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Research Studies is a compilation of published research articles funded by ´óÏóÊÓƵor authored by ´óÏóÊÓƵresearchers.

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1 to 25 of 213 Research Studies Displayed
Bentley-Edwards K, Glover L, Johnson AE
Testing interventions that address kidney health disparities.
The purpose of this study was to develop and test clinical trials addressing kidney health disparities through the ERASE-KD consortium. The consortium designed five phase 2 randomized clinical trials targeting related barriers to optimal kidney care, with input from community partners including patients, caregivers, and advocates. Four trials focus on reducing disparities in kidney transplantation or optimal kidney replacement therapy for stage 4-5 chronic kidney disease, while one addresses unplanned healthcare utilization in earlier stages. The interventions range from high-intensity patient-level approaches to system-based interventions. The consortium developed a conceptual framework identifying the root causes of kidney health differences and established specific foci for each intervention.
AHRQ-funded; HS028684.
Citation: Bentley-Edwards K, Glover L, Johnson AE . Testing interventions that address kidney health disparities. J Am Soc Nephrol 2025 May; 36(5):970-72. doi: 10.1681/asn.0000000609.
Keywords: Kidney Disease and Health, Disparities
Koukounas KG, Dixit MN, Thorsness R
Performance of dialysis facilities after health-equity scoring incentive.
This research letter describes the performance of dialysis facilities after the initiation of the Centers for Medicare and Medicaid Services (CMS)’ End-Stage Renal Disease Treatment Choice (ETC) Model, one of the largest randomized evaluations of a pay-for-performance program ever conducted in the United States. The ETC model randomly assigned dialysis centers and nephrologists in approximately 30% of hospital referral regions to receive financial incentives or penalties based on their patients’ receipts of home dialysis, kidney transplantation, and placement on a transplant waiting list. In the first model year (2021), the percentage of dialysis facilities that received financial penalties was substantially higher among facilities that disproportionately served patients with social risk factors. In the second model year (2022), the scoring methodology was changed to implement a health-equity incentive, which created a separate scoring strata according to the percentage of patients with Medicare at a given facility who are dually enrolled in Medicaid or receive low-income subsidies (≥50% vs. <50%). The additional of the health-equity incentive was not accompanied by a change in the disparity in performance between facilities in the lowest and highest social risk cohorts with respect to the use of home dialysis or the achievement of transplantation. However, the introduction of the incentive corresponded to a reduction of 11.8 percentage points in the difference in the percentage of facilities in the highest- and lowest-risk cohorts who received a financial penalty for performance.
AHRQ-funded; HS028285.
Citation: Koukounas KG, Dixit MN, Thorsness R . Performance of dialysis facilities after health-equity scoring incentive. N Engl J Med 2025 Apr 24; 392(16):1657-59. doi: 10.1056/NEJMc2413208.
Keywords: Kidney Disease and Health, Medicare
Koshy SKG, Tharakan AK, George LK SKG, Tharakan AK, George LK
Comparative effectiveness of on-pump versus off-pump coronary surgical revascularization related to postoperative acute kidney injury.
This paper is a comparative effectiveness study of on-pump versus off-pump coronary artery bypass surgery (CABG) related to postoperative acute kidney injury (AKI). The authors used Health Facts; a database composed of deidentified Cerner electronic records to compare CABG outcomes using the Kidney Disease: Improving Global Outcomes (KDIGO) AKI guideline criteria to define post-CABG AKI. Primary outcome variables were incident AKI: stage 1 (risk), stage 2 (injury) and stage 3 (failure). Out of 28,091 CABG procedures in Health Facts, 8,622 were retained for analysis. The majority of procedures (83.4%) used a pump. Between the off-pump and on-pump groups, in-hospital mortality and acute stroke did not differ significantly. Results for AKI showed 20.9% off-pump patients developed an AKI versus 27.0% on-pump patients. Between the off-pump and on-pump groups, stage 1 AKI (18.0% vs 22.0%) and stage 2 AKI (1.7% vs 3.7%) varied, without a significant difference in stage 3 AKI. Between the 2 group’s incidences of infection, intensive care unit stay > 72 hours, and hospital length of stay have been shown to be greater in patients who had stage stage 1 or 2 or 3 AKI after CABG. The authors concluded that reducing aortic clamp time and on-pump time, the avoidance of low hematocrit, and minimization of reduced blood flow during aortic cross-clamp time may assist in reducing AKI post-CABG.
