid-lowering medications. However, evidence regarding their cardiovascular effects in hemodialysis is insufficient. This study compared the effects of allopurinol and febuxostat on mortality and cardiovascular outcomes in patients receiving hemodialysis.</div></div><div><h3>Study Design</h3><div>A retrospective observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>Data of 6,791 patients who had no history of topiroxostat usage and underwent maintenance hemodialysis between March 2016 and March 2019 at Yokohama Daiichi Hospital, Zenjinkai, and its affiliated dialysis clinics in Japan’s Kanagawa and Tokyo metropolitan areas were collected.</div></div><div><h3>Exposure</h3><div>Allopurinol, febuxostat, and nontreatment.</div></div><div><h3>Outcomes</h3><div>All-cause mortality, cardiovascular disease (CVD) events, heart failure (HF), acute myocardial infarction (AMI), and stroke.</div></div><div><h3>Analytical Approach</h3><div>For the main analyses, marginal structural Cox proportional hazards models were used to estimate HRs adjusted for time-varying confounding and selection bias because of censoring.</div></div><div><h3>Results</h3><div>Allopurinol and febuxostat showed significantly better survival than nontreatment for all-cause mortality (HR, 0.40; 95% CI, 0.30-0.54 and HR, 0.49; 95% CI, 0.38-0.63, respectively), without significant difference between allopurinol and febuxostat. Allopurinol showed significantly better survival than nontreatment, whereas febuxostat did not for CVD events (HR, 0.89; 95% CI, 0.84-0.95 and HR, 1.01; 95% CI, 0.96-1.07, respectively), HF (HR, 0.71; 95% CI, 0.56-0.90 and HR, 1.03; 95% CI, 0.87-1.21, respectively), and AMI (HR, 0.48; 95% CI, 0.25-0.91 and HR, 0.76; 95% CI, 0.49-1.19, respectively). No comparisons showed significant results for stroke.</div></div><div><h3>Limitations</h3><div>The ratio of renal or intestinal excretion of uric acid and uremic toxins could not be elucidated, and we could not investigate gene polymorphism because of the large number of cases.</div></div><div><h3>Conclusions</h3><div>Allopurinol and febuxostat improved survival for all-cause mortality. Allopurinol and not febuxostat reduced the risk of CVD events, HF, and AMI.</div></div><div><h3>Plain Language Summary</h3><div>Uric acid-lowering therapy has been used to prevent gout attacks and protect organs by reducing inflammation by lowering uric acid levels. However, uric acid-lowering medications have recently been found to have a side effect of inhibiting a channel responsible for excreting toxins, such as adenosine triphosphate-binding cassette transporter G2; the effects of medications with a strong inhibitory effect, such as febuxostat, are currently under investigation. Patients with kidney failure or dialysis excrete toxins through feces from their i
{"title":"Allopurinol, Febuxostat, and Nonuse of Xanthine Oxidoreductase Inhibitor Treatment in Patients Receiving Hemodialysis: A Longitudinal Analysis","authors":"Takeo Ishii , Nodoka Seya , Masataka Taguri , Hiromichi Wakui , Ashio Yoshimura , Kouichi Tamura","doi":"10.1016/j.xkme.2024.100896","DOIUrl":"10.1016/j.xkme.2024.100896","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Allopurinol and febuxostat, which are xanthine oxidoreductase inhibitors, have been widely used as uric acid-lowering medications. However, evidence regarding their cardiovascular effects in hemodialysis is insufficient. This study compared the effects of allopurinol and febuxostat on mortality and cardiovascular outcomes in patients receiving hemodialysis.</div></div><div><h3>Study Design</h3><div>A retrospective observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>Data of 6,791 patients who had no history of topiroxostat usage and underwent maintenance hemodialysis between March 2016 and March 2019 at Yokohama Daiichi Hospital, Zenjinkai, and its affiliated dialysis clinics in Japan’s Kanagawa and Tokyo metropolitan areas were collected.</div></div><div><h3>Exposure</h3><div>Allopurinol, febuxostat, and nontreatment.</div></div><div><h3>Outcomes</h3><div>All-cause mortality, cardiovascular disease (CVD) events, heart failure (HF), acute myocardial infarction (AMI), and stroke.</div></div><div><h3>Analytical Approach</h3><div>For the main analyses, marginal structural Cox proportional hazards models were used to estimate HRs adjusted for time-varying confounding and selection bias because of censoring.