Current State and Future Trends to Optimize the Care of Chronic Kidney Disease in African Americans

Harding, Kimberly; Mersha, Tesfaye B.; Vassalotti, Joseph A.; Webb, Fern J.; Nicholas, Susanne B.

doi:10.1159/000479481

Cited by 14 publications

(17 citation statements)

References 66 publications

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“…Studies were conducted in the US, Canada, UK, and Norway and most were prospective or retrospective cohort studies. Overall, most (n = 24) studies reported higher risk of CKD progression in African-American/Afro-Caribbean [13][14][15][16][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. However, some (n = 12) studies found no significant ethnic differences in risk of CKD progression, which may be partly due to smaller study sample size, duration of follow up, and/or adjustment for confounders and mediators [9,[38][39][40][41][42][43][44][45][46][47][48].…”

Section: Ethnic Differences In Ckd Progression African-americans and mentioning

confidence: 98%

“…Our updated searches identified 5 relevant studies published between July 2017 and February 2020, resulting in a total of 55 studies included in the review. These 55 studies included 1 systematic review [9] and 8 literature reviews on CKD progression [12][13][14][15][16][17][18][19]. Together these reviews included 19 of the individual studies identified in our searches.…”

Section: Search Strategy Study Selection and Data Extractionmentioning

confidence: 99%

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Ethnic minority disparities in progression and mortality of pre-dialysis chronic kidney disease: a systematic scoping review

et al. 2020

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Background: There are a growing number of studies on ethnic differences in progression and mortality for predialysis chronic kidney disease (CKD), but this literature has yet to be synthesised, particularly for studies on mortality. Methods: This scoping review synthesized existing literature on ethnic differences in progression and mortality for adults with pre-dialysis CKD, explored factors contributing to these differences, and identified gaps in the literature. A comprehensive search strategy using search terms for ethnicity and CKD was taken to identify potentially relevant studies. Nine databases were searched from 1992 to June 2017, with an updated search in February 2020. Results: 8059 articles were identified and screened. Fifty-five studies (2 systematic review, 7 non-systematic reviews, and 46 individual studies) were included in this review. Most were US studies and compared African-American/Afro-Caribbean and Caucasian populations, and fewer studies assessed outcomes for Hispanics and Asians. Most studies reported higher risk of CKD progression in Afro-Caribbean/African-Americans, Hispanics, and Asians, lower risk of mortality for Asians, and mixed findings on risk of mortality for Afro-Caribbean/African-Americans and Hispanics, compared to Caucasians. Biological factors such as hypertension, diabetes, and cardiovascular disease contributed to increased risk of progression for ethnic minorities but did not increase risk of mortality in these groups. Conclusions: Higher rates of renal replacement therapy among ethnic minorities may be partly due to increased risk of progression and reduced mortality in these groups. The review identifies gaps in the literature and highlights a need for a more structured approach by researchers that would allow higher confidence in single studies and better harmonization of data across studies to advance our understanding of CKD progression and mortality.

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Section: Ethnic Differences In Ckd Progression African-americans and mentioning

confidence: 98%

Section: Search Strategy Study Selection and Data Extractionmentioning

confidence: 99%

Ethnic minority disparities in progression and mortality of pre-dialysis chronic kidney disease: a systematic scoping review

et al. 2020

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“…For example, it is possible that African-Americans are more likely to receive fragmented care, and we may underestimate care delivered. 40,41 We also do not have data in our CKD registry about other delivery outcomes such as referral for dialysis modality education or goals of care discussions. Finally, our regression analyses are limited to age, sex, and relevant comorbidities and do not include adjustment based on other important attributes, such as socioeconomic status, due to limitations of the registry.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Examining the Potential Impact of Race Multiplier Utilization in Estimated Glomerular Filtration Rate Calculation on African-American Care Outcomes

