National Kidney Foundation Research Articles

Analysis of bone mineral profile and TSH in early non-dialysis stages of chronic kidney disease - a retrospective cross-sectional study

The objective of this study is to analyse the levels of Thyroid stimulating hormone (TSH) and the Bone Mineral Profile (Vitamin D, Parathyroid hormone (PTH), calcium, phosphorus, magnesium, and alkaline phosphatase [ALP]) levels in the early stages of chronic kidney disease (CKD) based on Glomerular filtration rate (GFR). A retrospective analysis was conducted involving 247 CKD patients admitted to the nephrology department at Sri Ramachandra Medical College Hospital from January to June 2022. The estimated GFR (eGFR) was calculated utilizing the CKD-EPI formula provided by the National Kidney Foundation. All biomarkers were analysed using automated platforms. The baseline ages for the three groups were 52.5, 68, and 66.5 years respectively (p<0.001). The comparative analysis revealed statistically significant differences solely among Vitamin D, creatinine, PTH, and phosphorus across the three groups. Further correlation analysis demonstrated changes in bore significant correlations with only creatinine, vitamin D, and PTH. This study concludes that in the early stages of CKD, vitamin D followed by PTH appears to be the earliest biomarker for assessing CKD-Mineral and Bone Disorder (CKD-MBD) occurring prior to any alterations in calcium and phosphate levels. As such, early consideration of supplementation may prove beneficial in mitigating disease progression and preventing cardiovascular complications.

Evaluation of renal function: choosing the right equation

The article presents examples of the difference in estimated GFR (eGFR) results obtained using different CKD-EPI creatinine equations (2009) and (2021). In these examples, the results were not reclassified to a higher level of renal function, but the eGFR obtained remained within the same CKD stage despite the different equations. However, it should be borne in mind that a significant reclassification to higher eGFR categories may have undesirable consequences, such as changes in the composition of the CKD population and for initiation of renoprotection measures, dosing and discontinuation of certain medications, timely referral to a nephrologist and RRT planning.The article presents validated eGFR estimating equations according to the KDIGO 2024 Guidelines for the Evaluation and Management of CKD (CKD-EPI creatinine equation (2009), CKD-EPI creatinine equation (2021), CKD-EPI creatinine-cystatin C equation (2021), EKFC equation et al.), as well as eGFR calculators available on the National Kidney Foundation (NKF) website.

A-113 Evaluation of Cystatin C Ordering Trends in a Quaternary Care Health System

Abstract Background Cystatin C is an alternative and adjunct kidney biomarker to creatinine in the estimation of glomerular filtration rate (eGFR). The National Kidney Foundation and American Society of Nephrology have called for increased use of cystatin C in the evaluation of kidney function. Our institution brought cystatin C testing in-house in August 2021. The goal of this study was to evaluate the utilization and longitudinal ordering trends of cystatin C within our quaternary care health system. Methods Cystatin C is measured on a Roche cobas® c502 using an assay traceable to IFCC-certified reference material. The electronic health record system (Epic) was queried using Epic SlicerDicer to identify ordering trends within our academic medical center between July 2021 and January 2024. The frequency of unique (one-time) cystatin C orders and concomitant orders with creatinine was also conducted. An in-depth analysis and chart review was performed over a one-month period to evaluate ordering locations, underlying clinical conditions, including previous diagnosis of kidney disease, and correlations between cystatin C and creatinine measurements. Results Between July 2021 and January 2024, 11,577 tests were performed from 8,415 unique patients. Cystatin C orders remained stable since April 2022, with an average 370 orders (363-378) per month. Eighty percent of cystatin C test requests were accompanied with creatinine testing during the same encounter. In a detailed analysis of a one month period, cystatin C testing was primarily performed in patients with an existing diagnosis of kidney disease (66%) and in the evaluation of renal function in patients with a cancer diagnosis (23%). Conclusions There has been sustained adoption of cystatin C by providers at our institution. The majority of orders have occurred in patients with an underlying renal diagnosis, as well as comorbid or chronic conditions that may affect kidney function.

