Fp329impact of Educational Attainment on Health Outcomes in Moderate-to-Severe Chronic Kidney Disease

Morton, Rachael L.; Schlackow, Iryna; Staplin, Natalie; Gray, Alastair; Cass, Alan; Haynes, Richard; Emberson, Jonathan; Herrington, William G; Landray, Martin J; Baigent, Colin; Mihaylova, Borislava

doi:10.1093/ndt/gfv175.11

Cited by 3 publications

(2 citation statements)

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“…Compounding this with socioeconomic deprivation could further hinder access to specialist care and optimal treatment, as has been observed for patients with moderate-to-severe CKD (22). 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).…”

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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“…Poverty and adverse SDOH can worsen CKD and its poor outcomes, 5 and are mutually reinforcing. 6 Improving CKD outcomes interrupts this vicious cycle. Thus, these multidisciplinary teams could yield long-term benefits for patients and communities traditionally left behind.…”

Section: Expected Benefitsmentioning

confidence: 99%

The New Kidney-Focused Companies: A Privatized Approach to Value-Based Care and Addressing Social Determinants of Health

Lin

Dave

Kshirsagar

2022

JASN

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HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis

Tunnicliffe,

Palmer,

Cashmore

et al. 2023

Cochrane Database of Systematic Reviews

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BACKGROUND: Cardiovascular disease (CVD) is the most frequent cause of death in people with early stages of chronic kidney disease (CKD), for whom the absolute risk of cardiovascular events is similar to people who have existing coronary artery disease. This is an update of a review published in 2009, and includes evidence from 27 new studies (25,068 participants) in addition to the 26 studies (20,324 participants) assessed previously; and excludes three previously included studies (107 participants). This updated review includes 50 studies (45,285 participants); of these 38 (37,274 participants) were meta-analysed. OBJECTIVE: To evaluate the benefits (such as reductions in all-cause and cardiovascular mortality, major cardiovascular events, MI and stroke; and slow progression of CKD to end-stage kidney disease (ESKD)) and harms (muscle and liver dysfunction, withdrawal, and cancer) of statins compared with placebo, no treatment, standard care or another statin in adults with CKD who were not on dialysis. METHODS:Search methods: We searched the Cochrane Renal Group's Specialised Register to 5 June 2012 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs that compared the effects of statins with placebo, no treatment, standard care, or other statins, on mortality, cardiovascular events, kidney function, toxicity, and lipid levels in adults with CKD not on dialysis were the focus of our literature searches. Data collection and analysis: Two or more authors independently extracted data and assessed study risk of bias. Treatment effects were expressed as mean difference (MD) for continuous outcomes (lipids, creatinine clearance and proteinuria) and risk ratio (RR) for dichotomous outcomes (major cardiovascular events, all-cause mortality, cardiovascular mortality, fatal or non-fatal myocardial infarction (MI), fatal or nonfatal stroke, ESKD, elevated liver enzymes, rhabdomyolysis, cancer and withdrawal rates) with 95% confidence intervals (CI). MAIN RESULTS: We included 50 studies (45,285 participants): 47 studies (39,820 participants) compared statins with placebo or no treatment and three studies (5547 participants) compared two different statin regimens in adults with CKD who were not yet on dialysis. We were able to meta-analyse 38 studies (37,274 participants). The risk of bias in the included studies was high. Seven studies comparing statins with placebo or no treatment had lower risk of bias overall;

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Fp329impact of Educational Attainment on Health Outcomes in Moderate-to-Severe Chronic Kidney Disease

Cited by 3 publications

References 0 publications

Socioeconomic Position and Incidence of Glomerular Diseases

Socioeconomic Position and Incidence of Glomerular Diseases

The New Kidney-Focused Companies: A Privatized Approach to Value-Based Care and Addressing Social Determinants of Health

HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis

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