Race and Mortality in CKD and Dialysis: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study

Ku, Elaine; Yang, Wei; McCulloch, Charles E.; Feldman, Harold I.; Go, Alan S.; Lash, James P.; Bansal, Nisha; He, Jiang; Horwitz, Ed; Ricardo, Ana C.; Shafi, Tariq; Sondheimer, James; Townsend, Raymond R.; Waikar, Sushrut S.; Hsu, Chi‐yuan; Appel, Lawrence J.; Kusek, John W.; Rao, Panduranga S.; Rahman, Mahboob

doi:10.1053/j.ajkd.2019.08.011

Cited by 22 publications

(17 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Each imaging modality (ASL, MRSI, and DTI) was analyzed separately. Imaging data in controls, as well as preand post-KT groups, were adjusted for covariates of age, 32 race, 33 sex, 34 and education level 35,36 that can confound results. Because the exact time for KT is unpredictable, a linear mixed model approach was used to account for repeated observations on participants.…”

Section: Statistical Analysesmentioning

confidence: 99%

Normalization of Cerebral Blood Flow, Neurochemicals, and White Matter Integrity after Kidney Transplantation

Lepping¹,

Montgomery²,

Sharma³

et al. 2020

JASN

View full text Add to dashboard Cite

BackgroundCKD is associated with abnormalities in cerebral blood flow, cerebral neurochemical concentrations, and white matter integrity. Each of these is associated with adverse clinical consequences in the non-CKD population, which may explain the high prevalence of dementia and stroke in ESKD. Because cognition improves after kidney transplantation, comparing these brain abnormalities before and after kidney transplantation may identify potential reversibility in ESKD-associated brain abnormalities.MethodsIn this study of patients with ESKD and age-matched healthy controls, we used arterial spin labeling to assess the effects of kidney transplantation on cerebral blood flow and magnetic resonance spectroscopic imaging to measure cerebral neurochemical concentrations (N-acetylaspartate, choline, glutamate, glutamine, myo-inositol, and total creatine). We also assessed white matter integrity measured by fractional anisotropy (FA) and mean diffusivity (MD) with diffusion tensor imaging. We used a linear mixed model analysis to compare longitudinal, repeated brain magnetic resonance imaging measurements before, 3 months after, and 12 months after transplantation and compared these findings with those of healthy controls.ResultsStudy participants included 29 patients with ESKD and 19 controls; 22 patients completed post-transplant magnetic resonance imaging. Cerebral blood flow, which was higher in patients pretransplant compared with controls (P=0.003), decreased post-transplant (P<0.001) to values in controls. Concentrations of neurochemicals choline and myo-inositol that were higher pretransplant compared with controls (P=0.001 and P<0.001, respectively) also normalized post-transplant (P<0.001 and P<0.001, respectively). FA increased (P=0.001) and MD decreased (P<0.001) post-transplant.ConclusionsCertain brain abnormalities in CKD are reversible and normalize with kidney transplantation. Further studies are needed to understand the mechanisms underlying these brain abnormalities and to explore interventions to mitigate them even in patients who cannot be transplanted.Clinical Trial registry name and registration number:Cognitive Impairment and Imaging Correlates in End Stage Renal Disease, NCT01883349

show abstract

Section: Statistical Analysesmentioning

confidence: 99%

Normalization of Cerebral Blood Flow, Neurochemicals, and White Matter Integrity after Kidney Transplantation

Lepping¹,

Montgomery²,

Sharma³

et al. 2020

JASN

View full text Add to dashboard Cite

show abstract

“…Reasons underlying the paradoxical survival advantage among minority racial/ethnic dialysis patients have been proposed. The survival advantage may be due to multiple factors [6,[20][21][22][23][24][25]. Heterogeneity in the cause of ESRD could be one of the factors that contributes to better or worse survival rate among dialysis patients.…”

Section: Discussionmentioning

confidence: 99%

“…Heterogeneity in the cause of ESRD could be one of the factors that contributes to better or worse survival rate among dialysis patients. Black patients who start dialysis due to APOL1associated kidney disease are more likely to be younger or healthier at the time of dialysis initiation, whereas patients with other predisposing comorbid conditions who develop ESRD may have poorer health status [20]. Socioeconomic factors (e.g.…”

Section: Discussionmentioning

confidence: 99%

Association between ethnicity and kidney transplant waitlist outcomes beyond estimated post‐transplant survival score