</div></div><div><h3>Results</h3><div>Allopurinol and febuxostat showed significantly better survival than nontreatment for all-cause mortality (HR, 0.40; 95% CI, 0.30-0.54 and HR, 0.49; 95% CI, 0.38-0.63, respectively), without significant difference between allopurinol and febuxostat. Allopurinol showed significantly better survival than nontreatment, whereas febuxostat did not for CVD events (HR, 0.89; 95% CI, 0.84-0.95 and HR, 1.01; 95% CI, 0.96-1.07, respectively), HF (HR, 0.71; 95% CI, 0.56-0.90 and HR, 1.03; 95% CI, 0.87-1.21, respectively), and AMI (HR, 0.48; 95% CI, 0.25-0.91 and HR, 0.76; 95% CI, 0.49-1.19, respectively). No comparisons showed significant results for stroke.</div></div><div><h3>Limitations</h3><div>The ratio of renal or intestinal excretion of uric acid and uremic toxins could not be elucidated, and we could not investigate gene polymorphism because of the large number of cases.</div></div><div><h3>Conclusions</h3><div>Allopurinol and febuxostat improved survival for all-cause mortality. Allopurinol and not febuxostat reduced the risk of CVD events, HF, and AMI.</div></div><div><h3>Plain Language Summary</h3><div>Uric acid-lowering therapy has been used to prevent gout attacks and protect organs by reducing inflammation by lowering uric acid levels. However, uric acid-lowering medications have recently been found to have a side effect of inhibiting a channel responsible for excreting toxins, such as adenosine triphosphate-binding cassette transporter G2; the effects of medications with a strong inhibitory effect, such as febuxostat, are currently under investigation. Patients with kidney failure or dialysis excrete toxins through feces from their i","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100896"},"PeriodicalIF":3.2,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524001079/pdfft?md5=0825111d5fdbb51834c89ad06c223f76&pid=1-s2.0-S2590059524001079-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142310680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Rationale & Objective</h3><p>This study aims to compare the efficacy of a cannabis cream and a placebo in the treatment of chronic kidney disease (CKD)-associated pruritus.</p></div><div><h3>Study Design</h3><p>A double-blind randomized controlled study.</p></div><div><h3>Setting & Participants</h3><p>Sixty hemodialysis patients with the worst itching intensity numerical rating scale (WI-NRS) ≥3.</p></div><div><h3>Exposure</h3><p>Patients received cannabis cream or placebo.</p></div><div><h3>Outcomes</h3><p>The primary endpoint was the WI-NRS score at week 4. The secondary endpoints included the WI-NRS at week 2, the Skindex-10 score at weeks 2 and 4, and the mean difference score between baseline and week 4 for the WI-NRS and the Skindex-10 score.</p></div><div><h3>Analytical Approach</h3><p>We used unpaired t tests or Mann Whitney U tests, along with χ<sup>2</sup> or Fisher exact tests as appropriate. The adjusted mean differences were determined using ANCOVA, adjusting for baseline scores.</p></div><div><h3>Results</h3><p>Among 60 participants, the mean age was 61.6<!--> <!-->±<!--> <!-->14.4 years and the mean baseline WI-NRS was 6.7<!--> <!-->±<!--> <!-->1.7. The placebo and cannabis cream groups were similar at baseline, although more individuals in the placebo group had diabetes. At 4 weeks, the WI-NRS dropped to 2.6 in the cannabis group and 3.6 in the placebo group (the mean difference after adjustment for baseline scores:−1.1, 95% CI, −2.1 to<!--> <!-->−0.2; <em>P</em> <!-->=<!--> <!-->0.02). Skindex-10 scores at week 4 were also lower in the cannabis group, but after adjustment for baseline scores, statistical significance was not maintained. No side effects were observed in either group.</p></div><div><h3>Limitations</h3><p>A single study with a small sample size restricts its generalizability. Variances in participants’ diabetes statuses might have affected the itch outcomes. The absence of cannabinoid level assessment in blood prevents conclusive determination of the potential systemic impacts. A 4-week follow-up period inadequately captures long-term effect.</p></div><div><h3>Conclusions</h3><p>In CKD-associated pruritus, the topical cream containing cannabis significantly reduced the severity of itching symptoms compared to the placebo.</p></div><div><h3>Trial Registration</h3><p><span><span>clinicaltrials.gov</span><svg><path></path></svg></span> Identifier: <span><span>NCT06159686</span><svg><path></path></svg></span></p></div><div><h3>Plain Language Summary</h3><p>Chronic kidney disease (CKD)-associated pruritus presents a significant burden to hemodialysis patients, with current medications often falling short in alleviating symptoms. Cannabinoids, with their anti-inflammatory, antioxidative, and peripheral nerve activation reduction properties, hold promise in treating CKD-associated pruritus. Especially when applied topically, cannabinoids could provide moisturized skin along with their other effects. We ana
