Disparities In Kidney Disease Research Articles

376 American Kidney Fund Health Equity Coalition: Interprofessional Collaboration Addressing Four Domains of Racial Disparities in Kidney Disease

376 American Kidney Fund Health Equity Coalition: Interprofessional Collaboration Addressing Four Domains of Racial Disparities in Kidney Disease

An Endorsement of the Removal of Race From GFR Estimation Equations: A Position Statement From the National Kidney Foundation Kidney Disease Outcomes Quality Initiative

An Endorsement of the Removal of Race From GFR Estimation Equations: A Position Statement From the National Kidney Foundation Kidney Disease Outcomes Quality Initiative

The Potential for Pragmatic Trials to Reduce Racial and Ethnic Disparities in Kidney Disease.

The well-documented and unacceptable racial and ethnic disparities in the prevalence and outcomes of kidney disease are receiving increased attention within and beyond the nephrology community, with numerous calls for intentional, active approaches to ensure that care is equitable and that

Housing: A Critical Contributor to Kidney Disease Disparities.

Housing: A Critical Contributor to Kidney Disease Disparities.

Intelligent Diagnostic Prediction and Classification Models for Detection of Kidney Disease

Kidney disease is a major public health concern that has only recently emerged. Toxins are removed from the body by the kidneys through urine. In the early stages of the condition, the patient has no problems, but recovery is difficult in the later stages. Doctors must be able to recognize this condition early in order to save the lives of their patients. To detect this illness early on, researchers have used a variety of methods. Prediction analysis based on machine learning has been shown to be more accurate than other methodologies. This research can help us to better understand global disparities in kidney disease, as well as what we can do to address them and coordinate our efforts to achieve global kidney health equity. This study provides an excellent feature-based prediction model for detecting kidney disease. Various machine learning algorithms, including k-nearest neighbors algorithm (KNN), artificial neural networks (ANN), support vector machines (SVM), naive bayes (NB), and others, as well as Re-cursive Feature Elimination (RFE) and Chi-Square test feature-selection techniques, were used to build and analyze various prediction models on a publicly available dataset of healthy and kidney disease patients. The studies found that a logistic regression-based prediction model with optimal features chosen using the Chi-Square technique had the highest accuracy of 98.75 percent. White Blood Cell Count (Wbcc), Blood Glucose Random (bgr), Blood Urea (Bu), Serum Creatinine (Sc), Packed Cell Volume (Pcv), Albumin (Al), Hemoglobin (Hemo), Age, Sugar (Su), Hypertension (Htn), Diabetes Mellitus (Dm), and Blood Pressure (Bp) are examples of these traits.

Diagnosis, Education, and Care of Patients with APOL1-Associated Nephropathy: A Delphi Consensus and Systematic Review.

APOL1 variants contribute to the markedly higher incidence of ESKD in Blacks compared with Whites. Genetic testing for these variants in patients with African ancestry who have nephropathy is uncommon, and no specific treatment or management protocol for APOL1-associated nephropathy currently exists. A multidisciplinary, racially diverse group of 14 experts and patient advocates participated in a Delphi consensus process to establish practical guidance for clinicians caring for patients who may have APOL1-associated nephropathy. Consensus group members took part in three anonymous voting rounds to develop consensus statements relating to the following: (1) counseling, genotyping, and diagnosis; (2) disease awareness and education; and (3) a vision for management of APOL1-associated nephropathy in a future when treatment is available. A systematic literature search of the MEDLINE and Embase databases was conducted to identify relevant evidence published from January 1, 2009 to July 14, 2020. The consensus group agreed on 55 consensus statements covering such topics as demographic and clinical factors that suggest a patient has APOL1-associated nephropathy, as well as key considerations for counseling, testing, and diagnosis in current clinical practice. They achieved consensus on the need to increase awareness among key stakeholders of racial health disparities in kidney disease and of APOL1-associated nephropathy and on features of a successful education program to raise awareness among the patient community. The group also highlighted the unmet need for a specific treatment and agreed on best practice for management of these patients should a treatment become available. A multidisciplinary group of experts and patient advocates defined consensus-based guidance on the care of patients who may have APOL1-associated nephropathy.

COVID-19 mortality among kidney transplant candidates is strongly associated with social determinants of health.

