Racial differences in acute kidney injury of hospitalized adults with diabetes

Mathioudakis, Nestoras; Giles, Monica; Yeh, Hsin Chieh; Haywood, Carlton; Golden, Sherita Hill

doi:10.1016/j.jdiacomp.2016.03.031

Cited by 19 publications

(14 citation statements)

References 30 publications

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“…Previous studies have hypothesized that diabetic patients who develop AKI may possibly have reduced nephron mass and perhaps less severe associated nonrenal disease compared to those without diabetes, suggesting that a more milder form of in-jury was required to cause AKI in this group of patients [18]. Besides, in support of our findings, previous study has documented that diabetic patients have predominantly stage 1 AKI with fast recovery [28]. We therefore suspect the lower risk of in-hospital and post-hospitalization mortality associated with DM may be due to a lower severity of cardiovascular disease in the surviving population together with a less severe injury required to induce AKI in patients with DM relative to patients without DM (Table 4).…”

Section: Discussionsupporting

confidence: 89%

Association of Race with In-Hospital and Post-Hospitalization Mortality in Patients with Acute Kidney Injury

Hassan

Owoyemi

Abdel‐Rahman

et al. 2021

Nephron

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Introduction: Acute kidney injury (AKI) is known to be associated with increased mortality, and racial differences in hospital mortality exist in patients with AKI. However, it remains to be seen whether racial differences exist in post-hospitalization mortality among AKI patients. Methods: We analyzed data of adult AKI patients admitted to the University of Virginia Medical Center between January 1, 2001, and December 31, 2015, to compare in-hospital and post-hospitalization mortality among hospitalized black and white patients with AKI. Multivariable logistic regression analysis was used to analyze the association between race and in-hospital mortality, and 90-day post-hospitalization mortality among AKI patients that were discharged. Kaplan-Meier survival curve was used to evaluate long-term survival between black and white patients. Results: Black patients had lower in-hospital mortality than white patients after adjusting for age, sex, estimated glomerular filtration rate, hospital length of stay, severity of AKI, comorbidities, and the need for dialysis and mechanical ventilation (odds ratio: 0.82; 95% confidence interval, 0.70–0.96, p = 0.0015). Similarly, at 90-day post-hospitalization, black patients had significantly lower adjusted odds of death than white patients (odds ratio: 0.64; 95% confidence interval, 0.46–0.93; p = 0.008). The median length of follow-up was 11.9 months (0.6–46.7 months). Kaplan-Meier survival curve showed that long-term survival was significantly better in black patients compared to white patients (median duration of survival; 39.7 vs. 24.8 months; p ≤ 0.001). Conclusions: Black patients with AKI had lower in-hospital mortality, 90-day post-hospitalization mortality, and better long-term survival rates compared to white patients with AKI.

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Section: Discussionsupporting

confidence: 89%

Association of Race with In-Hospital and Post-Hospitalization Mortality in Patients with Acute Kidney Injury

Hassan

Owoyemi

Abdel‐Rahman

et al. 2021

Nephron

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“…Relaxing eligibility criteria related to comorbidity and age are critical for minority populations because they are more likely to have other chronic illnesses and may be more susceptible at earlier ages (Mathioudakis et al, 2016; Prasad, Helder, Brown, & Schaff, 2016; Yoo, De, Wilkins, Smith, & Blumenthal, 2016). We also provided small site grants each year to assist with retention items, parking and refreshments.…”

Section: Resultsmentioning

confidence: 99%

Applying a Conceptual Framework to Maximize the Participation of Diverse Populations in Cancer Clinical Trials

Nápoles

Cook

Ginossar

et al. 2017

Advances in Cancer Research

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The underrepresentation of ethnically diverse populations in cancer clinical trials results in the inequitable distribution of the risks and benefits of this research. Using a case study approach, we apply a conceptual framework of factors associated with the participation of diverse population groups in cancer clinical trials developed by Dr. Jean Ford and colleagues to increase understanding of the specific strategies, and barriers and promoters addressed by these strategies, that resulted in marked success in accrual of racially and ethnically diverse populations in cancer clinical research. Results indicate that the studies presented were able to successfully engage minority participants due to the creation and implementation of multi-level, multifaceted strategies that included: culturally and linguistically appropriate outreach, education, and research studies that were accessible in local communities; infrastructure to support engagement of key stakeholders, clinicians, and organizations serving minority communities; testimonials by ethnically diverse cancer survivors; availability of medical interpretation services; and providing infrastructure that facilitated the engagement in clinical research of clinicians who care for minority patient populations. These strategic efforts were effective in addressing limited awareness of trials, lack of opportunities to participate, and acceptance of engagement in cancer clinical trials. Careful attention to the context and population characteristics in which cancer clinical trials are conducted will be necessary to address disparities in research participation and cancer outcomes. These studies illustrate that progress on minority accrual into clinical research requires intentional efforts to overcome barriers at all three stages of the accrual process: awareness, opportunity and acceptance of participation.

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“…Whether black race is a risk factor for non-COVID-19-associated AKI has not been clearly established as data are inconsistent. 24,[46][47][48][49] Several studies failed to find any relationship between race and the development of AKI. 46,47 In contrast, a meta-analysis of .1.3 million individuals performed by the CKD Prognosis Consortium found that black patients had a higher risk of AKI than white patients at higher levels of eGFR and at most urinary albumin-creatinine ratios.…”

Section: Discussionmentioning

confidence: 99%

AKI in Hospitalized Patients with and without COVID-19: A Comparison Study

Fisher

Neugarten

Bellin

et al. 2020

JASN

301

347

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BackgroundReports from centers treating patients with coronavirus disease 2019 (COVID-19) have noted that such patients frequently develop AKI. However, there have been no direct comparisons of AKI in hospitalized patients with and without COVID-19 that would reveal whether there are aspects of AKI risk, course, and outcomes unique to this infection.MethodsIn a retrospective observational study, we evaluated AKI incidence, risk factors, and outcomes for 3345 adults with COVID-19 and 1265 without COVID-19 who were hospitalized in a large New York City health system and compared them with a historical cohort of 9859 individuals hospitalized a year earlier in the same health system. We also developed a model to identify predictors of stage 2 or 3 AKI in our COVID-19.ResultsWe found higher AKI incidence among patients with COVID-19 compared with the historical cohort (56.9% versus 25.1%, respectively). Patients with AKI and COVID-19 were more likely than those without COVID-19 to require RRT and were less likely to recover kidney function. Development of AKI was significantly associated with male sex, Black race, and older age (>50 years). Male sex and age >50 years associated with the composite outcome of RRT or mortality, regardless of COVID-19 status. Factors that were predictive of stage 2 or 3 AKI included initial respiratory rate, white blood cell count, neutrophil/lymphocyte ratio, and lactate dehydrogenase level.ConclusionsPatients hospitalized with COVID-19 had a higher incidence of severe AKI compared with controls. Vital signs at admission and laboratory data may be useful for risk stratification to predict severe AKI. Although male sex, Black race, and older age associated with development of AKI, these associations were not unique to COVID-19.

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Racial differences in acute kidney injury of hospitalized adults with diabetes

Cited by 19 publications

References 30 publications

Association of Race with In-Hospital and Post-Hospitalization Mortality in Patients with Acute Kidney Injury

Association of Race with In-Hospital and Post-Hospitalization Mortality in Patients with Acute Kidney Injury

Applying a Conceptual Framework to Maximize the Participation of Diverse Populations in Cancer Clinical Trials

AKI in Hospitalized Patients with and without COVID-19: A Comparison Study

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