The National Kidney Foundation's CKD Learning Collaborative: Transforming Care across University Health in Kansas City, Missouri

The National Kidney Foundation's CKD Learning Collaborative: Transforming Care across University Health in Kansas City, Missouri

An expert discussion on the atypical hemolytic uremic syndrome nomenclature—identifying a road map to precision: a report of a National Kidney Foundation Working Group

The term atypical hemolytic uremic syndrome has been in use since the mid-1970s. It was initially used to describe the familial or sporadic form of hemolytic uremic syndrome as opposed to the epidemic, typical form of the disease. Over time, the atypical hemolytic uremic syndrome term has evolved into being used to refer to anything that is not Shiga toxin-associated hemolytic uremic syndrome. The term describes a heterogeneous group of diseases of disparate causes, a circumstance that makes defining disease-specific natural history and/or targeted treatment approaches challenging. A working group of specialty-specific experts in the thrombotic microangiopathies was convened to review the validity of this broad term in an era of swiftly advancing science and targeted therapeutics. A Delphi approach was used to define and interrogate some of the key issues related to the atypical hemolytic uremic syndrome nomenclature.

Dementia Care Among United States Dialysis Providers: A Mixed Methods Study Evaluating Clinician Comfort and Knowledge

Rationale & ObjectiveGiven the high burden of dementia in dialysis patients, the dialysis workforce needs to be prepared to provide high-quality, person-centered dementia care. We explored comfort with and knowledge of dementia among U.S. dialysis care providers. Study DesignWeb-based survey Setting & ParticipantsEmails were sent to National Kidney Foundation and National Association of Nephrology Technicians/Technologists membership listservs (9/26/22-10/22/22). 1121 respondents had complete data for analysis (57% 35-49 years; 62% female; 62%/22% white/Black) [including 81 physicians, 61 advanced practice providers, 230 nurse managers, 260 nurses, 202 social workers, 195 dietitians, and 86 dialysis patient care technicians]. ExposuresProvider role, age, tenure, gender, previous dementia training, awareness of dementia guidance. OutcomesDementia Knowledge (assessed using Dementia Knowledge Assessment Scale (DKAS; score range, 0-25)]. Analytic ApproachCharacteristics of respondents, comfort with dementia care, and dementia knowledge were summarized and tabulated overall and by role. Robust regression was used to obtain coefficients confidence intervals for the associations between characteristics and DKAS scores, adjusting for role and tenure. Free-text responses to an open-ended question about treating patients with dementia or cognitive impairment were analyzed using thematic analysis. ResultsDementia knowledge among U.S. dialysis providers may be limited (overall DKAS score = 17; range, 13-21 across roles), despite most reporting knowing when patients had dementia (97%) and receiving training in dementia care (62%). Further, training may be inadequate: those who reported receiving dementia training had lower DKAS scores than those who reported not receiving training (β=-3.9, 95% CI: -4.4,-3.4). Thematic analysis of open-ended responses suggested that the impact of dementia on dialysis care and management and treatment beyond dialysis care are challenging for providers. LimitationsData were self-reported and limited information was gathered about quality, content, and timing of dementia training received. ConclusionMany U.S. dialysis care providers had suboptimal dementia knowledge, despite reporting being comfortable with providing dementia care and reporting they received prior training. Qualitative findings indicate complexity among providers regarding comfort with and knowledge of treating patients with cognitive impairment. Targeted training for the dialysis workforce in dementia knowledge and best practices for person-centered dementia care is warranted.

Advancing Genetic Testing in Kidney Diseases: Report From a National Kidney Foundation Working Group

About 37 million people in the United States have chronic kidney disease, a disease that encompasses diseases of multiple causes. About 10% or more of kidney diseases in adults and about 70% of selected chronic kidney diseases in children are expected to be explained by genetic causes. Despite the advances in genetic testing and an increasing understanding of the genetic bases of certain kidney diseases, genetic testing in nephrology lags behind other medical fields. More understanding of the benefits and logistics of genetic testing is needed to advance the implementation of genetic testing in chronic kidney diseases. Accordingly, the National Kidney Foundation convened a Working Group of experts with diverse expertise in genetics, nephrology, and allied fields to develop recommendations for genetic testing for monogenic disorders and to identify genetic risk factors for oligogenic and polygenic causes of kidney diseases. Algorithms for clinical decision making on genetic testing and a road map for advancing genetic testing in kidney diseases were generated. An important aspect of this initiative was the use of a modified Delphi process to reach group consensus on the recommendations. The recommendations and resources described herein provide support to nephrologists and allied health professionals to advance the use of genetic testing for diagnosis and screening of kidney diseases.