The COVID‐19 pandemic has affected all portions of the global population. However, many factors have been shown to be particularly associated with COVID‐19 mortality including demographic characteristics, behavior, comorbidities, and social conditions. Kidney transplant candidates may be particularly vulnerable to COVID‐19 as many are dialysis‐dependent and have comorbid conditions. We examined factors associated with COVID‐19 mortality among kidney transplant candidates from the National Scientific Registry of Transplant Recipients from March 1 to December 1, 2020. We evaluated crude rates and multivariable incident rate ratios (IRR) of COVID‐19 mortality. There were 131 659 candidates during the study period with 3534 all‐cause deaths and 384 denoted a COVID‐19 cause (5.00/1000 person years). Factors associated with increased COVID‐19 mortality included increased age, males, higher body mass index, and diabetes. In addition, Blacks (IRR = 1.96, 95% C.I.: 1.43–2.69) and Hispanics (IRR = 3.38, 95% C.I.: 2.46–4.66) had higher COVID‐19 mortality relative to Whites. Patients with lower educational attainment, high school or less (IRR = 1.93, 95% C.I.: 1.19–3.12, relative to post‐graduate), Medicaid insurance (IRR = 1.73, 95% C.I.: 1.26–2.39, relative to private), residence in most distressed neighborhoods (fifth quintile IRR = 1.93, 95% C.I.: 1.28–2.90, relative to first quintile), and most urban and most rural had higher adjusted rates of COVID‐19 mortality. Among kidney transplant candidates in the United States, social determinants of health in addition to demographic and clinical factors are significantly associated with COVID‐19 mortality.

COVID-19, Racism, and Racial Disparities in Kidney Disease: Galvanizing the Kidney Community Response.

PodcastThis article contains a podcast athttps://www.asn-online.org/media/podcast/JASN/2020_07_21_JASN2020060809.mp3.

COVID-19 and Kidney Disease Disparities in the United States

Racial, ethnic, socioeconomic, age, and sex-related health disparities in kidney disease are prominent in the United States. The Coronavirus Disease 2019 (COVID-19) pandemic has disproportionately affected marginalized populations. Older adults, people experiencing unstable housing, racial and ethnic minorities, and immigrants are potentially at increased risk for infection and severe complications from COVID-19. The direct and societal effects of the pandemic may increase risk of incident kidney disease and lead to worse outcomes for those with kidney disease. The rapid transition to telemedicine potentially limits access to care for older adults, immigrants, and people experiencing unstable housing. The economic impact of the pandemic has had a disproportionate effect on women, minorities, and immigrants, which may limit their ability to manage kidney disease and lead to complications or kidney disease progression. We describe the impact of COVID-19 on marginalized populations and highlight how the pandemic may exacerbate existing disparities in kidney disease.

At the Research-Clinical Interface: Returning Individual Genetic Results to Research Participants.

Whether individual results of genetic research studies ought to be disclosed to study participants has been debated in recent decades. Previously, the prevailing expert view discouraged the return of individual research results to participants because of the potential lack of analytic validity, questionable clinical validity and medical actionability, and questions about whether it is the role of research to provide participants with their data. With additional knowledge of participant perspectives and shifting views about the benefits of research and respect for participants, current expert consensus is moving toward support of returning such results. Significant ethical controversies remain, and there are many practical questions left to address, including appropriate procedures for returning results and the potential burden to clinicians when patients seek guidance about the clinical implications of research results. In this review, we describe current views regarding the return of genetic research results, including controversies and practical challenges, and consider the application of these issues to research on apolipoprotein L1 (APOL1), a gene recently associated with health disparities in kidney disease. Although this case is unique, it illustrates the complexities involved in returning results and highlights remaining questions.

