Chronic kidney disease in African Americans: Puzzle pieces are falling into place

Nally, Joseph V.

doi:10.3949/ccjm.84gr.17007

Cited by 10 publications

(9 citation statements)

References 26 publications

(20 reference statements)

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“…In a post-hoc sensitivity analysis omitting hemoglobin, there was no substantial change in the prevalence ratio for CKD (Appendix Table 4 in the Appendix). Red cell microcytosis associated with lower HBA copy numbers could potentially confer protection against kidney disease through improved blood rheology; 39 however, this mechanism does not explain the increased risk associated with higher HBA copy numbers (5,6) that have normal MCV. Thus, a clear hematological mechanism explaining the association between HBA copy number and kidney disease risk is not apparent.…”

Section: Discussionmentioning

confidence: 99%

“…Black Americans develop kidney disease at a younger age than other Americans and are three times more likely to develop end-stage kidney disease (ESKD), even after accounting for socioeconomic factors and comorbid medical conditions. [1][2][3][4][5][6] DNA sequence variants that increase the risk of kidney disease, such as those in HBB (sickle cell trait) 7,8 and APOL1 [9][10][11] are more common among Black Americans, yet only partly explain the racial disparity in kidney disease. The evaluation of genetic risk factors for diseases common in minority populations in the United States remains a high priority.…”

Section: Introductionmentioning

confidence: 99%

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HBACopy Number and Kidney Disease Risk among Black Americans: a Longitudinal Cohort Study

Jeffries

et al. 2021

Preprint

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Background: Alpha globin gene (HBA) copy number is variable among people of African descent. HBA limits endothelial nitric oxide signaling and variation in gene copy number could modify kidney disease risk in this population. Objective: To examine the association of HBA copy number with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). We hypothesized that higher HBA copy number would be associated with greater CKD prevalence and ESKD incidence. Design: Prospective, longitudinal cohort from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study which enrolled participants from 2003 through 2007 and conducted follow-up through June 2014. Data were analyzed from January 2018 through January 2021. Setting: Community-dwelling participants enrolled throughout the contiguous United States Participants: Black Americans age 45 years and older Measurements: HBA copy number was measured using droplet-digital PCR on genomic DNA; copy number ranged from 2 to ≥ 5 copies. The prevalence ratio (PR) of CKD and relative risk (RR) of incident reduced estimated glomerular filtration rate (eGFR) were calculated using modified Poisson multivariable regression employing a log-linear effect of HBA allele count. The hazard ratio (HR) of incident ESKD was calculated using Cox proportional hazards multivariable regression. Results: Among 9,918 participants, HBA gene copy number frequencies were 4%, 28%, 67%, and 1% for 2, 3, 4, and ≥5 copies, respectively. After adjusting for demographic, clinical, and genetic risk factors, each additional copy of HBA was associated with 14% greater prevalence of CKD (PR = 1.14, 95% CI 1.07 to 1.21; P < 0.0001). While there was no significant association with incident reduced eGFR (RR = 1.06, 95% CI 0.94 to 1.18; p = 0.36), the hazard of incident ESKD was 28% higher for each additional copy of HBA (HR = 1.28, 95% CI 1.01 to 1.61; P = 0.04). Limitations: This study did not identify the mechanism by which HBA copy number modifies kidney disease risk. This study focused on Black Americans, a population with a high frequency of the 3.7 kb gene deletion; it is unknown whether HBA modifies kidney disease risk in other populations with the 3.7 kb deletion. Conclusions: Increasing HBA copy number was associated with greater prevalent CKD and incident ESKD in a national longitudinal study of Black Americans. Funding Source: National Institutes of Health

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

HBACopy Number and Kidney Disease Risk among Black Americans: a Longitudinal Cohort Study

Jeffries

et al. 2021

Preprint

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“…Chronic kidney disease disproportionally impacts African Americans, making it a prototypical disease in which to investigate disparities in health utility assessments (HUAs) [ 1 ]. Due to the limited availability of organs and the large number patients with end-stage kidney disease (ESKD) on waiting lists for transplantation, the average patient waits roughly 4 years before receiving a kidney transplant [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Implementing a Health Utility Assessment Platform to Acquire Health Utilities in a Hemodialysis Outpatient Setting: Feasibility Study