Identifying Major Barriers to Home Dialysis (The IM-HOME Study): Findings From a National Survey of Patients, Care Partners, and Providers

Rationale & ObjectiveDeveloping strategies to improve home dialysis use requires a comprehensive understanding of barriers. We sought to identify the most important barriers to home dialysis use from the perspective of patients, care partners, and providers. Study DesignThis is a convergent parallel mixed-methods study. Setting & ParticipantsWe convened a seven-member advisory board of patients, care partners, and providers who collectively developed lists of major patient/care partner-perceived barriers and provider-perceived barriers to home dialysis. We used these lists to develop a survey that was distributed to patients, care partners, and providers—through the American Association of Kidney Patients and the National Kidney Foundation. The surveys asked participants to: 1) rank their top three major barriers (quantitative); and 2) describe barriers to home dialysis (qualitative). Analytical ApproachWe compiled a list of the top three patient/care partner-perceived and top three provider-perceived barriers (quantitative) and conducted a directed content analysis of open-ended survey responses (qualitative). ResultsThere were 522 complete responses (233 providers; 289 patients/care partners). The top three patient/care partner-perceived barriers were: fear of performing home dialysis; lack of space; and the need for home-based support. The top three provider-perceived barriers were: poor patient education; limited mechanisms for home-based support staff, mental health, and education; and lack of experienced staff. We identified nine themes through qualitative analysis: limited education; financial disincentives; limited resources; high burden of care; built environment/structure of care delivery that favor in-center hemodialysis; fear and isolation; perceptions of inequities in access to home dialysis; provider perspectives about patients; and patient/provider resiliency. LimitationsThis was an online survey that is subject to non-response bias. ConclusionsThe top three barriers to home dialysis for patient/care partners and providers incompletely overlap, suggesting the need for diverse strategies that simultaneously address patient-perceived barriers at home and provider-perceived barriers in the clinic.

Bridging the Gap in Genomic Implementation: Identifying User Needs for Precision Nephrology

Genomic medicine holds transformative potential for personalized nephrology care; however, its clinical integration poses challenges. Automated clinical decision support (CDS) systems in the electronic health record (EHR) offer a promising solution but have shown limited impact. This study aims to glean practical insights into nephrologists' challenges using genomic resources, informing precision nephrology decision support tools. We conducted an anonymous electronic survey among US nephrologists from January 19, 2021 to May 19, 2021, guided by the Consolidated Framework for Implementation Research. It assessed practice characteristics, genomic resource utilization, attitudes, perceived knowledge, self-efficacy, and factors influencing genetic testing decisions. Survey links were primarily shared with National Kidney Foundation members. We analyzed 319 surveys, with most respondents specializing in adult nephrology. Although respondents generally acknowledged the clinical use of genomic resources, varying levels of perceived knowledge and self-efficacy were evident regarding precision nephrology workflows. Barriers to genetic testing included cost/insurance coverage and limited genomics experience. The study illuminates specific hurdles nephrologists face using genomic resources. The findings are a valuable contribution to genomic implementation research, highlighting the significance of developing tailored interventions to support clinicians in using genomic resources effectively. These findings can guide the future development of CDS systems in the EHR. Addressing unmet informational and workflow support needs can enhance the integration of genomics into clinical practice, advancing personalized nephrology care and improving kidney disease outcomes. Further research should focus on interventions promoting seamless precision nephrology care integration.

#2454 Meeting guideline goals at hemodialysis patients impact their survival?