Editorial note: welcome to Volume 23 and the year 2020

The Editorial Board of African Journal of Nephrology (AJN) and I wish all readers, contributors and reviewers a very happy and successful year 2020. The year 2019 was a very productive year for AJN and the African Association of Nephrology (AFRAN). The 2019 AFRAN congress, held from 25 to 29 September 2019 in Mombasa (Kenya), was a very successful one, with the participation of hundreds of delegates from all regions of Africa. The congress was held in partnership with the Kenya Renal Association and the African Paediatric Nephrology Association (AFPNA). The main congress was preceded by several successful courses. Prof Antony Were from Kenya was elected President of AFRAN. The next AFRAN congress will be held next year in Côte d’Ivoire. In 2019, we published excellent reviews covering global disparities in kidney disease and its treatment as well as the use of data from renal registries in randomised controlled trials. We therefore encourage our readers to participate in the collection of data for registries as well as to make use of registry data for research. The AJN 2019 volume also published excellent original articles that showcased the strength of clinical nephrology research in various regions of Africa. The year 2020 is expected to witness several national and regional nephrology meetings. I urge all convenors to use AJN to publicize their meetings, as well as publish their proceedings. The World Congress of Nephrology will take place in Abu Dhabi from 26 to 29 March 2020. This year, World Kidney Day is scheduled for Thursday, 12 March 2020. The theme is “Kidney Health for Everyone Everywhere – from Prevention to Detection and Equitable Access to Care”. I am confident that, in 2020, AJN will continue the trends set in the previous year, by publishing outstanding in-depth review articles as well as interesting original research articles. Finally, I am pleased to announce that this year, the South African Renal Society Congress will take place in Durban at the International Convention Centre, from 25-29 November 2020. The theme of the congress is “Big Data and Access to Quality Renal Care”. As President of the Local Organising Committee, I invite everyone to SARS Congress 2020. WOZA – DURBAN! Alain G AssoungaEditor-in-Chief

Burden, Access, and Disparities in Kidney Disease

Burden, Access, and Disparities in Kidney Disease

Alpha Globin Gene Copy Number Is Associated with Kidney Disease Among Black Individuals

Introduction: In addition to forming hemoglobin in red blood cells, alpha globin (HBA) has non-erythroid effects and is expressed in vascular endothelial cells where it interacts with endothelial nitric oxide (NO) synthase (eNOS) to limit nitric oxide diffusion across the myoendothelial junction. Reduced expression of HBA or disruption of HBA/eNOS interactions increases endothelial nitric oxide signaling. Humans have 0 to 3 copies of HBA per chromosome and Black individuals have increased variation in HBA allele count. Moreover, Black individuals are more likely to develop end-stage kidney disease (ESKD) and unexplained genetic factors may contribute to racial disparities in kidney disease not attributable to socioeconomic factors. Given that decreased endothelial NO signaling accelerates renal disease in mouse models, we hypothesized that lower HBA gene copy number would be associated with lower risk of kidney disease among Black individuals. Methods: We used droplet digital PCR to measure HBA copy number in Black individuals enrolled in the REasons for Geographic and Racial Differences in Stroke cohort. This national, prospective observational study enrolled 30,239 men and women >45 years of age from the 48 contiguous United States. Prevalent chronic kidney disease (CKD) was defined as eGFR <60 ml/min/1.73m2or urine albumin/creatinine ratio ≥30 mg/g at enrollment. Incident end-stage kidney disease (ESKD) was identified by linkage to the United States Renal Data System. The relative risk (RR) of prevalent CKD was calculated using modified Poisson multivariable regression employing a linear effect of HBA allele count and adjusting for 13 pre-specified genetic, biomedical, and socioeconomic factors. The hazard ratio (HR) for incident ESKD was calculated using Cox proportional hazards regression with the same covariates. Results: HBA copy number ranged from 2 to 6 among 9,918 Black participants (4% with 2 copies, 28% with 3, 67% with 4, and 1% with ≥ 5), with 25% of all participants having CKD at baseline. Participants were followed for a median (25th, 75thpercentile) of 10.1 (5.5, 12.5) years for the development of ESKD, with 2.4% of all participants developing ESKD. As shown in the table, after multivariable adjustment and calculated relative to the most common copy number (4), model-estimated CKD risk was 23% lower among those with 2 copies and 12% lower among those with 3 copies of HBA, while CKD risk was 14% higher among those with 5 or 6 copies of HBA. In addition, relative to 4 copies, ESKD risk was 40% lower among those with 2 copies and 22% lower among those with 3 copies, while the risk of ESKD increased by 29% in those with 5 or 6 copies of HBA. Conclusions: We identified a novel, independent genetic association of HBA copy number with CKD prevalence and ESKD incidence among Black individuals in a national, prospective cohort study in the US. The findings are consistent with our hypothesis that decreased alpha globin gene expression could increase endothelial NO signaling in small renal arteries and confer protection against renovascular injury, while increased alpha globin gene expression couldlimit endothelial NO signaling. These findings suggest that further study of the impact of HBA expression on normal renal physiology and susceptibility to injury is needed. Disclosures Naik: Elsevier: Other: Content Editor.