{"title":"Cannabis-Containing Cream for CKD-Associated Pruritus: A Double-Blind, Placebo Controlled Trial","authors":"Suthiya Anumas , Pranporn Kuropakornpong , Panlop Chakkavittumrong , Adis Tasanarong , Pattharawin Pattharanitima","doi":"10.1016/j.xkme.2024.100894","DOIUrl":"10.1016/j.xkme.2024.100894","url":null,"abstract":"<div><h3>Rationale & Objective</h3><p>This study aims to compare the efficacy of a cannabis cream and a placebo in the treatment of chronic kidney disease (CKD)-associated pruritus.</p></div><div><h3>Study Design</h3><p>A double-blind randomized controlled study.</p></div><div><h3>Setting & Participants</h3><p>Sixty hemodialysis patients with the worst itching intensity numerical rating scale (WI-NRS) ≥3.</p></div><div><h3>Exposure</h3><p>Patients received cannabis cream or placebo.</p></div><div><h3>Outcomes</h3><p>The primary endpoint was the WI-NRS score at week 4. The secondary endpoints included the WI-NRS at week 2, the Skindex-10 score at weeks 2 and 4, and the mean difference score between baseline and week 4 for the WI-NRS and the Skindex-10 score.</p></div><div><h3>Analytical Approach</h3><p>We used unpaired t tests or Mann Whitney U tests, along with χ<sup>2</sup> or Fisher exact tests as appropriate. The adjusted mean differences were determined using ANCOVA, adjusting for baseline scores.</p></div><div><h3>Results</h3><p>Among 60 participants, the mean age was 61.6<!--> <!-->±<!--> <!-->14.4 years and the mean baseline WI-NRS was 6.7<!--> <!-->±<!--> <!-->1.7. The placebo and cannabis cream groups were similar at baseline, although more individuals in the placebo group had diabetes. At 4 weeks, the WI-NRS dropped to 2.6 in the cannabis group and 3.6 in the placebo group (the mean difference after adjustment for baseline scores:−1.1, 95% CI, −2.1 to<!--> <!-->−0.2; <em>P</em> <!-->=<!--> <!-->0.02). Skindex-10 scores at week 4 were also lower in the cannabis group, but after adjustment for baseline scores, statistical significance was not maintained. No side effects were observed in either group.</p></div><div><h3>Limitations</h3><p>A single study with a small sample size restricts its generalizability. Variances in participants’ diabetes statuses might have affected the itch outcomes. The absence of cannabinoid level assessment in blood prevents conclusive determination of the potential systemic impacts. A 4-week follow-up period inadequately captures long-term effect.</p></div><div><h3>Conclusions</h3><p>In CKD-associated pruritus, the topical cream containing cannabis significantly reduced the severity of itching symptoms compared to the placebo.</p></div><div><h3>Trial Registration</h3><p><span><span>clinicaltrials.gov</span><svg><path></path></svg></span> Identifier: <span><span>NCT06159686</span><svg><path></path></svg></span></p></div><div><h3>Plain Language Summary</h3><p>Chronic kidney disease (CKD)-associated pruritus presents a significant burden to hemodialysis patients, with current medications often falling short in alleviating symptoms. Cannabinoids, with their anti-inflammatory, antioxidative, and peripheral nerve activation reduction properties, hold promise in treating CKD-associated pruritus. Especially when applied topically, cannabinoids could provide moisturized skin along with their other effects. We ana","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 10","pages":"Article 100894"},"PeriodicalIF":3.2,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524001055/pdfft?md5=9ebd8c183076a7f011c19ee48f1febdc&pid=1-s2.0-S2590059524001055-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-14DOI: 10.1016/j.xkme.2024.100892
Lei Jiang , Suxia Wang , Ying Tan , Tao Su