AHRQ-funded; HS022140.
Citation: Koshy SKG, Tharakan AK, George LK SKG, Tharakan AK, George LK . Comparative effectiveness of on-pump versus off-pump coronary surgical revascularization related to postoperative acute kidney injury. Am J Cardiol 2025 Mar 1; 238:9-11. doi: 10.1016/j.amjcard.2024.11.016..
Keywords: Patient-Centered Outcomes Research, Comparative Effectiveness, Kidney Disease and Health, Surgery, Cardiovascular Conditions
Lamina T, Brandt S, Abdi HI
The effect of protein intake on bone disease, kidney disease, and sarcopenia: a systematic review.
This systematic review examined the association between dietary protein intake and the risk of bone disease, kidney disease, and sarcopenia to inform protein dietary reference intake updates. The authors included randomized and nonrandomized controlled trials, prospective cohort studies, and nested case-control studies examining dietary protein intake without exercise. They assessed the risk of bias (RoB), performed a qualitative synthesis of low to moderate RoB studies, and evaluated the strength of evidence. Of 82 articles detailing 81 unique studies, only 13 were assessed with low to moderate RoB and synthesized, comprising bone disease, kidney disease, and sarcopenia. The overarching evidence was insufficient, largely due to the limited number of low to moderate RoB studies, the diversity of dietary protein interventions, and the broad range of outcomes. There was sparse literature on children and adolescents, and only a single study each examined the impact of dietary protein intake on bone disease risk (yielding mixed findings) in these populations and on kidney disease. Findings on the impact of protein intake on bone disease in adults and sarcopenia risk were mixed.
AHRQ-funded; 75Q80120D00008.
Citation: Lamina T, Brandt S, Abdi HI . The effect of protein intake on bone disease, kidney disease, and sarcopenia: a systematic review. Curr Dev Nutr 2025 Mar; 9(3):104546. doi: 10.1016/j.cdnut.2025.104546.
Keywords: Kidney Disease and Health, Evidence-Based Practice, Nutrition, Risk
Potluri VS, Reddy YNV, Tummalapalli SL
Early effects of the end-stage renal disease treatment choices model on kidney transplant waitlist additions.
This study examined the effect of End-Stage Renal Disease Treatment Choices (ETC) payment adjustments on U.S. kidney transplant waitlist additions. Researchers used data from the Organ Procurement and Transplantation Network registry to analyze waitlisting trends. The ETC Model was not found to be associated with significant changes in new waitlist additions.
AHRQ-funded; HS026372; HS028684.
Citation: Potluri VS, Reddy YNV, Tummalapalli SL . Early effects of the end-stage renal disease treatment choices model on kidney transplant waitlist additions. Clin J Am Soc Nephrol 2025 Jan; 20(1):124-35. doi: 10.2215/cjn.0000000000000571.
Keywords: Kidney Disease and Health, Transplantation, Payment
Moore CL, Gross CP, Hart L
Construction and performance of a clinical prediction rule for ureteral stone without the use of race or ethnicity: a new STONE score.
The authors sought to determine if a revised STONE score with race removed as a variable could be constructed with similar diagnostic accuracy. They used retrospective data from the original STONE score on patients with confirmed kidney stone by computed tomography. The modified score did not lose clinical accuracy and the authors recommended its use.
AHRQ-funded; HS018322.
Citation: Moore CL, Gross CP, Hart L . Construction and performance of a clinical prediction rule for ureteral stone without the use of race or ethnicity: a new STONE score. J Am Coll Emerg Physicians Open 2024 Dec; 5(6):e13324. doi: 10.1002/emp2.13324.
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Kidney Disease and Health, Diagnostic Safety and Quality
Aklilu AM, Menez S, Baker ML
Early, individualized recommendations for hospitalized patients with acute kidney injury: a randomized clinical trial.
