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. 2021 Sep 1;4(9):e2127014.
doi: 10.1001/jamanetworkopen.2021.27014.

Trends in Chronic Kidney Disease Care in the US by Race and Ethnicity, 2012-2019

Chi D Chu  1   2 , Neil R Powe  3   4   5 , Charles E McCulloch  6 , Deidra C Crews  7   8 , Yun Han  9   10 , Jennifer L Bragg-Gresham  10 , Rajiv Saran  9   10 , Alain Koyama  11 , Nilka R Burrows  11 , Delphine S Tuot  1   3   4   5 ; Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team
Collaborators, Affiliations

Trends in Chronic Kidney Disease Care in the US by Race and Ethnicity, 2012-2019

Chi D Chu et al. JAMA Netw Open. .

Abstract

Importance: Significant racial and ethnic disparities in chronic kidney disease (CKD) progression and outcomes are well documented, as is low use of guideline-recommended CKD care.

Objective: To examine guideline-recommended CKD care delivery by race and ethnicity in a large, diverse population.

Design, setting, and participants: In this serial cross-sectional study, adult patients with CKD that did not require dialysis, defined as a persistent estimated glomerular filtration rate less than 60 mL/min/1.73 m2 or a urine albumin-creatinine ratio of 30 mg/g or higher for at least 90 days, were identified in 2-year cross-sections from January 1, 2012, to December 31, 2019. Data from the OptumLabs Data Warehouse, a national data set of administrative and electronic health record data for commercially insured and Medicare Advantage patients, were used.

Exposures: The independent variables were race and ethnicity, as reported in linked electronic health records.

Main outcomes and measures: On the basis of guideline-recommended CKD care, the study examined care delivery process measures (angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker prescription for albuminuria, statin prescription, albuminuria testing, nephrology care for CKD stage 4 or higher, and avoidance of chronic nonsteroidal anti-inflammatory drug prescription) and care delivery outcome measures (blood pressure and diabetes control).

Results: A total of 452 238 patients met the inclusion criteria (mean [SD] age, 74.0 [10.2] years; 262 089 [58.0%] female; a total of 7573 [1.7%] Asian, 49 970 [11.0%] Black, 15 540 [3.4%] Hispanic, and 379 155 [83.8%] White). Performance on process measures was higher among Asian, Black, and Hispanic patients compared with White patients for angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker use (79.8% for Asian patients, 76.7% for Black patients, and 79.9% for Hispanic patients compared with 72.3% for White patients in 2018-2019), statin use (72.6% for Asian patients, 69.1% for Black patients, and 74.1% for Hispanic patients compared with 61.5% for White patients), nephrology care (64.8% for Asian patients, 72.9% for Black patients, and 69.4% for Hispanic patients compared with 58.3% for White patients), and albuminuria testing (53.9% for Asian patients, 41.0% for Black patients, and 52.6% for Hispanic patients compared with 30.7% for White patients). Achievement of blood pressure control to less than 140/90 mm Hg was similar or lower among Asian (71.8%), Black (63.3%), and Hispanic (69.8%) patients compared with White patients (72.9%). Achievement of diabetes control with hemoglobin A1c less than 7.0% was 50.1% in Asian patients, 49.3% in Black patients, and 46.0% in Hispanic patients compared with 50.3% for White patients.

Conclusions and relevance: Higher performance on CKD care process measures among Asian, Black, and Hispanic patients suggests that differences in medication prescription and diagnostic testing are unlikely to fully explain known disparities in CKD progression and kidney failure. Improving care delivery processes alone may be inadequate for reducing these disparities.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr McCulloch reported receiving grants from the Centers for Disease Control and Prevention during the conduct of the study. Dr Crews reported receiving grants from Somatus Medical Inc and serving as the cochair of the Bayer HealthCare Pharmaceuticals Inc Patient and Physician Advisory Board Steering Committee for Disparities in Chronic Kidney Disease Project outside the submitted work. Dr Saran reported receiving grants from the Centers for Disease Control and Prevention during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Trends in Chronic Kidney Disease Care Delivery Process Measures by Race and Ethnicity, 2012-2019
ACEi indicates angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; eGFR, estimated glomerular filtration rate; UACR, urine albumin-creatinine ratio.
Figure 2.
Figure 2.. Trends in Blood Pressure and Diabetes Control in Chronic Kidney Disease by Race and Ethnicity, 2012-2019
Figure 3.
Figure 3.. Odds Ratios (ORs) and 95% CIs for Chronic Kidney Disease Care Delivery Outcomes and Race and Ethnicity
The reference class for all models is White individuals. Model 1 is unadjusted. Model 2 is adjusted for age and sex. Model 3 is additionally adjusted for hypertension, diabetes (except for hemoglobin A1c outcome), coronary heart disease, cerebrovascular disease, and estimated glomerular filtration rate (eGFR). ACEi indicates angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; NSAID, nonsteroidal anti-inflammatory drug; UACR, urine albumin-creatinine ratio.
See this image and copyright information in PMC

References

    1. United States Renal Data System . 2020 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2020.
    1. Thompson S, James M, Wiebe N, et al. ; Alberta Kidney Disease Network . Cause of death in patients with reduced kidney function. J Am Soc Nephrol. 2015;26(10):2504-2511. doi:10.1681/ASN.2014070714 - DOI - PMC - PubMed
    1. Shlipak MG, Tummalapalli SL, Boulware LE, et al. . The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) controversies conference. Kidney Int. 2021;99(1):34-47. doi:10.1016/j.kint.2020.10.012 - DOI - PubMed
    1. Nicholas SB, Kalantar-Zadeh K, Norris KC. Racial disparities in kidney disease outcomes. Semin Nephrol. 2013;33(5):409-415. doi:10.1016/j.semnephrol.2013.07.002 - DOI - PMC - PubMed
    1. Crews DC, Bello AK, Saadi G; World Kidney Day Steering Committee . Burden, access, and disparities in kidney disease. Kidney Int Rep. 2019;4(3):372-379. doi:10.1016/j.ekir.2019.01.011 - DOI - PMC - PubMed

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