<div><h3>Rationale & Objective</h3><p>Postpartum renal cortical necrosis (postpartum RCN) is a severe form of obstetric acute kidney injury. This study aimed to identify clinicopathologic features in Chinese postpartum RCN cases to determine how pathologic findings may contribute to the treatment and prognosis.</p></div><div><h3>Study Design</h3><p>Single-center, case series.</p></div><div><h3>Setting & Participants</h3><p>Twelve patients with postpartum RCN had kidney biopsies at Peking University First Hospital between 2014 and 2021. The diagnosis of postpartum RCN was made according to typical magnetic resonance imaging or pathologic features. Clinical, laboratory, and pathologic data were compared between patients with estimated glomerular filtration rate<!--> <!--><30 (poor outcome) and<!--> <!-->≥30<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> after 6 months.</p></div><div><h3>Observations</h3><p>All patients with postpartum RCN presented with stage 3 acute kidney injury attributed to a probable atypical hemolytic uremic syndrome. Pregnancy terminations occurred at a median gestational age of 35.5 weeks. Kidney biopsy was performed from 18 days to 4 months from delivery. On biopsy, hemoglobin, platelet count, and lactate dehydrogenase levels had been restored to 137<!--> <!-->g/L, 214 ×<!--> <!-->10<sup>9</sup>/L, and 231.50<!--> <!-->±<!--> <!-->65.01<!--> <!-->U/L, respectively. Four patients exhibited poor outcome, demonstrating higher schistocyte count, serum creatinine, and mean arterial pressure at onset. Pathologically, glomerular segmental sclerosis was prevalent. The “not otherwise specified” variant was the most common type, followed by collapsing variant, cellular variant, and tip variant. Patients with poor kidney outcome had more glomerular coagulative necrosis, capillary thrombosis, extensive cortical coagulative necrosis, and pronounced arteriole/artery lesions including increased interlobular arteriole intimal edema and fibrin thrombosis, but a lower occurrence of segmental sclerosis.</p></div><div><h3>Limitations</h3><p>Limited sample size and retrospective design.</p></div><div><h3>Conclusions</h3><p>We identified key pathologic features in patients with postpartum RCN and atypical hemolytic uremic syndrome, highlighting the necessity for more effective therapeutic options. There is a clear demand for noninvasive biomarkers that can accurately track disease progression and inform treatment duration for long-term outcomes improvement.</p></div><div><h3>Plain-Language Summary</h3><p>Our study investigated postpartum renal cortical necrosis (RCN) in 12 Chinese women, a severe form of kidney injury that occurs after childbirth, often linked to atypical hemolytic uremic syndrome (aHUS). We aimed to identify clinical and pathologic features to improve treatment and predict patient outcomes. The women experienced stage 3 acute kidney injury, with kidney biopsies revealing various degrees of glomerular and vascular dam
{"title":"Postpartum Renal Cortical Necrosis: A Case Series","authors":"Lei Jiang , Suxia Wang , Ying Tan , Tao Su","doi":"10.1016/j.xkme.2024.100892","DOIUrl":"10.1016/j.xkme.2024.100892","url":null,"abstract":"<div><h3>Rationale & Objective</h3><p>Postpartum renal cortical necrosis (postpartum RCN) is a severe form of obstetric acute kidney injury. This study aimed to identify clinicopathologic features in Chinese postpartum RCN cases to determine how pathologic findings may contribute to the treatment and prognosis.</p></div><div><h3>Study Design</h3><p>Single-center, case series.</p></div><div><h3>Setting & Participants</h3><p>Twelve patients with postpartum RCN had kidney biopsies at Peking University First Hospital between 2014 and 2021. The diagnosis of postpartum RCN was made according to typical magnetic resonance imaging or pathologic features. Clinical, laboratory, and pathologic data were compared between patients with estimated glomerular filtration rate<!--> <!--><30 (poor outcome) and<!--> <!-->≥30<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> after 6 months.</p></div><div><h3>Observations</h3><p>All patients with postpartum RCN presented with stage 3 acute kidney injury attributed to a probable atypical hemolytic uremic syndrome. Pregnancy terminations occurred at a median gestational age of 35.5 weeks. Kidney biopsy was performed from 18 days to 4 months from delivery. On biopsy, hemoglobin, platelet count, and lactate dehydrogenase levels had been restored to 137<!