Increased Incidence of Chronic Kidney Injury in African Americans Following Cardiac Transplantation

Bayne, Joseph; Francke, Michael; Ma, Elaine; Rubin, Geoffrey; Avula, Uma Mahesh R.; Baksh, Haajra; Givens, Raymond C.; Wan, Elaine

doi:10.1007/s40615-020-00906-4

Cited by 3 publications

(4 citation statements)

References 44 publications

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“…This study did not assess SE factors such as education level, household income or wealth, insurance type, or geographic location, which may be confounding this finding. While the adult literature reveals factors such as SE differences, comorbidities, and access to health care as possible contributors to both AKI and to chronic kidney after HT, these findings are less common in pediatric AKI studies, warranting future studies evaluating association of race/ethnicity, and severe AKI I 16–19 . A recent study did demonstrate a higher prevalence of AKI in premature infants that were Black and Hispanic compared with non‐Hispanic white infants, although the explanation of this was unclear 20 .…”

Section: Discussionmentioning

confidence: 99%

“…While the adult literature reveals factors such as SE differences, comorbidities, and access to health care as possible contributors to both AKI and to chronic kidney after HT, these findings are less common in pediatric AKI studies, warranting future studies evaluating association of race/ethnicity, and severe AKI I. [16][17][18][19] A recent study did demonstrate a higher prevalence of AKI in premature infants that were Black and Hispanic compared with non-Hispanic white infants, although the explanation of this was unclear. 20 Postulated potential mechanisms were differential utilization of prenatal care, control of pregnancy-induced hypertension, and administration of prenatal steroids.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative physiological parameters associated with severe acute kidney injury after pediatric heart transplant

Alali

Acosta

Ahmed

et al. 2022

Pediatric Transplantation

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The HT population are at increased risk of AKI when compared to children undergoing congenital heart surgery as they carry unique risks such as preoperative AKI, nephrotoxic immunosuppressants post-HT, RV systolic and almost universal RV diastolic dysfunction, and duration of cardiopulmonary bypass support. [1][2][3][4] In fact, the incidence of AKI in the immediate postoperative period is as high as 73% and 50% will develop severe AKI which has more impact on increased morbidity. [5][6][7] Thus, it becomes paramount for the clinicians

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Postoperative physiological parameters associated with severe acute kidney injury after pediatric heart transplant

Alali

Acosta

Ahmed

et al. 2022

Pediatric Transplantation

View full text Add to dashboard Cite

show abstract

“…6 Compared to White people or to all other groups, Black people are 2 to 3 times more likely to die of preventable heart disease and stroke, to lack adequate access to specialized care, and to suffer kidney complications following a heart transplant. 7,8,9,10,11 Cardiac care and research-including on outcomes after coronary angiography and percutaneous coronary intervention-take place in a context of persistent raceassociated health and health care inequity. 12,13 Achieving racial equity in cardiology and health care more generally will require new degrees of active collaboration among stakeholders and intentional antidiscrimination and antibias practices.…”

Section: Commentarymentioning

confidence: 99%

How Should Clinicians Own Their Roles as Past and Present Exacerbators of Health Inequity and as Present and Future Contributors to Health Equity?

2022

AMA Journal of Ethics

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To improve health outcomes, the science and practice of medicine must move quickly in response to new information. Yet, in other important ways, health professionals must operate slowly and in a mode of intentional stillness to center empathy and light a path from empathy to solidarity. Solidarity, or standing with, prompts efforts to create circumstances in which disadvantaged communities can achieve health equity. This article argues for intentional stillness and solidarity to inspire ethical conduct and structural change. In the case presented, inaction and delay, which are neither virtuous nor antiracist forms of stillness in this context, would leave intact the status quo of disparity and inequity in cardiac medicine.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity.Be still my soul the Lord is on thy side Bear patiently the cross of grief or pain Leave to thy God to order and provide In every change He faithful will remain Be still my soul thy best, thy heavenly friend Through thorny ways leads to a joyful end

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“…Black HT recipients are more likely than White recipients to have also received a simultaneous kidney transplant [ 43 ]. A small single-center retrospective study indicates greater declines in estimated GFR after solitary HT for Black recipients compared to non-Black recipients despite similar maintenance calcineurin inhibitor levels [ 44 ]. For patients with reduced GFR in the setting of HF, LVAD placement results in early improvement in renal function that returns to the pre-LVAD baseline after one year, for reasons that are unclear [ 45 ].…”

Section: Advanced Heart Failure Therapy Evaluationmentioning

confidence: 99%

Are the current evaluation tools for advanced therapies biased?

Givens

2021

Current Opinion in Cardiology

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Purpose of review Despite attention to racial disparities in outcomes for heart failure (HF) and other chronic diseases, progress against these inequities has been gradual at best. The disparities of COVID-19 and police brutality have highlighted the pervasiveness of systemic racism in health outcomes. Whether racial bias impacts patient access to advanced HF therapies is unclear. Recent findings As documented in other settings, racial bias appears to operate in HF providers’ consideration of patients for advanced therapy. Multiple medical and psychosocial elements of the evaluation process are particularly vulnerable to bias. Summary Reducing gaps in access to advanced therapies will require commitments at multiple levels to reduce barriers to healthcare access, standardize clinical operations, research the determinants of patient success and increase diversity among providers and researchers. Progress is achievable but likely requires as disruptive and investment of immense resources as in the battle against COVID-19.

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Increased Incidence of Chronic Kidney Injury in African Americans Following Cardiac Transplantation

Cited by 3 publications

References 44 publications

Postoperative physiological parameters associated with severe acute kidney injury after pediatric heart transplant

Postoperative physiological parameters associated with severe acute kidney injury after pediatric heart transplant

How Should Clinicians Own Their Roles as Past and Present Exacerbators of Health Inequity and as Present and Future Contributors to Health Equity?

Are the current evaluation tools for advanced therapies biased?

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