Kidney Week 2023: Spotlighting Disparities in Nephrology

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The need for greater focus on racial disparities in health care and health outcomes has become impossible to ignore across all specialties in medicine in recent years.

Among patients with kidney disease, long-standing disparities have contributed to increased prevalence and disease-related mortality. These differences have been the focal point of calls from nephrologists and patients for increased awareness and strengthened efforts toward addressing these issues.

“There's a huge disparity when it comes to planning, prevention, and a proactive approach to kidney disease in minoritized populations that we really need to pay attention to,” said Maya Clark-Cutaia, RN, MSN, PhD, assistant professor of nursing at New York University Rory Meyers College of Nursing, in an interview with HCPLive Nephrology.

At the American Society of Nephrology Kidney Week 2023, these calls for increased emphasis were evidenced through more than 50 abstracts focused on disparities and a pair of sessions focusing on diversity and equity, with perspective from program staff in the Division of Kidney, Urologic and Hematologic Diseases within the National Institute of Diabetes and Digestive and Kidney Diseases.

As part of our coverage of Kidney Week 2023, we are highlighting a group of selected abstracts detailing disparities in access to care, clinical outcomes, and representation in the field of nephrology.

Racial, Neighborhood Disparities in Access to Kidney Transplantation and Waitlisting¹

Chiao Wen Lan, MPH, PhD, social scientist at Health Services Advisory Group, and a team of investigators examined access to transplants, time on dialysis to listing, and time spent on the waitlist before transplantation among patients with end-stage renal disease (ESRD), calling attention to disparities based on race and neighborhood characteristics. Using data from the ESRD Quality Reporting System and the Area Deprivation Index, investigators found 9.5% of patients added to the transplant waitlist resided in the most disadvantaged neighborhoods.

Among patients who received transplants, waitlist time was consistently longer for Black patients compared to White patients (P < .001), and patients from more disadvantaged neighborhoods waited longer on the list before getting transplanted compared to those from the least disadvantaged areas (15.3 vs 13.4 months, P < .0001). White ESRD patients in the most disadvantaged neighborhoods were added to the waitlist faster (38.6 months) and spent less time on the waitlist (14.9 months) prior to transplantation than Black patients in the least disadvantaged neighborhoods (43.2 months; P < .01 and 16.1 months, P < .0001).

Racial and Ethnic Differences in Incident CKD in US Veterans²

Acknowledging a lack of research regarding incident chronic kidney disease (CKD) by race and ethnicity compared to what is known about disparities in end-stage kidney disease, a team of investigators led by Guofen Yan, PhD, professor of biostatistics at the University of Virginia School of Medicine, sought to examine the incidence of earlier-stage CKD among veterans of various races and ethnicities. To do so, investigators collected data for 1,883,779 veterans with the first occurrence of the estimated glomerular filtration rate (eGFR) between 60-100 mL/min/1.73m2 during 2003-2015 and followed them through May 2018 for incident CKD, defined as the first time when follow-up eGFR decreased to <60 mL/min/1.73m2 for >3 months.

After adjusting for age, sex, index year, and baseline eGFR, the adjusted risk of incident CKD was 53% greater for Black patients (95% confidence interval [CI], 1.51-1.55; P < .0001) and 3-9% greater for other race groups compared to White patients. Black patients still faced the greatest risk in subgroup analyses of veterans with baseline eGFR 90-100 and 60-89 mL/min/1.73m2 (adjusted hazard ratio [aHR], 1.81; 95% CI, 1.76-1.86 and aHR, 1.46; 95% CI, 1.44-1.48, respectively; both P < .0001). Among those with available data on urine albumin-to-creatinine ratio (UACR) ≥30 mg/g, Black veterans exhibited a 29% greater risk of CKD (95% CI, 1.21-1.36; P < .0001).

Motivational Strategies for Improving Dialysis Nonadherence in African American Patients³

In this study, Lindsey Theut, of Creighton University School of Medicine, and colleagues assessed the feasibility of motivational interviewing, an evidence-based counseling style for increasing intrinsic motivation, for combating hemodialysis nonadherence and low treatment motivation among African American patients.

To assess the impact of motivational interviewing on these patients, investigators conducted a parallel arm randomized controlled trial of African American patients ≥ 18 years of age who missed hemodialysis or shortened hemodialysis by 15 minutes/month during the 3 months prior to the study. A total of 30 patients were randomized to usual care or 6 sessions of motivational interviewing over 8 weeks.

In total, 57.1% of patients in the motivational interviewing group completed all 6 motivational interviewing sessions, during which they primarily discussed empowerment, support network, and understanding ESKD. Investigators noted some patients described having low trust in and feeling intimidated by the health system, and most participants indicated they saw motivational interviewing as an effective communication style for hemodialysis adherence.

Trends in Race/Ethnicity of ASN Kidney Week Faculty from 2018-2022⁴

A retrospective analysis of self-reported race and ethnicity among ASN Kidney Week faculty led by Tushar Chopra, MD, associate professor in the department of medicine at the University of Virginia, shone light on the underrepresentation of Asian, Black, and Hispanic individuals in the Kidney Week faculty roster. Investigators used demographic data for speakers, moderators, and program chairs obtained from ASN’s database to conduct a descriptive analysis of Kidney Week faculty cohort racial proportions from 2018-2022.

Investigators noted 23% (n = 12,132) of ASN members and 16% (n = 508) of faculty did not self-report race/ethnicity during the 2018-2022 meetings. Upon analysis, White (33-35%) was the most common self-reported race among ASN members, followed by Asian (24%), Latino (5.4%-6%), and Black (4.3%-4.6%). Analysis of trends over time revealed the proportion of White Kidney Week faculty declined from 54.5% to 48.3% while Black Kidney Week faculty increased from 2.7% to 5.4% between 2018-2022, suggesting the start of a potential uptick in representation.

References:

1. Wen Lan C, Crews DC, Mohan S, et al. Health Equity Gaps in Access to Kidney Transplant. Paper Presented at: American Society of Nephrology Kidney Week 2023. November 1-5, 2023.
2. Yan G, Scialla JJ, Nee R, et al. Racial and Ethnic Differences in Incident CKD in US Veterans. Paper Presented at: American Society of Nephrology Kidney Week 2023. November 1-5, 2023.
3. Theut L, St. Julien ZN, Nair D, et al. Motivational Strategies to Empower African Americans to Improve Dialysis Nonadherence. Paper Presented at: American Society of Nephrology Kidney Week 2023. November 1-5, 2023.
4. Chopra T, Pivert KA, Balogun RA, et al. Trends in Race/Ethnicity of ASN Kidney Week Faculty (Speakers, Moderators, and Program Chairs): 2018-2022. Paper Presented at: American Society of Nephrology Kidney Week 2023. November 1-5, 2023.