This randomized clinical trial evaluated whether personalized recommendations from a kidney action team improved outcomes for hospitalized patients with acute kidney injury (AKI). The study, conducted across seven hospitals in two health systems, involved 4,003 patients. In the intervention group, a team consisting of a physician and pharmacist delivered customized recommendations through electronic health records within one hour of AKI detection. The primary outcome measured was a composite of AKI progression, dialysis need, or mortality within 14 days of randomization. Despite making 14,539 recommendations and achieving higher implementation rates in the intervention group (33.8% vs 24.3% in usual care), the intervention did not significantly reduce the primary outcome.
AHRQ-funded; HS027626.
Citation: Aklilu AM, Menez S, Baker ML . Early, individualized recommendations for hospitalized patients with acute kidney injury: a randomized clinical trial. JAMA 2024 Dec 24; 332(24):2081-90. doi: 10.1001/jama.2024.22718.
Keywords: Inpatient Care, Kidney Disease and Health, Electronic Health Records (EHRs), Health Information Technology (HIT), Teams, Patient-Centered Outcomes Research
Charkviani M, Kattah AG, Rule AD
Acute kidney injury survivor remote patient monitoring: a single center's experience and an effectiveness evaluation.
This cohort study evaluated the effectiveness of a remote patient monitoring (RPM) program for acute kidney injury survivors who were discharged home without requiring dialysis. Forty patients actively participated in the program, which involved home vital sign monitoring, symptom tracking, and weekly laboratory assessments. Fluid status issues triggered most alerts within the program. When compared to matched historical controls, the RPM group showed no significant difference in overall hospital readmission rates within six months. However, patients with baseline estimated glomerular filtration rates below 45 mL/min/1.73m² experienced higher rates of emergency department visits when using RPM. The study was potentially limited by its small sample size.
AHRQ-funded; HS028060.
Citation: Charkviani M, Kattah AG, Rule AD . Acute kidney injury survivor remote patient monitoring: a single center's experience and an effectiveness evaluation. Kidney Med 2024 Nov; 6(11):100905. doi: 10.1016/j.xkme.2024.100905..
Keywords: Kidney Disease and Health, Telehealth, Health Information Technology (HIT)
Sandal S, Ahn J, Chen Y
Differences in racial and ethnic disparities between first and repeat kidney transplantation.
Research examined racial and ethnic disparities in first-time versus repeat kidney transplantation using United States Renal Data System data from 1995-2018. The study analyzed outcomes for over 2.4 million patients, including White, Black, and Hispanic individuals. The investigation revealed that Black patients experienced greater disparities in accessing repeat transplantation compared to first-time procedures. Hispanic patients faced increased barriers to waitlisting for repeat transplantation versus initial transplants. The findings indicate persistent systemic barriers affecting access to repeat kidney transplantation among racial and ethnic minority groups.
AHRQ-funded; HS024600.
Citation: Sandal S, Ahn J, Chen Y . Differences in racial and ethnic disparities between first and repeat kidney transplantation. Transplantation 2024 Oct; 108(10):2144-52. doi: 10.1097/tp.0000000000005051..
Keywords: Transplantation, Kidney Disease and Health, Disparities, Racial and Ethnic Minorities, Access to Care
Ehmann MR, Klein EY, Zhao X
Epidemiology and clinical outcomes of community-acquired acute kidney injury in the emergency department: a multisite retrospective cohort study.
This retrospective cohort study’s objective was to describe the epidemiology of community-acquired acute kidney injury (CA-AKI) in the United States and the associated clinical outcomes. CA-AKI was identified using KDIGO (Kidney Disease: Improving Global Outcomes) serum creatinine (Scr)-based criteria. Outcomes for encounters resulting in hospitalization included the in-hospital trajectory of AKI severity, dialysis initiation, intensive care unit (ICU) admission, and death. Outcomes for all encounters included occurrence over 180 days of hospitalization, ICU admission, new or progressive chronic kidney disease, dialysis initiation, and death. For all encounters, 10.4% of patients met the criteria for any stage of AKI on arrival to the ED, with 16.6% of patients admitted to the hospital from the ED having CA-AKI on arrival to the ED. The likelihood of AKI recovery was inversely related to the CA-AKI stage on arrival to the ED. Among encounters for hospitalized patients, CA-AKI was associated with in-hospital dialysis initiation, ICU admission, and death compared with patients without CA-AKI. Among all encounters, CA-AKI was associated with new or progressive chronic kidney disease, dialysis initiation, subsequent hospitalization including ICU admission, and death during the subsequent 180 days.