--> <!-->g/L, 214 ×<!--> <!-->10<sup>9</sup>/L, and 231.50<!--> <!-->±<!--> <!-->65.01<!--> <!-->U/L, respectively. Four patients exhibited poor outcome, demonstrating higher schistocyte count, serum creatinine, and mean arterial pressure at onset. Pathologically, glomerular segmental sclerosis was prevalent. The “not otherwise specified” variant was the most common type, followed by collapsing variant, cellular variant, and tip variant. Patients with poor kidney outcome had more glomerular coagulative necrosis, capillary thrombosis, extensive cortical coagulative necrosis, and pronounced arteriole/artery lesions including increased interlobular arteriole intimal edema and fibrin thrombosis, but a lower occurrence of segmental sclerosis.</p></div><div><h3>Limitations</h3><p>Limited sample size and retrospective design.</p></div><div><h3>Conclusions</h3><p>We identified key pathologic features in patients with postpartum RCN and atypical hemolytic uremic syndrome, highlighting the necessity for more effective therapeutic options. There is a clear demand for noninvasive biomarkers that can accurately track disease progression and inform treatment duration for long-term outcomes improvement.</p></div><div><h3>Plain-Language Summary</h3><p>Our study investigated postpartum renal cortical necrosis (RCN) in 12 Chinese women, a severe form of kidney injury that occurs after childbirth, often linked to atypical hemolytic uremic syndrome (aHUS). We aimed to identify clinical and pathologic features to improve treatment and predict patient outcomes. The women experienced stage 3 acute kidney injury, with kidney biopsies revealing various degrees of glomerular and vascular dam","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 10","pages":"Article 100892"},"PeriodicalIF":3.2,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524001031/pdfft?md5=384ac10f418f779e7eb6cf2cc390cb8e&pid=1-s2.0-S2590059524001031-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-14DOI: 10.1016/j.xkme.2024.100890
Jimin Hwang , Kwanghyun Kim , Josef Coresh , Lesley A. Inker , Morgan E. Grams , Jung-Im Shin
<div><h3>Rationale & Objective</h3><p>In 2021, the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) updated the creatinine-based estimated glomerular filtration rate (eGFR) equation and removed the coefficient for race. The development and validation of this equation involved binarizing race into African American and non-African American, involving few Asian participants. This study aimed to examine the difference between the 2021 equation and the previous 2009 equation on CKD prevalence estimates in 2 Asian populations.</p></div><div><h3>Study Design</h3><p>Observational study using 2 national surveys.</p></div><div><h3>Setting & Participants</h3><p>Participants from the 2019 Korea National Health and Nutrition Survey and participants self-reported as Asian from the 2011-2020 US National Health and Nutrition Survey.</p></div><div><h3>Exposure</h3><p>eGFR using 2009 and 2021 CKD-EPI creatinine equation.</p></div><div><h3>Outcomes</h3><p>Prevalence of CKD (eGFR<!--> <!--><60<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> or urine albumin-creatinine ratio<!--> <!-->≥30<!--> <!-->mg/g).</p></div><div><h3>Analytical Approach</h3><p>Sampling-weighted prevalence estimated using the 2009 and 2021 equations as well as the percentage of individuals with CKD G3+<!--> <!-->using the 2009 equation being reclassified as not having CKD G3+<!--> <!-->using the 2021 equation.</p></div><div><h3>Results</h3><p>The prevalence of CKD estimated using the 2021 equation was 9.75% (95% confidence intervals [CI], 8.80-10.80%) in Koreans and 11.60% (95% CI, 10.23-13.13%) in US Asians. The prevalence of CKD estimated using the 2021 equation was slightly lower than that using the 2009 equation in both Korean and US Asian populations by 0.63% (95% CI, 0.44-0.90%) and 0.84% (95% CI, 0.52-1.34%), respectively. Furthermore, 32.8% and 30.2% of Koreans and US Asians with CKD G3-5, respectively, estimated using the 2009 equation were reclassified as not having CKD G3-5 when the eGFR was calculated using the 2021 equation.</p></div><div><h3>Limitations</h3><p>Measured GFR was not available.</p></div><div><h3>Conclusions</h3><p>Use of the 2021 CKD-EPI creatinine equation leads to a small decrease in CKD prevalence in both Korean and US Asian populations, and of similar magnitude, resulting in significant reclassification among those originally classified as having CKD G3+.