Adejare¹,

Duncan²,

Motz³

et al. 2022

JMIR Form Res

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Background Patients with end-stage kidney disease (ESKD) wait roughly 4 years for a kidney transplant. A potential way to reduce wait times is using hepatitis C virus (HCV)–viremic kidneys. Objective As preparation for developing a shared decision-making tool to assist patients with ESKD with the decision to accept an HCV-viremic kidney transplant, our initial goal was to assess the feasibility of using The Gambler II, a health utility assessment tool, in an ambulatory dialysis clinic setting. Our secondary goals were to collect health utilities for patients with ESKD and to explore whether the use of race-matched versus race-mismatched exemplars impacted the knowledge gained during the assessment process. Methods We used The Gambler II to elicit utilities for the following ESKD-related health states: hemodialysis, kidney transplant with HCV-unexposed kidney, and transplantation with HCV-viremic kidney. We created race exemplar video clips describing these health states and randomly assigned patients into the race-matched or race-mismatched video arms. We obtained utilities for these 3 health states from each patient, and we evaluated knowledge about ESKD and HCV-associated health conditions with pre- and postintervention knowledge assessments. Results A total of 63 patients with hemodialysis from 4 outpatient Dialysis Center Inc sites completed the study. Mean adjusted standard gamble utilities for hemodialysis, transplant with HCV-unexposed kidney, and transplantation with HCV-viremic kidney were 82.5, 89, and 75.5, respectively. General group knowledge assessment scores improved by 10 points (P<.05) following utility assessment process. The use of race-matched exemplars had little effect on the results of the knowledge assessment of patients. Conclusions Using The Gambler II to collect utilities for patients with ESKD in an ambulatory dialysis clinic setting proved feasible. In addition, educational information about health states provided as part of the utility assessment process tool improved patients’ knowledge and understanding about ESKD-related health states and implications of organ transplantation with HCV-viremic kidneys. A wide variation in patient health state utilities reinforces the importance of incorporating patients’ preferences into decisions regarding use of HCV-viremic kidneys for transplantation.

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“…This fact may be attributed to differences in tumor biology (6), socioeconomic status or functional outcomes (7). Additionally, AA have a higher probability of developing chronic kidney disease (CKD) at a younger age relative to Caucasians and are also more likely to present with comorbidities such as diabetes and hypertension (8).…”

Section: Introductionmentioning

confidence: 99%

Does race impact functional outcomes in patients undergoing robotic partial nephrectomy?

et al. 2020

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Background: The role of race on functional outcomes after robotic partial nephrectomy (RPN) is still a matter of debate. We aimed to evaluate the clinical and pathologic characteristics of African American (AA) and Caucasian patients who underwent RPN and analyzed the association between race and functional outcomes.Methods: Data was obtained from a multi-institutional database of patients who underwent RPN in 6 institutions in the USA. We identified 999 patients with complete clinical data. Sixty-three patients (6.3%) were AA, and each patient was matched (1:3) to Caucasian patients by age at surgery, gender, Charlson Comorbidity Index (CCI) and renal score. Bivariate and multivariate logistic regression analyses were used to evaluate predictors of acute kidney injury (AKI). Kaplan-Meier method and multivariable semiparametric Cox regression analyses were performed to assess prevalence and predictors of significant eGFR reduction during follow-up.Results: Overall, 252 patients were included. AA were more likely to have hypertension (58.7% vs. 35.4%, P=0.001), even after 1:3 match. Overall 42 patients (16.7%) developed AKI after surgery and 35 patients (13.9%) developed significant eGFR reduction between 3 and 15 months after RAPN. On multivariate analysis, AA race did not emerge as a significant factor for predicting AKI (OR 1.10, P=0.8). On Cox multivariable analysis, only AKI was found to be associated with significant eGFR reduction between 3 and 15 months after RAPN (HR 2.49, P=0.019).Conclusions: Although African American patients were more likely to have hypertension, renal function outcomes of robotic partial nephrectomies were not significantly different when stratified by race. However, future studies with larger cohorts are necessary to validate these findings.

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Chronic kidney disease in African Americans: Puzzle pieces are falling into place

Cited by 10 publications

References 26 publications

HBACopy Number and Kidney Disease Risk among Black Americans: a Longitudinal Cohort Study

HBACopy Number and Kidney Disease Risk among Black Americans: a Longitudinal Cohort Study

Implementing a Health Utility Assessment Platform to Acquire Health Utilities in a Hemodialysis Outpatient Setting: Feasibility Study

Does race impact functional outcomes in patients undergoing robotic partial nephrectomy?

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