AHRQ-funded; HS027793; HS026640.
Citation: Ehmann MR, Klein EY, Zhao X . Epidemiology and clinical outcomes of community-acquired acute kidney injury in the emergency department: a multisite retrospective cohort study. Am J Kidney Dis 2024 Jun; 83(6):762-71.e1. doi: 10.1053/j.ajkd.2023.10.009..
Keywords: Community-Acquired Infections, Kidney Disease and Health, Emergency Department, Outcomes
Goedken AM, Ismail WW, Barrett LDG
Kidney transplantation in patients with tuberous sclerosis complex.
This study investigated kidney transplantation patterns among patients with tuberous sclerosis complex (TSC), a disorder affecting the mTOR pathway that can lead to renal angiomyolipoma and chronic kidney disease. The researchers conducted a retrospective cohort analysis using United Network for Organ Sharing (UNOS) data, focusing on individuals waitlisted for their first kidney transplant due to TSC-associated kidney failure between 1987 and 2020. The study identified 200 patients with TSC-associated kidney failure on the waitlist, including 12 pediatric cases. Women comprised two-thirds of the waitlisted individuals. Of the total cohort, 140 patients received a transplant, with a median waitlist duration of two years. The analysis revealed that younger age at the time of waitlisting was associated with a higher likelihood of proceeding to transplantation. Post-transplant outcomes were promising, with 91.8% of recipients surviving with a functioning allograft one year after the procedure. These findings suggest that most TSC patients who are waitlisted for kidney transplantation do receive a transplant and experience favorable short-term outcomes.
AHRQ-funded; HS029292.
Citation: Goedken AM, Ismail WW, Barrett LDG . Kidney transplantation in patients with tuberous sclerosis complex. Pediatr Transplant 2024 Jun; 28(4):e14765. doi: 10.1111/petr.14765..
Keywords: Transplantation, Kidney Disease and Health
Rikin S, Bauman L, Arnaoudova I
Multidisciplinary proactive e-consults to improve guideline-directed medical therapies for patients with diabetes and chronic kidney disease: an implementation study.
Researchers conducted an efficacy-implementation pilot study of multidisciplinary, proactive electronic consultation (MPE) for type 2 diabetes (T2D) and chronic kidney disease (CKD) for primary care provider (PCP)-patient dyads at an academic health system. They interviewed PCPs and specialists to assess feasibility, acceptability, and appropriateness of MPE and analyzed responses to identify major themes. Prescription data were extracted from electronic health records to assess preliminary effectiveness to increase guideline-directed medical therapies (GDMTs). They concluded that MPE was an acceptable and appropriate health system strategy to identify and address gaps in GDMT among patients with T2D and CKD. PCPs raised feasibility concerns which could be improved with program enhancements.
AHRQ-funded; HS028877.
Citation: Rikin S, Bauman L, Arnaoudova I . Multidisciplinary proactive e-consults to improve guideline-directed medical therapies for patients with diabetes and chronic kidney disease: an implementation study. BMJ Open Diabetes Res Care 2024 May 6; 12(3). doi: 10.1136/bmjdrc-2024-004155..
Keywords: Diabetes, Kidney Disease and Health, Chronic Conditions, Guidelines, Health Information Technology (HIT)
Adler JT, Kuk AE, Cron DC
Insurance transitions from employer-based insurance to Medicare and waitlisting for kidney transplantation: placing Marietta v. DaVita in context.
In a retrospective cohort study of incident dialysis patients aged 18-62 with employer-sponsored group health plans (EGHPs), researchers found that 36% switched to Medicare before the end of the 30-month coordination period. Patients residing in counties with higher social vulnerability and those with non-commercial dialysis modalities were more likely to switch early. Early switchers were less likely to be waitlisted for kidney transplantation, even after adjusting for various confounders. This association persisted even among patients who maintained their EGHP for at least one month after starting dialysis. These findings highlight the potential impact of recent legal changes allowing EGHPs to decrease dialysis reimbursements, which may increase early switching to Medicare and consequently affect transplant access.