et al. 2020

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BACKGROUND: Advancing health equity entails reducing disparities in care. African-American patients with chronic kidney disease (CKD) have poorer outcomes, including dialysis access placement and transplantation. Estimated glomerular filtration rate (eGFR) equations, which assign higher eGFR values to African-American patients, may be a mechanism for inequitable outcomes. Electronic health record-based registries enable population-based examination of care across racial groups. OBJECTIVE: To examine the impact of the race multiplier for African-Americans in the CKD-EPI eGFR equation on CKD classification and care delivery. DESIGN: Cross-sectional study SETTING: Two large academic medical centers and affiliated community primary care and specialty practices. PARTICIPANTS: A total of 56,845 patients in the Partners HealthCare System CKD registry in June 2019, among whom 2225 (3.9%) were African-American. MEASUREMENTS: Exposures included race, age, sex, comorbidities, and eGFR. Outcomes were transplant referral and dialysis access placement. RESULTS: Of 2225 African-American patients, 743 (33.4%) would hypothetically be reclassified to a more severe CKD stage if the race multiplier were removed from the CKD-EPI equation. Similarly, 167 of 687 (24.3%) would be reclassified from stage 3B to stage 4. Finally, 64 of 2069 patients (3.1%) would be reassigned from eGFR > 20 ml/min/1.73 m 2 to eGFR ≤ 20 ml/min/ 1.73 m 2 , meeting the criterion for accumulating kidney transplant priority. Zero of 64 African-American patients with an eGFR ≤ 20 ml/min/1.73 m 2 after the race multiplier was removed were referred, evaluated, or waitlisted for kidney transplant, compared to 19.2% of African-American patients with eGFR ≤ 20 ml/min/1.73 m 2 with the default CKD-EPI equation.LIMITATIONS: Single healthcare system in the Northeastern United States and relatively small African-American patient cohort may limit generalizability. CONCLUSIONS: Our study reveals a meaningful impact of race-adjusted eGFR on the care provided to the African-American CKD patient population.

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“…other biologic pathways (6)(7)(8)(9)(10). Among the many biologic mechanisms underlying DN, inflammation in the kidney by mononuclear phagocytic lineage cells (9)(10)(11) and the impact of growth factors and proinflammatory cytokines, such as IL-1, IL-6, IL-18, and TNF-a, and other chemokines may have direct or indirect contributions to the pathogenesis of DN (12,13).…”

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confidence: 99%

hs-CRP Is Associated With Incident Diabetic Nephropathy: Findings From the Jackson Heart Study

et al. 2019

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African Americans (AA) suffer disproportionately from diabetic nephropathy (DN). C-reactive protein (CRP) has been associated with prevalent DN, but its association with incident DN in AA is unknown. We examined hs-CRP and incident DN in AA. RESEARCH DESIGN AND METHODSWe conducted a longitudinal analysis of data from exams 1, 2, and 3 in 4,043 eligible Jackson Heart Study (JHS) participants. Participants with DN or without hs-CRP at exam 1 were excluded. Incident DN was defined as urinary albumin-to-creatinine ratio (ACR) >30 mg/g or self-reported dialysis/transplantation and type 2 diabetes mellitus (DM) or HbA 1c >6.5% by exam 2 or 3 among participants free of DN at exam 1. Kaplan-Meier curves examined DN event-free survival probability by hs-CRP. With Cox proportional hazards regression we estimated hazard ratios (HRs) and 95% CI for DN by hs-CRP tertiles, adjusting for demographics and clinical and laboratory data. RESULTSDuring 7.8 years of median follow-up time, participants who developed DN had significantly higher baseline hs-CRP, age, fasting glucose, triglycerides, ACR, systolic blood pressure, waist circumference, and duration of DM (P < 0.05). The overall incident rate of DN was 7.9%. The mean time to incident DN was shorter for participants with hs-CRP in the high tertile (>4.24 mg/L) than in the low tertile (<1.46 mg/L); P < 0.001. Participants with high hs-CRP had higher incidence of DN (HR 2.34, 95% CI 1.04-5.24) versus the reference group. CONCLUSIONSInflammation, as measured by hs-CRP levels, may be associated with incident DN in AA. Further studies are warranted to replicate and elucidate the basis for this association.The prevalence of diabetic nephropathy (DN) and end-stage kidney disease (ESKD) among individuals with type 2 diabetes mellitus (DM) has been rising (1). Racial/ethnic minority populations are disproportionately affected by DM and its complications, particularly DN and end-stage kidney disease (2-5). The reasons behind these disparities have not been fully elucidated but may involve a complex interplay of social, cultural, and environmental factors juxtaposed with their impact on gene expression (epigenetics), differing frequencies of select gene polymorphisms, and

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Current State and Future Trends to Optimize the Care of Chronic Kidney Disease in African Americans

Cited by 14 publications

References 66 publications

Ethnic minority disparities in progression and mortality of pre-dialysis chronic kidney disease: a systematic scoping review

Ethnic minority disparities in progression and mortality of pre-dialysis chronic kidney disease: a systematic scoping review

Examining the Potential Impact of Race Multiplier Utilization in Estimated Glomerular Filtration Rate Calculation on African-American Care Outcomes

hs-CRP Is Associated With Incident Diabetic Nephropathy: Findings From the Jackson Heart Study

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