Homkrailas

Bunnapradist

2021

Transpl Int

View full text Add to dashboard Cite

White kidney transplant candidates have the highest pre-transplant mortality rate compared to other ethnicities. The reason for a higher mortality rate is not well-understood. Estimated post-transplant survival (EPTS) score has been used to predict patient survival after transplant and may be associated with pre-transplant survival. First-time kidney transplant candidates listed between 2015 and 2018 were identified from the Organ Procurement Transplantation Network database. Individuals listed for multiple organs, at multiple centers, and age <18 years were excluded. We examined the impact of ethnicity on waitlist mortality and delisting. A total of 114 806 candidates were included. The study population was categorized into four groups which were 43% white, 28% Black, 19.2% Hispanic, and 9.8% "other ethnicities." At 5.2 years, the cumulative incidences of death and delist were 32%, 31%, 29%, and 26%, respectively. Compared to whites, adjusted subdistribution hazard ratio (aSHR) for death and delist among Black, Hispanics, and "other ethnicities" were 0.92 (95% CI 0.89-0.95), 0.89 (95% CI 0.85-0.91), and 0.76 (95% CI 0.72-0.80) after adjustment by EPTS along with other factors, respectively. After adjusting for EPTS score along with additional confounding factors and functional status at initial listing, white ethnicity was independently associated with an increased risk for death and delist.

show abstract

“…Thus, correction for hematocrit is important for accurate CBF measurements in ESKD. Our models were adjusted for age, 53 race, 54 sex, 55 and level of education. 56,57 Age in particular is associated with changes in brain volume and function, and age-related changes observed over many years could be In summary, abnormalities in CBF, neurochemical concentrations and white matter integrity in CKD are normalized with KT.…”

Section: Discussionmentioning

confidence: 99%

“…Each imaging modality (ASL, MRSI and DTI) was analyzed separately. Imaging data in controls, as well as pre- and post-KT groups were adjusted for covariates of age, 53 race, 54 sex, 55 and education level 56, 57 that can confound results. Since the exact time for KT is unpredictable, a linear mixed-model approach was used to account for repeated observations on participants.…”

Section: Discussionmentioning

confidence: 99%

Normalization of Cerebral Blood Flow, Neurochemicals, and White Matter Integrity After Kidney Transplantation

Lepping

Montgomery

Sharma

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Chronic kidney disease (CKD) is associated with abnormalities in cerebral blood flow (CBF), cerebral neurochemical concentrations and white matter integrity, each of which are associated with adverse clinical consequences in the non-CKD population, and may explain the high prevalence of dementia and stroke in end stage kidney disease (ESKD). Since cognition improves after kidney transplantation (KT), we examined these brain abnormalities pre-to post-KT to identify potential reversibility in ESKD-associated brain abnormalities. Methods: We measured the effects of KT on CBF assessed by arterial spin labeling, cerebral neurochemical concentrations (N-acetylaspartate, choline, glutamate and glutamine, myo-inositol and total creatine) measured by magnetic resonance spectroscopic imaging, and white matter integrity measured by fractional anisotropy (FA) and mean diffusivity (MD) with diffusion tensor imaging. We used a linear mixed model analysis to compare longitudinal, repeated brain MRI measurements pre-KT, and 3 months and 12 months post-KT, and also compared findings with healthy controls. Results: 29 ESKD patients and 19 age-matched healthy controls participated in the study. 22 patients underwent post-KT MRI. CBF, which was higher pre-KT than in controls (p=0.003), decreased post-KT (p<0.0001) to values in controls. KT also normalized concentrations of osmotic neurochemicals choline (p<0.0001) and myo-inositol (p=0.0003) that were higher pre-KT compared to controls. Post-KT, FA increased (p=0.001) and MD decreased (p=0.0001). Conclusions: Brain abnormalities in CKD are reversible and normalize with KT. Further studies are needed to understand the mechanisms underlying these brain abnormalities and to explore interventions to mitigate them even in patients who cannot be transplanted.

show abstract

Race and Mortality in CKD and Dialysis: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study

Cited by 22 publications

References 61 publications

Normalization of Cerebral Blood Flow, Neurochemicals, and White Matter Integrity after Kidney Transplantation

Normalization of Cerebral Blood Flow, Neurochemicals, and White Matter Integrity after Kidney Transplantation

Association between ethnicity and kidney transplant waitlist outcomes beyond estimated post‐transplant survival score

Normalization of Cerebral Blood Flow, Neurochemicals, and White Matter Integrity After Kidney Transplantation

Contact Info

Product

Resources

About