AHRQ-funded; HS028476.
Citation: Adler JT, Kuk AE, Cron DC . Insurance transitions from employer-based insurance to Medicare and waitlisting for kidney transplantation: placing Marietta v. DaVita in context. J Am Soc Nephrol 2024 Apr; 35(4):495-98. doi: 10.1681/asn.0000000000000298..
Keywords: Transplantation, Kidney Disease and Health, Health Insurance, Access to Care, Medicare
Aklilu AM, Kumar S, Nugent J
COVID-19-associated acute kidney injury and longitudinal kidney outcomes.
This retrospective longitudinal multicenter cohort study’s objective was to assess long-term kidney outcomes of patient who had COVID-19-associated acute kidney injury (AKI). This study was conducted in a large hospital system using electronic health records data on adult hospitalized patients with AKI and COVID-19 or other illnesses. Included patients were those 1) who were hospitalized during the COVID-19 pandemic (March 2020-June 2022), were screened for SARS-CoV-2, had AKI, and survived to discharge, or 2) had been hospitalized during the 5 years before the pandemic (October 2016-January 2020), had a positive influenza A or B test result, had AKI, and survived to discharge. The study cohort included 9624 hospitalized patients (mean age, 69.0 years; 4955 females) with AKI, including 987 patients with COVID-AKI, 276 with influenza-associated AKI, and 8361 with AKI associated with other illnesses (other-AKI). When compared with the other 2 groups, patients with COVID-19-associated AKI were slightly younger in age, had a higher baseline eGFR, worse baseline comorbidity scores, higher markers of illness severity, and longer hospital stay. Compared with the other-AKI group, the COVID-AKI group had lower major adverse kidney events (MAKE) (adjusted hazard ratio [aHR], 0.67) due to lower all-cause mortality (aHR, 0.31) and lower rates of worsened kidney function.
AHRQ-funded; HS027626.
Citation: Aklilu AM, Kumar S, Nugent J . COVID-19-associated acute kidney injury and longitudinal kidney outcomes. JAMA Intern Med 2024 Apr; 18(4):414-23. doi: 10.1001/jamainternmed.2023.8225..
Keywords: COVID-19, Kidney Disease and Health, Outcomes
Goldman S, Zhao J, Bieber B
Gastric acid suppression therapy and its association with peritoneal dialysis-associated peritonitis in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).
This study’s goal was to determine whether gastric acid suppression (GAS) (proton pump inhibitor (PPI) or histamine-2 receptor antagonists (H2RA)) use was associated with all-cause and organism-specific peritonitis in peritoneal dialysis (PD) patients. The authors used data from the Peritoneal Dialysis Outcomes and Practice Patterns Study (595 facilities, 8 countries, years 2014-2022), and associations between GAS use and time to first episode of all-cause peritonitis was examined. Out of a total of 23,797 baseline study patients, 6020 (25.3%) used PPIs, and 1382 (5.8%) used H2RAs. Overall risks of GAS use and peritonitis risk [adjusted hazard ratio (AHR)=1.05), and use of PPI (AHR 1.06) or H2RA (AHR 1.02) did not reach statistical significance. In organism-specific analyses, GAS users displayed higher peritonitis risks for gram-negative (AHR 1.29), gram-positive (AHR 1.15), culture-negative (AHR 1.20), enteric (AHR 1.23), and particularly Streptococcal (AHR 1.47) peritonitis episodes. GAS was also associated with higher overall mortality (AHR 1.13).
AHRQ-funded; HS025756.
Citation: Goldman S, Zhao J, Bieber B . Gastric acid suppression therapy and its association with peritoneal dialysis-associated peritonitis in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Kidney360 2024 Mar 1; 5(3):370-79. doi: 10.34067/kid.0000000000000325..
Keywords: Kidney Disease and Health, Adverse Events, Risk
Watnick S, Blake PG, Mehrotra R
System-level strategies to improve home dialysis: policy levers and quality initiatives.