Abstract Background and Aims The Institute of Medicine (IOM) defines clinical practice guidelines as "statements that include recommendations, intended to optimize patient care, that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options". First publication of Clinical Guidelines by the National Kidney Foundation (NKF), addressing good clinical practice in hemodialysis, was published in 1998. The aim of the present study was to investigate the influence of adherence to current guidelines of Mineral and Bone Disorders, Anemia and Adequacy of Dialysis, on their survival in patients undergoing hemodialysis. Method This is a single center retrospective study of 113 chronic hemodialysis patients (79 males and 34 females), with median age 70 years (56, 78), median duration on hemodialysis 52 months (21, 95). Based on whether or not they met the KDIGO guidelines’ targets for anemia, bone disease, dialysis adequacy, and the targets of all three guidelines during the last three years, patients were divided in two groups: group A with the patients who met the goals of the guidelines and group B with the patients who did not meet the goals. Clinical and biochemical parameters were compared among the groups of patients as well as hemodialysis adequacy (Kt/V). The survival analysis of the patients was calculated by Kaplan-Meier, while the possible effect of any parameter on survival was also evaluated with Cox-Regression. Results There was significant difference between the two groups in age, phosphorous (P), PTH, Kt/V, URR and Alb. There was no significant difference between the two groups in sex, duration of HD, Hemoglobin (Hg), Calcium (Ca++), Hypertension and Diabetes (Table). In Cox analyses, patient survival was associated with delivered dialysis dose (single pool Kt/V, p=0.044). There was no significant difference between the two groups when we compare the adherence to guidelines for MBD (p=0.507) and anemia (p=0.394). There was no statistical difference when we compare the achievement of targets of all three guidelines (p=0.796). We identified as an independent risk factor for patient survival the serum albumin (p<0.001). Patient survival was better with higher dialysis dose and adequate serum albumin level. Conclusion Clinical guidelines are useful tools for good clinical practice for hemodialysis patients. Adherence to clinical guidelines regarding dialysis adequacy is an independent risk factor for better survival of patients undergoing hemodialysis.

#2892 The role of physical activity in onco-nephrology; a new weapon in the management of urological malignancies

Abstract Background and Aims New clinical evidence demonstrated that Physical Activity (PA) brings numerous benefits both at the level of Health-RelatedQuality of Life (HRQoL), biological mechanisms and at the psychological level. Indeed, it is well known that cancer treatments results in a series of symptoms and side effects that debilitates the patients with cancer and can be counteracted with physical activity. PA has an effect on several aspects of biological mechanisms: sex hormones, metabolic hormones, inflammation and adiposity, and immune function. Furthermore, strong evidence shows that aerobic or combined (aerobic and endurance) training reduces symptoms of anxiety, depression and fatigue. Combined training also leads to improvements in HRQoL, preventing and improving muscle loss and sarcopenia. This study aims to assess the influence of physical activity on this improved scenario. Method A consecutive cohort of 82 pts was enrolled in the Urological Department at San Raffaele Scientific Institute between 2018-2021. The control group (CT) was composed of 31 patients affected by CKD alone (GFR < 60 ml/min/1.73 m2, K-DIGO 2012 classification) and 51 patients with CKD and a recent history of urological malignancies (within 12 months) represented the case group (CS). Inclusion criteria were: Age (>18 years old), eGFR (<60 ml/min/1.73), Malnutritional Screening Tool (MST<2), Urological Cancer aggressiveness (no metastatic process), Informed consent (signed). Each patient underwent an initial nephrological and nutritional evaluation during which a conventional CKD Mediterranean-like diet with a controlled protein intake (MCPD) (0.6-1 g total protein/kg body weight/die and 30-35 kcal/kg body weight/die) was prescribed together with physical activity recommendation according to The National Kidney Foundation (NKF) for a period of 6 months (±2 months). Physical activity recommendations included some aerobic exercise for 30 min on most days of the week, plus other activities to increase muscle strength (exercises with resistance bands) e/o to improve flexibility (such as stretching) once or twice a week. To assess the influence of physical activity within the collaborative nephrologist-nutritionist approach (NNCA) on enhanced kidney function, the Rapid Assessment of Physical Activity (RAPA) test was administered to each patient. The test consists of two indicators: RAPA 1 will indicate aerobic physical activity levels (from 0=sedentary to 7=physically active), while RAPA 2 will indicate other types of exercises (0=none; 1=strength; 2=flexibility; 3=both). Subsequently, Bioelectrical Impedance Analysis (BIA) was conducted on all participants in the cohort to collect data on Body Cell Mass per height squared (BCM/h2), Phase Angle (PA), Extracellular Mass (ECM)/BCM, and Extracellular to Intracellular water ratio (ECW/ICW). Statistical analysis: Linear regression and Pearson's Chi-Squared test; Data analysis: R programming language and RStudio integrated development environment. Results Table 1 shows the patient's baseline characteristics. Table 2 shows anthropometric indices and parameters at pre- and post-dietary and nephrological intervention. Table 3 underlines the poor condition prevalent in CKD patients with or without oncological history, also confirmed by the low level of usual physical activity detected by the RAPA test at T0. Sure enough, our population was mainly inactive and sedentary. Results show that, after the intervention, our patients became regularly active (RAPA 1 score T0: 2.47; RAPA 1 score T1: 3.17; Delta = + 0.7, p < 0.0001); the same trend was observed for RAPA 2 score (observed increase 14%, p < 0.002). Conclusion Based on these findings, it can be inferred that standard clinical care should incorporate thorough assessment of both nutritional status and PA. The adoption of a MCPD, coupled with exercise training within a collaborative nephrologist-nutritionist approach, emerges as a potential strategy to enhance the HRQoL of this particular kind of patient.

