Ethnic Differences and Treatment Trajectories in Chronic Kidney Disease

Abstract

Little is known about barriers to care experienced by Latino children with chronic kidney disease (CKD). We conducted a qualitative study with children with CKD and their families to elucidate conceptions about disease process, expression, and treatment; perceived access to care barriers; and potential for treatment non-adherence. Semi-structured interviews were conducted with 42 individuals from 28 family units treated for CKD in San Diego, California. Transcripts were analyzed by coding consensus, co-occurrence, and comparison. Latino patients cited pre-diagnosis barriers in accessing primary and subspecialty care not mentioned by non-Latino Whites. Whites described a pro-active style of interacting with the health care system not mentioned by Latinos. There were no differences apparent in reports of medication adherence, but both groups emphasized the importance of extended social networks in adhering to treatment regimens. Families' perspectives provide valuable information that can serve future studies and interventions for improving care for children with CKD.

Canadian Senior Renal Leaders Community of Practice: Vulnerable Populations With Chronic Kidney Disease—Evidence to Inform Policy

“…Inadequate access to early screening and prevention has been noted in low SES populations in the United States 22 ; ethnic minority populations in the United States 23 - 25 ; and in Indigenous populations in Canada and Australia. 5 , 9 , 26 - 28 These populations also experience disparities in access to all renal replacement therapies, as do rural/remote populations, undocumented immigrants, the unemployed, and substance misusers. It has been shown that disadvantaged populations experience reduced access to and worse outcomes from dialysis treatments.…”

“…Disparities exist across the continuum of care for CKD, regardless of jurisdiction. Inadequate access to early screening and prevention has been noted in low SES populations in the United States 22 ; ethnic minority populations in the United States 23-25 ; and in Indigenous populations in Canada and Australia. 5,9,26-28 These populations also experience disparities in access to all renal replacement therapies, as do rural/remote populations, undocumented immigrants, the unemployed, and substance misusers.…”

Adolescent Organ Transplants: A Lifetime Commitment to Medication

“…Adolescent patients and their relationship with their parents have often been shown to affect the adolescent's medication adherence. A study revealed that impaired family function was associated with higher rates of nonadherence (Shellmer et al, 2011), where family stress and bad home life listed as indicators of a conflictive environment (Johnson et al 2008). The impaired family function may create an unstable environment for the patient, causing it to be more difficult for the patient to receive the support that is necessary for treatment and medication adherence.…”

Type 2 Diabetes Mellitus in Latinx Populations in the United States: A Culturally Relevant Literature Review

“…Deaths from T2DM in Latinx populations are also 1.25 times higher than non-Latinx populations [ 5 ]. Disparities experienced by Latinx Americans are apparent in the trends and statistics of disease prevalence among this community, for example, though T2DM is the major cause of CKD in Latinx individuals, those with CKD maintain poor management of T2DM, lack medication adherence, may be unaware of the association of CKD with T2DM, and have the potential to progress to ominous disease faster than non-Latinx communities [ 6 , 7 ]. The COVID-19 pandemic has further emphasized health disparities experienced by Latinx Americans, as these populations are experiencing higher rates of COVID-19 infection, potentially due to their increased likelihood of having a comorbid condition, such as T2DM [ 8 ].…”