This article discusses trends in home dialysis use, reviews the evolving understanding of what constitutes high quality care for the home dialysis population (as well as how this can be measured), and discusses policy and advocacy efforts that continue to shape the care of US patients, and compares with experiences in other countries. The authors conclude by discussing future directions for quality and advocacy efforts.
AHRQ-funded; HS028684.
Citation: Watnick S, Blake PG, Mehrotra R . System-level strategies to improve home dialysis: policy levers and quality initiatives. Clin J Am Soc Nephrol 2023 Dec; 18(12):1616-25. doi: 10.2215/cjn.0000000000000299..
Keywords: Home Healthcare, Kidney Disease and Health, Policy, Quality Improvement, Quality of Care
Charkviani M, Barreto EF, Pearson KK
Development and implementation of an acute kidney injury remote patient monitoring program: research letter.
This paper describes the development and preliminary feasibility of an acute kidney injury remote patient monitoring (AKI RPM) program launched in October 2021 to help improve quality and efficiency of care. Enrolled patients were those who experienced AKI during a hospitalization and underwent nephrology consultation. Those patients were provided with home monitoring technology and underwent weekly laboratory assessments. Nurses evaluated the data daily and used prespecified protocols for management and escalation of care if needed. Twenty patients enrolled in the first 5 months, with a median duration of program participation of 36 days. Eight patients experienced an unplanned readmission or emergency department visit, half of which were attributed to AKI and related circumstances. Of the 9 patients who provided postgraduation surveys, all were satisfied with the RPM program and 89% would recommend RPM to other patients with similar health conditions.
AHRQ-funded; HS028060-01.
Citation: Charkviani M, Barreto EF, Pearson KK . Development and implementation of an acute kidney injury remote patient monitoring program: research letter. Can J Kidney Health Dis 2023 Jan-Dec; 10:20543581231192746. doi: 10.1177/20543581231192746..
Keywords: Kidney Disease and Health, Telehealth, Health Information Technology (HIT)
Aklilu AM, Kumar S, Yamamoto Y
Outcomes associated with sodium-glucose cotransporter-2 inhibitor use in acute heart failure hospitalizations complicated by AKI.
This retrospective study examined the association of sodium-glucose cotransporter-2 inhibitor (SGLT2i) use with patients who have KDIGO-defined acute kidney injury (AKI) during acute heart failure (AHF) hospitalizations and their kidney function recovery at 14 days and 30 days using time-varying multivariable Cox-regression analyses. The study looked at 3305 adults hospitalized across 5 Yale New Haven Health Systems between January 2020 and May 2022 with AHF complicated by KDIGO-defined AKI. Of those individuals hospitalized with AHF and AKI, 356 received SGLT2i following AKI diagnosis either as initiation or continuation. The rate of renal recovery was not significantly different among those exposed and unexposed to SGLT2i following AKI (adjusted HR 0.94). SGLT2i exposure was associated with lower risk of 30-day mortality (adjusted HR 0.45). Rates of renal recovery were similar between the exposed and nonexposed cohorts regardless of the proximity of SGLT2i exposure to AKI diagnosis.
AHRQ-funded; HS027626.
Citation: Aklilu AM, Kumar S, Yamamoto Y . Outcomes associated with sodium-glucose cotransporter-2 inhibitor use in acute heart failure hospitalizations complicated by AKI. Kidney360 2023 Oct; 4(10):1371-81. doi: 10.34067/kid.0000000000000250..
Keywords: Kidney Disease and Health, Heart Disease and Health, Cardiovascular Conditions, Inpatient Care, Medication, Outcomes
Giles C, Novakovic M, Hopman W
The quality of discharge summaries after acute kidney injury.
The objectives of this retrospective chart review were to determine the quality of discharge summaries in acute kidney injury (AKI) patients and to identify predictors for higher quality summaries. Researchers examined the discharge summaries for 300 randomly selected adult patients who survived a hospitalization with AKI at a tertiary care hospital in Ontario. Results showed that most discharge summaries were missing key AKI elements, even for patients with severe AKI. The researchers concluded that these gaps indicated opportunities for improving discharge summary communication following AKI.
AHRQ-funded; HS028060.