Epidemiological Characteristics of Chronic Renal Failure Patients of Hodeidah, Yemen in 2023

Chronic renal failure (CRF) is an emergent worldwide public health problem. The increasing incidence of CRF warrants a need for an epidemiological approach to better understand the disease and its prevention. Therefore, the study aims to describe the epidemiological characteristics of chronic renal failure patients in Hodeidah, Yemen. The study included 560 patients with CRF in retrospective study (a case series based on medical files) in Center of Dialysis and Renal Diseases of Hodeidah, Yemen from 1st January 2023 to 31st December 2023. The patients were diagnosed based on evidence – based clinical practice guideline of all stages of CRF that was extracted from the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKFKDOQI). Epidemiological data were reported with ethical approval consideration, data obtained were analyzed. 560 cases were diagnosed with renal failure, 555 patients (99.107 %) of them were diagnosed with CRF and 5 patients (0.89 %) were diagnosed with acute renal failure (ARF). CRF patients was founded 61.81 % in the males while 38.11 % in the females. However, this difference was statistically significant (X2= 30.921; p < 0.00001). The age range of patients was from 5 to 95 years, where 54.64% of cases occurred more than 50 years then 39.28 % between 18 to 49 years and the lower frequency was in children less than 18 years (5.22%) with different significant ( X2= 226.314 ; p < 0.00001). In addition, 81.98 % of patients in rural and 18.02 % in urban. The maximum cases were reported in summer session namely 13.21 % in July and 11.25 % in August. On the other hand , the major causes were chronic diseases 406 case (73.14 %) that diagnosed and recorded , 161 case (29 %) of hypertension ,132 case (23.78 %) of diabetes , 113 (20.36 %) of inflammation nephrolithiasis obstructive uropathy , 8 cases (1.44 %) of genetic polycystic renal disease , and 4 cases ( 0.72 % ) of sedative narcotic addiction and 137 case (24.68%) of unknown causes with different significant ( X2= 119.00 ; p < 0.00001). The chronic diseases namely diabetes and hypertension were the major causes reported to develop the CRF, therefore, to prevent the development of CRF based on center for control diseases and control (CDC), managing risk factors.

Development of CRISPR/Cas9-Based Mouse Models for X-linked Alport Syndrome

Intro: Alport Syndrome (AS) is a rare hereditary disorder characterized by progressive renal impairment and sensorineural hearing loss, resulting from mutations in the genes that encode COL4 synthesis. X-linked Alport Syndrome (XLAS) is the most common form of AS, comprising an estimated 80% of all human AS cases (the others being various forms of autosomal recessive or autosomal dominant AS), and is caused by various mutations on the COL4A5 gene. However, to date, there are no animal models of XLAS. Methods: To facilitate comprehensive preclinical investigations and therapeutic developments, we established two novel mouse models of XLAS using CRISPR/Cas9 technology. Leveraging the robust C57Bl/6J mouse strain, we precisely introduced the L1655R and C1570S mutations, which represent the predominant human variants of XLAS observed in the Western United States. Discussion: Our innovative mouse models not only serve as invaluable tools for elucidating the underlying mechanisms of XLAS pathogenesis but also provide a platform for evaluating the effcacy of potential therapeutic interventions. The establishment of these faithful genetic replicas of human XLAS marks a significant advancement in the field, offering unprecedented opportunities for in-depth mechanistic studies and the development of targeted therapeutic strategies for this debilitating renal and auditory disorder. This research is supported by the National Institutes of Health under Ruth L. Kirschstein National Research Service Award 5T32DK091317 from the National Institute of Diabetes and Digestive and Kidney Diseases and the National Kidney Foundation of Utah and Idaho. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

