A Matter of Choice

Feder, Judith; Nadel, Mark V.; Krishnan, Mahesh

doi:10.2215/cjn.04470415

Cited by 14 publications

(14 citation statements)

References 9 publications

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“…Although understudied in the context of glomerular disease, individuals with CKD from lower socioeconomic backgrounds have poorer long-term outcomes, including a higher likelihood of progression to ESKD, cardiovascular events, disability, and all-cause mortality (22)(23)(24)(25)(26), thus reinforcing the need for earlier identification and intervention. The increased burden of illness associated with ESKD places additional financial constraints on patients through work absences and reductions in earning capacity (27,28). This would be particularly detrimental to patients with glomerular disease who are at an especially high risk of disease progression from a younger working age (29,30).…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic Position and Incidence of Glomerular Diseases

Canney

Induruwage

Sahota

et al. 2020

CJASN

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Background and objectives Social deprivation is a recognized risk factor for undifferentiated CKD; however, its association with glomerular disease is less well understood. We sought to investigate the relationship between socioeconomic position and the population-level incidence of biopsy-proven glomerular diseases. Design, setting, participants, & measurements In this retrospective cohort study, a provincial kidney pathology database (2000-2012) was used to capture all incident cases of membranous nephropathy (n5392), IgA nephropathy (n5818), FSGS (n5375), ANCA-related GN (ANCA-GN, n5387), and lupus nephritis (n5389) in British Columbia, Canada. Quintiles of area-level household income were used as a proxy for socioeconomic position, accounting for regional differences in living costs. Incidence rates were direct standardized to the provincial population using census data for age and sex and were used to generate standardized rate ratios. For lupus nephritis, age standardization was performed separately in men and women. Results A graded increase in standardized incidence with lower income was observed for lupus nephritis (P,0.001 for trend in both sexes) and ANCA-GN (P50.04 for trend). For example, compared with the highest quintile, the lowest income quintile had a standardized rate ratio of 1.7 (95% confidence interval, 1.19 to 2.42) in women with lupus nephritis and a standardized rate ratio of 1.5 (95% confidence interval, 1.09 to 2.06) in ANCA-GN. The association between income and FSGS was less consistent, in that only the lowest income quintile was associated with a higher incidence of disease (standardized rate ratio, 1.55; 95% confidence interval, 1.13 to 2.13). No significant associations were demonstrated for IgA nephropathy or membranous nephropathy. Conclusions Using population-level data and a centralized pathology database, we observed an inverse association between socioeconomic position and the standardized incidence of lupus nephritis and ANCA-GN.

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Section: Discussionmentioning

confidence: 99%

Socioeconomic Position and Incidence of Glomerular Diseases

Canney

Induruwage

Sahota

et al. 2020

CJASN

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“…In general, ESRD patients are confronted with deteriorating health status, struggles with complex dietary restrictions, poly-pharmacy and complex care coordination for ESRD, and other comorbidities, particularly in the context of common cognitive impairment and frequent depression [21]. For in-center hemodialysis, the chronic dependence on nurses, social workers, nutritionists, technicians, vascular surgeons, and nephrologists for 3–4 h, 3 times a week, or more frequent dialysis sessions for this life-saving procedure limits quality of life, particularly for an aging population.…”

Section: Factors Contributing To Disparities In Care Of Aas With Esrdmentioning

confidence: 99%

Current State and Future Trends to Optimize the Care of African Americans with End-Stage Renal Disease

Harding¹,

Mersha

Webb

et al. 2017

Am J Nephrol

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Background: Chronic kidney disease is a progressive disease, which terminates in end-stage renal diseases (ESRD) that requires either dialysis or kidney transplantation for the patient to survive. There is an alarming trend in the disparities of ESRD in African Americans (AAs). Currently, AAs represent more than 30% of incident ESRD cases, yet they constitute 15% of the overall US population. Despite the reductions in mortality, increases in access to patient-centered home dialysis and preemptive kidney transplantation for the overall US ESRD population over the last decade, disparities in the care of AAs with ESRD remain largely unaffected. Summary: This review discusses patient-, community-, and practitioner-related factors that contribute to disparities in ESRD care for AAs. In particular, the review addresses issues related to end-of-life support, the importance of Apolipoprotein-1 gene variants, and the advent of pharmacogenomics toward achieving precision care. The need for accessible clinical intelligence for the ESRD population is discussed. Several interventions and a call to action to address the disparities are presented. Key Messages: Significant disparities in ESRD care exist for AAs. Strategies to enhance patient engagement, education, accountable partnerships, and clinical intelligence may reduce these disparities.

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“…Dialysis providers’ support for patient goals regarding ability to work and employment could be considered as a QI measure. A recent policy perspective argued that the Centers for Medicare & Medicaid Services (CMS) should support activities to promote the initiation of more timely counseling about employment, as well as ESKD treatment options, for patients who are expected to require RRT [ 12 ]. The primary objective would be to facilitate ESKD patients’ maintenance of their pre-dialysis employment.…”

Section: Discussionmentioning

confidence: 99%

“…In the years following the establishment of the kidney disease Medicare program, increasing numbers of older and sicker individuals were accepted for dialysis as more facilities opened, resulting in a treated ESKD population for whom return to work was less feasible than was originally anticipated [ 8 ]. However, despite these demographic changes in the overall treated population, identifying strategies to promote employment opportunity among working-age persons on dialysis remains a valued objective [ 9 , 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Job requirements and employer expectations are important influences on whether a person is able to continue working at a particular job after the start of RRT. In addition, the availability of disability benefits for ESKD patients in the US is an acknowledged influence on whether persons who consider themselves able to work do actually remain in the labor force [ 4 , 12 , 14 ]. However, with regard to feeling able to work, a key factor in sociological terms may be the balance that people experience between “good days” and “bad days”—a phenomenon common to many people who have a chronic illness [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Ability to Work among Patients with ESKD: Relevance of Quality Care Metrics

Kutner

Zhang

2017

Healthcare

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Enabling patient ability to work was a key rationale for enacting the United States (US) Medicare program that provides financial entitlement to renal replacement therapy for persons with end-stage kidney disease (ESKD). However, fewer than half of working-age individuals in the US report the ability to work after starting maintenance hemodialysis (HD). Quality improvement is a well-established objective in oversight of the dialysis program, but a more patient-centered quality assessment approach is increasingly advocated. The ESKD Quality Incentive Program (QIP) initiated in 2012 emphasizes clinical performance indicators, but a newly-added measure requires the monitoring of patient depression—an issue that is important for work ability and employment. We investigated depression scores and four dialysis-specific QIP measures in relation to work ability reported by a multi-clinic cohort of 528 working-age maintenance HD patients. The prevalence of elevated depression scores was substantially higher among patients who said they were not able to work, while only one of the four dialysis-specific clinical measures differed for patients able/not able to work. Ability to work may be among patients’ top priorities. As the parameters of quality assessment continue to evolve, increased attention to patient priorities might facilitate work ability and employment outcomes.

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A Matter of Choice

Cited by 14 publications

References 9 publications

Socioeconomic Position and Incidence of Glomerular Diseases

Socioeconomic Position and Incidence of Glomerular Diseases

Current State and Future Trends to Optimize the Care of African Americans with End-Stage Renal Disease

Ability to Work among Patients with ESKD: Relevance of Quality Care Metrics

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