Citation: Giles C, Novakovic M, Hopman W . The quality of discharge summaries after acute kidney injury. Can J Kidney Health Dis 2023 Jan-Dec; 10:20543581231199018. doi: 10.1177/20543581231199018..
Keywords: Kidney Disease and Health, Injuries and Wounds, Hospital Discharge
Menez S, Coca Moledina, Moledina DG
Evaluation of plasma biomarkers to predict major adverse kidney events in hospitalized patients with COVID-19.
There is an increased risk for major adverse kidney events (MAKE) in patients hospitalized with COVID-19. The purpose of this prospective cohort study was to identify plasma biomarkers predictive of MAKE in patients hospitalized with COVID-19. The study found that in total, 95 patients (16%) experienced MAKE. Each 1 SD increase in soluble tumor necrosis factor receptor 1 (sTNFR1) and sTNFR2 was significantly associated with an increased risk of MAKE. A limitation of the study was a lack of control group of hospitalized patients without COVID-19.
AHRQ-funded; HS027626.
Citation: Menez S, Coca Moledina, Moledina DG . Evaluation of plasma biomarkers to predict major adverse kidney events in hospitalized patients with COVID-19. Am J Kidney Dis 2023 Sep; 82(3):322-32.e1. doi: 10.1053/j.ajkd.2023.03.010..
Keywords: COVID-19, Kidney Disease and Health, Inpatient Care
Kim D, Swaminathan S, Lee Y
Racial and ethnic disparities in excess deaths after COVID-19 vaccine deployment among persons with kidney failure.
COVID-19 resulted in clear racial/ethnic disparities in excess deaths among persons with kidney failure. It is not clear whether or how these disparities changed throughout the pandemic, especially after the deployment of COVID-19 vaccines. The purpose of this study was to examine disparities in excess mortality for the Medicare population with kidney failure from March 2020, through December 2021. The study found that there were 686,719 patients with kidney failure in January 2020. Researchers reported an increase in excess deaths beginning March 1, 2020, with a peak in January 2021. From March 1, 2020, through January 30, 2021, and there were substantial disparities in excess deaths across racial/ethnic groups. The number of excess deaths was 5582, 4303, and 2679 for non-Hispanic White, non-Hispanic Black, and Hispanic patients, respectively. The percent excess deaths was 31.9% for Hispanic patients, 27.5% for non-Hispanic Black patients, and 16.4% for non-Hispanic White patients. After the wide distribution of COVID-19 vaccines since the end of January 2021, the lowest percent excess deaths was observed among Hispanic patients, followed by Black patients, and White patients.
AHRQ-funded; HS028285.
Citation: Kim D, Swaminathan S, Lee Y . Racial and ethnic disparities in excess deaths after COVID-19 vaccine deployment among persons with kidney failure. Clin J Am Soc Nephrol 2023 Sep; 18(9):1207-09. doi: 10.2215/cjn.0000000000000226..
Keywords: COVID-19, Racial and Ethnic Minorities, Disparities, Vaccination, Kidney Disease and Health, Mortality
Tummalapalli SL, Struthers SA, White D
Optimal care for kidney health: development of a Merit-based Incentive Payment System (MIPS) value pathway.
This article detailed the iterative consensus-building process used by the American Society of Nephrology Quality Committee to develop the Optimal Care for Kidney Health Merit-based Incentive Payment System (MIPS) Value Pathway (MVP). The Optimal Care for Kidney Health MVP, published in the 2023 Medicare Physician Fee Schedule Final Rule, included measures related to angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use, hypertension control, readmissions, acute kidney injury requiring dialysis, and advance care planning. The MVP nephrology’s goal was to streamline measure selection in MIPS and served as a case study of collaborative policymaking between one professional organization and national regulatory agencies.
AHRQ-funded; HS028684.
Citation: Tummalapalli SL, Struthers SA, White D . Optimal care for kidney health: development of a Merit-based Incentive Payment System (MIPS) value pathway. J Am Soc Nephrol 2023 Aug; 34(8):1315-28. doi: 10.1681/asn.0000000000000163..
Keywords: Kidney Disease and Health, Payment, Healthcare Costs, Medicare
Kaufmann MB, Tan JC, Chertow GM
Deceased donor kidney transplantation for older transplant candidates: a new microsimulation model for determining risks and benefits.