A Novel Approach for Assessing Mitochondrial Respiration in Freshly Isolated Glomerular and Tubular Fractions from Whole Mouse Kidney

Intro: Understanding mitochondrial function within specific renal compartments is crucial for unraveling the intricate metabolic processes underlying kidney physiology and pathophysiology. In this study, we present a novel method for accurately measuring mitochondrial respiration in freshly isolated glomerular and tubular fractions derived from dissected kidneys. Methods: Employing a differential adhesive sieving technique, we isolated glomerular and tubular fractions from freshly harvested whole kidneys (n=2) and subsequently utilized a standard substrate-inhibitor titration protocol to assess mitochondrial respiration in the Oroboros Oxygraph O2K (Oroboros Instruments, Innsbruck AT). Results: Notably, our findings revealed distinct state 3 respiration rates in various fractions, with the 70 μm tubule fraction exhibiting a rate of 2133.029 pmol/sec/mgprotein, the 40 μm tubule fraction displaying a rate of 522.4116 pmol/sec/mgprotein, the first glomerular fraction demonstrating a rate of 407.7911 pmol/sec/mgprotein, and the second tubular fraction manifesting a rate of 362.3286 pmol/sec/mgprotein. Moreover, these fragments exhibited differential substrate preferences, as the addition of succinate increased state 3 respiration by ~90% in the 70 μm tubule fraction. In contrast, succinate increased respiration by ~30% in the 40 μm tubule and glomerular fractions. Discussion: These ongoing experiments provide compelling evidence supporting the feasibility and reliability of our approach in quantifying mitochondrial respiration within isolated renal fractions. Our methodology not only enables precise measurements of mitochondrial function in distinct nephron segments but also lays the groundwork for further investigations into the physiological and pathological implications of mitochondrial dynamics in kidney health and disease. This research is supported by the National Institutes of Health under Ruth L. Kirschstein National Research Service Award 5T32DK091317 from the National Institute of Diabetes and Digestive and Kidney Diseases and the National Kidney Foundation of Utah and Idaho. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Effectiveness of a Brief Point of Care Ultrasound Course at a National Nephrology Conference.

The rising demand for point of care ultrasound (POCUS) instruction during nephrology fellowship has been limited due to a shortage of trained faculty and courses designed specifically for nephrologists. A hands-on POCUS pre-course was organized during the April 2023 National Kidney Foundation (NKF) Spring Clinical Meeting to address this challenge. The course consisted of pre-recorded lectures and a 4-hour hands-on workshop guided by multidisciplinary POCUS experts. The anonymous post-course survey received responses from 25 out of 39 participants, yielding a 64.1% response rate. On a scale of 0-10, confidence levels for acquiring kidney images rose from 2.6 + 2.3 (mean + SD) pre-workshop to 7.8 + 1.5 post-workshop (p<0.001). Similarly, a remarkable improvement in confidence for acquiring lung and cardiac images was seen as scores increased from 1.8 + 2.4 to 7.7 + 1.5 (p<0.001) and from 1.5 + 2.2 to 7.2 + 1.3 (p<0.001), respectively. Additionally, respondents reported a substantial improvement in their confidence to interpret kidney, lung, and cardiac POCUS images, with scores increasing from 4.5 + 2.2 to 7.7 + 1.1 (p<0.001), 2.3 + 2.4 to 7.6 + 1.5 (p<0.001), and 2 + 2 to 7.3 + 1.5 (p<0.001), respectively. Barriers to implementing POCUS use at institutions included a perceived lack of trained faculty, limited protected time for faculty, and insufficient support from division leadership. The NKF POCUS pre-course successfully improved participants' confidence in acquiring and interpreting basic POCUS images.

