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Patients who develop AKI during a hospitalization are at substantial risk for the development of CKD by 1 year following hospitalization and timing of AKI recovery is a strong predictor, even for the mildest forms of AKI.

Background Poor access to food among low income adults has been recognized as a risk factor for CKD, but there is no data on the impact of food insecurity on progression to ESRD. We hypothesized that food insecurity would be independently associated with risk of ESRD among persons with and without CKD. Study Design Longitudinal cohort study Setting & Participants 2,320 adults (≥20 years) with CKD and 10,448 adults with ‘No-CKD’ enrolled in NHANES III (1988–1994) with household income ≤400% of the federal poverty level linked to Medicare ESRD Registry for a median follow-up period of 12 years. Predictor Food insecurity, defined as an affirmative response to the food insecurity screening question. Outcome Development of treated ESRD. Measurements Demographics, income, diabetes, hypertension, eGFR, and albuminuria. DAL was estimated from the 24-hr dietary recall. We used a Fine-Gray competing risk model to estimate the relative hazard [RH] for ESRD associated with food insecurity after adjusting for covariates. Results 4.5% adults with CKD were food insecure. Food insecure individuals were more likely to be younger, have diabetes (29.9%) and hypertension (73.9%), or have albuminuria (90.4%) as compared to their counterparts (V p<0.05). Median DAL in the food secure vs. food insecure group was 51.2 mEq/day vs 55.6 mEq/day, respectively (p=0.05). Food insecure adults were more likely to develop ESRD (RH [95% CI]: 1.38 [1.08–3.10]) compared to food secure adults after adjustment for demographics, income, diabetes, hypertension, eGFR and albuminuria. In the No-CKD group, 5.7% were food insecure. Here, we did not find a significant association between food insecurity and ESRD (0.77 [0.40–1.49]). Limitations use of a single 24-hr diet recall, lack of laboratory follow-up data, and measure of changes in food insecurity over time; follow-up of the cohort ended 10 years ago. Conclusion Among individuals with CKD, food insecurity was independently associated with a higher likelihood of developing ESRD. Innovative approaches to address food insecurity should be tested for their impact on CKD outcomes.

Introduction This study examined state-level variation in chronic kidney disease (CKD) awareness using national estimates of disease awareness among adults in the U.S. with CKD. Methods Data on U.S. adults were obtained from two national, population-based surveys: (1) the Behavioral Risk Factor Surveillance System (BRFSS 2011; n=506,467), a state-level phone survey containing information on self-reported kidney disease; and (2) the National Health and Nutrition Examination Survey (NHANES 2005–2012; n=20,831), containing physical health examination, surveys containing data on self-reported kidney disease, risk factors, and laboratory values. CKD was defined as an estimated glomerular filtration rate of 15–59 mL/minute/1.73 m2 or urinary albumin-to-creatinine ratio >30 mg/g. As BRFSS does not include laboratory data, CKD status for each person was imputed (multiple) based on a logistic regression model predicting NHANES CKD status. CKD awareness in each state was estimated as the weighted proportion of BRFSS participants with imputed CKD who reported having kidney disease. Results Overall, estimated CKD awareness was 9.0% (95% CI=8.0%, 10.0%), ranging from 5.8% (95% CI=4.8%, 6.8%) in Iowa to 11.7% (95% CI=9.7%, 13.7%) in Arizona. Awareness was greater among adults with hypertension (12.0%) and diabetes (15.3%) than among adults without those conditions, and lower in Hispanics (6.0%) than in non-Hispanic whites (8.8%), non-Hispanic blacks (9.9%), and other racial/ethnic groups (12.7%). Conclusions Among individuals with CKD, awareness of their condition was very low and varied approximately twofold among states. This is the first study to estimate awareness of kidney disease by state for the U.S. adult population.

BACKGROUND: Pharmacies and pharmacists play an important role in the health care system, improving health outcomes and enhancing quality through better pharmaceutical care. Yet, little information is available to accurately evaluate pharmacy store quality and thereby encourage quality improvement at the pharmacy store level.