Burden, access, and disparities in kidney disease

Kidney disease is a global public health problem; affects more than 750million persons worldwide. The burden of kidney disease varies substantially across the world, as does its detection and treatment. Emerging evidence suggests that developing countries have a similar or even greater kidney disease burden than developed countries. In many settings, rates of kidney disease and the provision of care are defined by socioeconomic, cultural, and political factors, leading to significant disparities, even in developed countries. These disparities exist across the spectrum of kidney disease -prevention, screening, care and treatment. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease. This editorial highlights these disparities and emphasizes the role of public policies and organizational structures in addressing them. We outline opportunities to improve our understanding of disparities, the best ways to address them, and how to streamline efforts toward achieving kidney health equity across the globe.

Carga, acceso y disparidades en enfermedad renal

Kidney disease is a global public health problem that affects more than 750 million persons worldwide. The burden of kidney disease varies substantially across the world, as does its detection and treatment. Although the magnitude and impact of kidney disease is better defined in developed countries, emerging evidence suggests that developing countries have a similar or even greater kidney disease burden. In many settings, rates of kidney disease and the provision of its care are defined by socioeconomic, cultural, and political factors, leading to significant disparities in disease burden, even in developed countries. These disparities exist across the spectrum of kidney disease-from preventive efforts to curb development of acute kidney injury (AKI) or chronic kidney disease (CKD), to screening for kidney disease among persons at high risk, to access to subspecialty care and treatment of kidney failure with renal replacement therapy (RRT). World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. In this editorial, we highlight these disparities and emphasize the role of public policies and organizational structures in addressing them. We outline opportunities to improve our understanding of disparities in kidney disease, the best ways for them to be addressed, and how to streamline efforts toward achieving kidney health equity across the globe.

Burden, access, and disparities in kidney disease

Burden, access, and disparities in kidney disease

Burden, access and disparities in kidney disease: chronic kidney disease hotspots and progress one step at a time.

The 2019 International Society of Nephrology World Kidney Day theme is Kidney Health for Everyone Everywhere. It focuses on the uneven burden of acute kidney injury and chronic kidney disease (CKD) in different communities, identifies disparities and challenges in access to care and calls for universal health coverage for prevention and early treatment of kidney disease. This topic is fully in line with the Clinical Kidney Journal (ckj) editorial strategy for improving worldwide kidney care without leaving any community behind. Indeed, the first PubMed-recorded use of the term CKD hotspot was in ckj, where it was defined as ‘countries, region[s], communities or ethnicities with higher than average incidence of CKD’. This issue of ckj contains the World Kidney Day editorial as well as contributions that illustrate two concepts: the need to validate biochemical thresholds generated in developed countries in other populations, as exemplified by Kidney Disease: Improving Global Outcomes CKD–mineral and bone disorder parameters in an African population, and the fact that some disease associations characteristic of developing countries may be described initially in developed countries, as exemplified by the association of APOL1 variants with CKD or by minimal change disease secondary to malaria, but have to be validated locally.

Burden, Access, and Disparities in Kidney Disease.

Kidney disease is a global public health problem, affecting over 750 million persons worldwide. The burden of kidney disease varies substantially across the world, as does its detection and treatment. In many settings, rates of kidney disease and the provision of its care are defined by socio-economic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. Here, we highlight that many countries still lack access to basic diagnostics, a trained nephrology workforce, universal access to primary health care, and renal replacement therapies. We point to the need for strengthening basic infrastructure for kidney care services for early detection and management of acute kidney injury and chronic kidney disease across all countries and advocate for more pragmatic approaches to providing renal replacement therapies. Achieving universal health coverage worldwide by 2030 is one of the World Health Organization's Sustainable Development Goals. While universal health coverage may not include all elements of kidney care in all countries, understanding what is feasible and important for a country or region with a focus on reducing the burden and consequences of kidney disease would be an important step toward achieving kidney health equity.

Заболевания почек: бремя болезни и доступность медицинской помощи

Заболевания почек: бремя болезни и доступность медицинской помощи

Burden, access, and disparities in kidney disease

Kidney disease is a global public health problem, affecting over 750 million persons worldwide. In many settings, rates of kidney disease and the provision of its care are defined by socio-economic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management.