AI-driven translations for kidney transplant equity in Hispanic populations

Health equity and accessing Spanish kidney transplant information continues being a substantial challenge facing the Hispanic community. This study evaluated ChatGPT’s capabilities in translating 54 English kidney transplant frequently asked questions (FAQs) into Spanish using two versions of the AI model, GPT-3.5 and GPT-4.0. The FAQs included 19 from Organ Procurement and Transplantation Network (OPTN), 15 from National Health Service (NHS), and 20 from National Kidney Foundation (NKF). Two native Spanish-speaking nephrologists, both of whom are of Mexican heritage, scored the translations for linguistic accuracy and cultural sensitivity tailored to Hispanics using a 1–5 rubric. The inter-rater reliability of the evaluators, measured by Cohen’s Kappa, was 0.85. Overall linguistic accuracy was 4.89 ± 0.31 for GPT-3.5 versus 4.94 ± 0.23 for GPT-4.0 (non-significant p = 0.23). Both versions scored 4.96 ± 0.19 in cultural sensitivity (p = 1.00). By source, GPT-3.5 linguistic accuracy was 4.84 ± 0.37 (OPTN), 4.93 ± 0.26 (NHS), 4.90 ± 0.31 (NKF). GPT-4.0 scored 4.95 ± 0.23 (OPTN), 4.93 ± 0.26 (NHS), 4.95 ± 0.22 (NKF). For cultural sensitivity, GPT-3.5 scored 4.95 ± 0.23 (OPTN), 4.93 ± 0.26 (NHS), 5.00 ± 0.00 (NKF), while GPT-4.0 scored 5.00 ± 0.00 (OPTN), 5.00 ± 0.00 (NHS), 4.90 ± 0.31 (NKF). These high linguistic and cultural sensitivity scores demonstrate Chat GPT effectively translated the English FAQs into Spanish across systems. The findings suggest Chat GPT’s potential to promote health equity by improving Spanish access to essential kidney transplant information. Additional research should evaluate its medical translation capabilities across diverse contexts/languages. These English-to-Spanish translations may increase access to vital transplant information for underserved Spanish-speaking Hispanic patients.

Evaluating Laboratory Communications to NKF-WG Recommended Stakeholders during Implementation of the CKD-EPI 2021 Equation.

In 2022, the National Kidney Foundation's Laboratory Engagement Working Group (NKF-WG) released recommendations for clinical implementation of the race-free Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 estimated glomerular filtration rate (eGFR) equation.This study examined laboratory communications during CKD-EPI 2021 implementation including communication methods and delivery, content inclusion, and alignment with stakeholder inclusion as defined by the NKF-WG. An anonymous web-based survey was distributed to members of ADLM (AACC) and the American Society for Clinical Laboratory Science (ASCLS) in November 2022 to solicit laboratory directors of CLIA-licensed clinical laboratories in the United States. Seventeen questions covering topics related to implementation of CKD-EPI 2021, stakeholder inclusion, methods and timing of communications delivery, and content inclusion were surveyed. All participating laboratories (n = 28) reported including physicians/advanced practitioners in implementation communications, while only 10.7% reported inclusion of patients. When reporting on methods of communication, 81.5% (n = 27) of respondents reported using multiple methods of communication with providers and 88.8% issued provider communications prior to implementation. In contrast, when patient communications were delivered, 87.5% (n = 8) issued these communications exclusively after CKD-EPI 2021 implementation and the majority (6 of 8) reported using only one method of communication during delivery. When reporting on content inclusion, 64.3% (n = 28) of laboratories reported including concerns regarding previous race-based eGFR equations in communications with physicians/advanced practitioners, while only 16.7% (n = 18) of those who included this information did so with patients. Participants reported limited engagement in CKD-EPI 2021 laboratory-to-patient implementation communications as well as limited inclusion of additional stakeholder groups, as defined in the NKF-WG recommendations. Laboratories utilized multiple communication methods and deliveries in physician/advanced practitioner communications; however, this strategy was not replicated when engaging with additional NKF-WG stakeholder groups.

Enhancing Kidney Transplantation and the Role of Xenografts: Report of a Scientific Workshop Sponsored by the National Kidney Foundation