This study examined what potential health gains could be made by increasing kidney transplant access to older candidates from the use of a deceased donor kidney through developing and calibrating a microsimulation model of the transplantation process and long-term outcomes. The authors estimated risk equations for transplant outcomes using the Scientific Registry of Transplant Recipients (SRTR), which contains data on all US transplants (2010-2019). They calibrated the model to key transplant outcomes and used acceptance sampling, retaining the best-fitting 100 parameter sets. They then examined life expectancy gains from allocating kidneys even of lower quality across patient subgroups defined by age and designated race/ethnicity. The best-fitting 100 parameter sets (among 4,000,000 sampled) enabled their model to closely match key transplant outcomes. They found clear survival benefits for older transplant candidates who receive deceased kidney donors, even lower quality ones, compared with remaining on the waitlist.
AHRQ-funded; HS026128.
Citation: Kaufmann MB, Tan JC, Chertow GM . Deceased donor kidney transplantation for older transplant candidates: a new microsimulation model for determining risks and benefits. Med Decis Making 2023 Jul; 43(5):576-86. doi: 10.1177/0272989x231172169..
Keywords: Kidney Disease and Health, Transplantation
Chu CD, Xia F, Du Y
Estimated prevalence and testing for albuminuria in US adults at risk for chronic kidney disease.
The purpose of this cohort study was to assess the extent of albuminuria underdetection from lack of testing and examine its association with CKD treatment. Researchers examined records of adults with hypertension or diabetes, utilizing data from the 2007 to 2018 National Health and Nutrition Examination Surveys (NHANES) and the Optum deidentified electronic health record (EHR) data set of US health care organizations. The total EHR study population included 192,108 patients; 96.6% with hypertension, and 26.2% with diabetes. The study found that 17.5% of patients had albuminuria testing; of whom 34.3% had albuminuria. Among 158,479 patients who were untested, the estimated albuminuria prevalence rate was 13.4%. Thus, only 35.2% of the projected population with albuminuria had been tested. Albuminuria testing was associated with higher adjusted odds of receiving ACEi or ARB treatment, SGLT2i treatment, and having blood pressure controlled to less than 140/90 mm Hg. The researchers concluded that approximately two-thirds of patients with albuminuria were undetected due to lack of testing.
AHRQ-funded; HS026383.
Citation: Chu CD, Xia F, Du Y . Estimated prevalence and testing for albuminuria in US adults at risk for chronic kidney disease. JAMA Netw Open 2023 Jul; 6(7):e2326230. doi: 10.1001/jamanetworkopen.2023.26230..
Keywords: Kidney Disease and Health, Chronic Conditions, Diabetes, Blood Pressure, Evidence-Based Practice
Cron DC, Tsai TC, Patzer RE
The association of dialysis facility payer mix with access to kidney transplantation.
The purpose of this retrospective population-based cohort study was to evaluate the relationships between insurance status, facility-level payer mix, and 1-year incidence of wait-listing for access to kidney transplantation. The researchers utilized data from the United States Renal Data System from 2013 to 2018, and included patients aged 18 to 75 years initiating chronic dialysis between 2013 and 2017, excluding patients with a prior kidney transplant or with major contraindications to kidney transplant. The primary study outcome was patients added to a waiting list for kidney transplant within 1 year of dialysis initiation. The study found that a total of 233, 003 patients across 6565 facilities met the study inclusion criteria. Of 6565 dialysis facilities, the mean commercial payer mix was 21.2% with a standard deviation of 15.6 percentage points. Patient-level commercial insurance was related with an increased incidence of wait-listing. At the facility-level, greater commercial payer mix was related with increased wait-listing. However, after statistical adjustment, including adjusting for patient-level insurance status, commercial payer mix was not significantly associated with outcome.
AHRQ-funded; HS028476.
Citation: Cron DC, Tsai TC, Patzer RE . The association of dialysis facility payer mix with access to kidney transplantation. JAMA Netw Open 2023 Jul; 6(7):e2322803. doi: 10.1001/jamanetworkopen.2023.22803..
Keywords: Kidney Disease and Health, Access to Care, Transplantation

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