Recruitment of Hispanics into an observational study of chronic kidney disease: The Hispanic Chronic Renal Insufficiency Cohort Study experience

Abstract

Despite the large burden of chronic kidney disease (CKD) in Hispanics, this population has been underrepresented in research studies. We describe the recruitment strategies employed by the Hispanic Chronic Renal Insufficiency Cohort Study, which led to the successful enrollment of a large population of Hispanic adults with CKD into a prospective observational cohort study. Recruitment efforts by bilingual staff focused on community clinics with Hispanic providers in high-density Hispanic neighborhoods in Chicago, academic medical centers, and private nephrology practices. Methods of publicizing the study included church meetings, local Hispanic print media, Spanish television and radio stations, and local health fairs. From October 2005 to July 2008, we recruited 327 Hispanics aged 21–74 years with mild-to-moderate CKD as determined by age-specific estimated glomerular filtration rate (eGFR). Of 716 individuals completing a screening visit, 49% did not meet eGFR inclusion criteria and 46% completed a baseline visit. The mean age at enrollment was 57.1 and 67.1% of participants were male. Approximately 75% of enrolled individuals were Mexican American, 15% Puerto Rican, and 10% had other Latin American ancestry. Eighty two percent of participants were Spanish-speakers. Community-based and academic primary care clinics yielded the highest percentage of participants screened (45.9% and 22.4%) and enrolled (38.2% and 24.5%). However, academic and community-based specialty clinics achieved the highest enrollment yield from individuals screened (61.9% to 71.4%). A strategy focused on primary care and nephrology clinics and the use of bilingual recruiters allowed us to overcome barriers to the recruitment of Hispanics with CKD.

Strategies addressing barriers to clinical trial enrollment of underrepresented populations: A systematic review

“…[20–26] Of the remaining eleven publications, one[27] was designed to support the infrastructure for community-based clinical trials related to diabetes and hypertension management. The other publications reported on enrollment efforts for specific trials related to patient management for chronic conditions (n=7) [28–34], an observational study of chronic kidney disease [35], hormonal therapy[36] and sexually-transmitted infections. [37]…”

CKD Progression and Mortality among Hispanics and Non-Hispanics

“…12,24 The CRIC and H-CRIC Studies assembled the first large longitudinal cohort of Hispanics with CKD in the United States by overcoming known barriers to recruiting and evaluating Hispanics into clinical studies, including bilingual recruitment strategies and study instruments. 25,26 Through robust primary and secondary data collection on clinical exposures and events, these studies offer an excellent opportunity to examine understudied relations between race/ethnicity, CKD, and outcomes. 27,28 Furthermore, the CRIC Study has employed rigorous methodologic approaches to study CKD epidemiology, including the refinement of outcome measures and analytic strategies (e.g., complementary time to event and slope analyses, competing risk analyses) for CKD progression.…”

“…Exclusion criteria included inability to consent, New York Heart Association class 3 or 4 heart failure, cirrhosis, HIV/AIDS, polycystic kidney disease, prior dialysis therapy or transplant, immunosuppressive therapy within 6 months, or chemotherapy for cancer within 2 years. The H-CRIC Study, an ancillary study to the CRIC Study, adopted eligibility and exclusion criteria identical to the parent study 11 25 Both studies were approved by the institutional review boards of the participating centers, and the research was conducted in accordance with the principles of the Declaration of Helsinki. All study participants provided written informed consent.…”

Predictors and Outcomes of Health–Related Quality of Life in Adults with CKD

“…Major eligibility criteria for the CRIC Study included adults ages 21-74 years old with mild to moderate CKD using age-based eGFR on the basis of the fourvariable Modification of Diet in Renal Disease estimating equation (15). Aside from recruiting only participants of Hispanic ethnicity, the H-CRIC Study adopted eligibility and exclusion criteria identical to the CRIC Study (16 (17). Participants from the CRIC and H-CRIC Studies comprise the cohort for these analyses.…”