Chronic kidney disease affects an estimated 37 million people in the United States; of these, >800,000 have end-stage renal disease requiring chronic dialysis or a kidney transplant to survive. Despite efforts to increase the donor kidney supply, approximately 100,000 people are registered on the kidney transplant waitlist with no measurable decrease over the past 2 decades. Outcomes of kidney transplantation are significantly better than for chronic dialysis: kidney transplant recipients have lower rates of mortality and cardiovascular events and better quality of life, but waitlist time matters. Time on dialysis waiting for a deceased-donor kidney is a strong independent risk factor for outcomes after a kidney transplant. Deceased-donor recipients with waitlist times on dialysis <6 months have graft survival rates equivalent to living-donor recipients with waitlist times on dialysis >2 years. In 2021, >12,000 people had been on the kidney transplant waitlist for ≥5 years. As the gap between the demand for and availability of donor kidneys for allotransplantation continues to widen, alternative strategies are needed to provide a stable, sufficient, and timely supply. A strategy that is gaining momentum toward clinical application is pig-to-human kidney xenotransplantation. This report summarizes the proceedings of a meeting convened on April 11-12, 2022, by the National Kidney Foundation to review and assess the state of pig-to-human kidney xenotransplantation as a potential cure for end-stage renal disease.

Biomedical Evaluation of Early Chronic Kidney Disease in the Air Force: Building a Predictive Model from the Taiwan Military Health Service.

Chronic kidney disease (CKD) is one of the most common diseases worldwide. The increasing prevalence and incidence of CKD have contributed to the critical problem of high medical costs. Due to stressful environments, aircrew members may have a high risk of renal dysfunction. A better strategy to prevent CKD progression in Air Force personnel would be to diagnosis CKD at an early stage. Since few studies have been conducted in Taiwan to examine the long-term trends in early CKD in Air Force aircrew members, this study is highly important. We investigated the prevalence of CKD and established a predictive model of disease variation among aircrew members. In this retrospective study, we included all subjects who had received physical examinations at a military hospital from 2004 to 2010 and who could be tracked for four years. The Abbreviated Modification of Diet in Renal Disease Formula (aMDRD) was used to estimate the glomerular filtration rate (GFR) and was combined with the National Kidney Foundation/ Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) to identify CKD patients. A total of 212 aircrew members were assessed. The results showed that the prevalence of CKD was 3.8%, 9.4%, 9.0%, and 9.4% in each of the four years. According to the logistic regression analysis, abnormal urobilinogen levels, ketones, and white blood cell (WBC) counts in urine and a positive urine occult blood test increased the risk of CKD. A positive urine occult blood test can be used to predict the future risk of CKD. Moreover, the generalized estimating equation (GEE) model showed that a greater risk of CKD with increased examination time, age and seniority had a negative effect. In conclusion, abnormal urobilinogen levels, ketones, and urine WBC counts in urine as well as a positive urine occult blood test might serve as independent predictors for CKD. In the future, we can focus not only on annual physical examinations but also on simple and accurate examinations, such as urine occult blood testing, to determine the risk of CKD and prevent its progression in our aircrew members.

Toward Equitable Kidney Function Estimation in Critical Care Practice: Guidance From the Society of Critical Care Medicine's Diversity, Equity, and Inclusion in Renal Clinical Practice Task Force.

Accurate glomerular filtration rate (GFR) assessment is essential in critically ill patients. GFR is often estimated using creatinine-based equations, which require surrogates for muscle mass such as age and sex. Race has also been included in GFR equations, based on the assumption that Black individuals have genetically determined higher muscle mass. However, race-based GFR estimation has been questioned with the recognition that race is a poor surrogate for genetic ancestry, and racial health disparities are driven largely by socioeconomic factors. The American Society of Nephrology and the National Kidney Foundation (ASN/NKF) recommend widespread adoption of new "race-free" creatinine equations, and increased use of cystatin C as a race-agnostic GFR biomarker. Literature review and expert consensus. English language publications evaluating GFR assessment and racial disparities. We provide an overview of the ASN/NKF recommendations. We then apply an Implementation science methodology to identify facilitators and barriers to implementation of the ASN/NKF recommendations into critical care settings and identify evidence-based implementation strategies. Last, we highlight research priorities for advancing GFR estimation in critically ill patients. Implementation of the new creatinine-based GFR equation is facilitated by low cost and relative ease of incorporation into electronic health records. The key barrier to implementation is a lack of direct evidence in critically ill patients. Additional barriers to implementing cystatin C-based GFR estimation include higher cost and lack of test availability in most laboratories. Further, cystatin C concentrations are influenced by inflammation, which complicates interpretation. The lack of direct evidence in critically ill patients is a key barrier to broad implementation of newly developed "race-free" GFR equations. Additional research evaluating GFR equations in critically ill patients and novel approaches to dynamic kidney function estimation is required to advance equitable GFR assessment in this vulnerable population.