Introduction Greater distance to full-service supermarkets and low income may impair access to healthy diets and contribute to chronic kidney disease (CKD) and hypertension. The study aim was to determine relationships among residence in a “food desert,” low income, CKD, and blood pressure. Methods Adults in the 2003–2010 National Health and Nutrition Examination Survey (N=22,173) were linked to food desert data (www.ers.usda.gov) by Census Tracts. Food deserts have low median income and are further from a supermarket or large grocery store (>1 mile in urban areas, >10 miles in rural areas). Weighted regression was used to determine the association of residence in a food desert and family income with dietary intake, systolic blood pressure (SBP), and odds of CKD. Data analysis was performed in 2014–2015. Results Compared with those not in food deserts, participants residing in food deserts had lower levels of serum carotenoids (p<0.01), a biomarker of fruit and vegetable intake, and higher SBP (1.53 mmHg higher, 95% CI=0.41, 2.66) after adjustment for demographics and income. Residence in a food desert was not associated with odds of CKD (OR=1.20, 95% CI=0.96, 1.49). Lower, versus higher, income was associated with lower serum carotenoids (p<0.01) and higher SBP (2.00 mmHg higher for income–poverty ratio ≤1 vs >3, 95% CI=1.12, 2.89), but also greater odds of CKD (OR=1.76 for income–poverty ratio ≤1 vs >3, 95% CI=1.48, 2.10). Conclusions Limited access to healthy food due to geographic or financial barriers could be targeted for prevention of CKD and hypertension.

Purpose of review This review discusses the macrocirculatory and microcirculatory aspects of renal perfusion, as well as novel methods by which to measure renal blood flow. Finally, therapeutic options are briefly discussed, including renal-specific microcirculatory effects. Recent findings The optimal mean arterial pressure (MAP) needed for preservation of renal function has been debated but is most likely a MAP of 60–80 mmHg. In addition, attention should be paid to renal outflow pressure, typically central venous pressure. Heterogeneity in microcirculation can exist and may be mitigated through appropriate use of vasopressors with unique microcirculatory effects. Excessive catecholamines have been shown to be harmful and should be avoided. Both angiotensin II and vasopressin may improve glomerular flow through a number of mechanisms. Macrocirculatory and microcirculatory blood flow can be measured through a number of bedside ultrasound modalities, sublingual microscopy and urinary oxygen measurement, Summary Acute kidney injury (AKI) is a common manifestation of organ failure in shock, and avoidance of hemodynamic instability can mitigate this risk. Measurement of renal haemodynamics is not routinely performed but may help to guide therapeutic goals. A thorough understanding of pathophysiology, measurement techniques and therapeutic options may allow for a personalized approach to blood pressure management in patients with septic shock and may ultimately mitigate AKI.

Black or Hispanic veterans with CKD are more likely than white patients to see a nephrologist, yet are also more likely to suffer disease progression. Biologic and environmental factors may play a bigger role than nephrology consultation in driving racial disparities in CKD progression.

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