</p></div><div><h3>Plain-Language Summary</h3><p>The 2009 serum creatinine-based kidney function estimating equation used demographic information including race. Because race is a social construct, race was eliminated in the new equation developed in 2021. As race was categorized into African American and non-African American during its development, this study examined the impact of the 2021 equation in 2 distinct Asian populations (Koreans and US Asians) using 2 national datasets. We found that the prevalence of chronic kidney disease (CKD) estimated using the 2021 equation was slightly lo
{"title":"Estimated GFR in the Korean and US Asian Populations Using the 2021 Creatinine-Based GFR Estimating Equation Without Race","authors":"Jimin Hwang , Kwanghyun Kim , Josef Coresh , Lesley A. Inker , Morgan E. Grams , Jung-Im Shin","doi":"10.1016/j.xkme.2024.100890","DOIUrl":"10.1016/j.xkme.2024.100890","url":null,"abstract":"<div><h3>Rationale & Objective</h3><p>In 2021, the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) updated the creatinine-based estimated glomerular filtration rate (eGFR) equation and removed the coefficient for race. The development and validation of this equation involved binarizing race into African American and non-African American, involving few Asian participants. This study aimed to examine the difference between the 2021 equation and the previous 2009 equation on CKD prevalence estimates in 2 Asian populations.</p></div><div><h3>Study Design</h3><p>Observational study using 2 national surveys.</p></div><div><h3>Setting & Participants</h3><p>Participants from the 2019 Korea National Health and Nutrition Survey and participants self-reported as Asian from the 2011-2020 US National Health and Nutrition Survey.</p></div><div><h3>Exposure</h3><p>eGFR using 2009 and 2021 CKD-EPI creatinine equation.</p></div><div><h3>Outcomes</h3><p>Prevalence of CKD (eGFR<!--> <!--><60<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> or urine albumin-creatinine ratio<!--> <!-->≥30<!--> <!-->mg/g).</p></div><div><h3>Analytical Approach</h3><p>Sampling-weighted prevalence estimated using the 2009 and 2021 equations as well as the percentage of individuals with CKD G3+<!--> <!-->using the 2009 equation being reclassified as not having CKD G3+<!--> <!-->using the 2021 equation.</p></div><div><h3>Results</h3><p>The prevalence of CKD estimated using the 2021 equation was 9.75% (95% confidence intervals [CI], 8.80-10.80%) in Koreans and 11.60% (95% CI, 10.23-13.13%) in US Asians. The prevalence of CKD estimated using the 2021 equation was slightly lower than that using the 2009 equation in both Korean and US Asian populations by 0.63% (95% CI, 0.44-0.90%) and 0.84% (95% CI, 0.52-1.34%), respectively. Furthermore, 32.8% and 30.2% of Koreans and US Asians with CKD G3-5, respectively, estimated using the 2009 equation were reclassified as not having CKD G3-5 when the eGFR was calculated using the 2021 equation.</p></div><div><h3>Limitations</h3><p>Measured GFR was not available.</p></div><div><h3>Conclusions</h3><p>Use of the 2021 CKD-EPI creatinine equation leads to a small decrease in CKD prevalence in both Korean and US Asian populations, and of similar magnitude, resulting in significant reclassification among those originally classified as having CKD G3+.</p></div><div><h3>Plain-Language Summary</h3><p>The 2009 serum creatinine-based kidney function estimating equation used demographic information including race. Because race is a social construct, race was eliminated in the new equation developed in 2021. As race was categorized into African American and non-African American during its development, this study examined the impact of the 2021 equation in 2 distinct Asian populations (Koreans and US Asians) using 2 national datasets. We found that the prevalence of chronic kidney disease (CKD) estimated using the 2021 equation was slightly lo","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 10","pages":"Article 100890"},"PeriodicalIF":3.2,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524001018/pdfft?md5=850b159bd4b7cfb283e0456b06f7620a&pid=1-s2.0-S2590059524001018-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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