Some of the latest research advances in nephrology presented at the National Kidney Virtual Foundation’s spring meeting included post-market safety data on Patiromer (Veltassa), metformin for polycystic kidney disease, and kidney care during the COVID-19 pandemic. Here are a few more research highlights:
Differences in kidney transplants
Reem Hamoda, MPH at the University of Chicago and colleagues, when it comes to waiting for a kidney transplant, there are significant race, ethnicity, and gender differences in End-Stage Kidney Disease Networks (ESRD).
In a study of over 1.3 million adult dialysis patients in the US kidney data system from 2005 to 2016, the likelihood of women being on the waiting list for kidney transplants was far lower. Of these patients, 19.4% were placed on the waiting list.
In the 18 ESRD networks in the US, the likelihood of white women being put on the waiting list was 18% (HR 0.82, 95% CI 0.80-0.83) and black women was 26% ( HR 0.74, 95% CI 0.72-0.75) lower on the waiting list compared to white men.
The only two networks that did not experience this inequality were Network 4, including Delaware and Pennsylvania, and Network 16, including Alaska, Idaho, Montana, Oregon, and Washington. But in almost every network, black women were the most disadvantaged when it came to accessing the kidney transplant waiting list.
“I really think part of the answer might just be saying that women just don’t get referred enough, but I don’t think it’s the full answer,” Hamoda said during a virtual poster presentation. “I think a tiered, multifactorial area is important so that we can most fully adjust these differences.”
Comorbid diabetes & CRF gaps
Doctors may not have all the answers when it comes to treating patients with comorbid type 2 diabetes and chronic kidney disease (CKD), reported Dr. George Bakris, also from the University of Chicago, and colleagues.
There were some notable gaps in knowledge in the results of a CME-certified activity given to 193 diabetologists and endocrinologists on clinical decision-making issues related to CRF and type 2 diabetes.
The survey consisted of 25 case-based multiple-choice questions asked from February to April 2020. Overall, 89% of clinicians answered incorrectly to questions about SGLT2 inhibitors – including canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance). – and their data comparisons on cardiovascular outcomes. Similarly, when asked about the mechanism of cardiorenal syndrome, 87% of doctors reacted incorrectly.
In addition, 73% were unaware of any evidence-based strategies to delay the progression of CRF in patients with diabetes.
About two-thirds of physicians also incorrectly answered questions about topics related to fibrosis as part of CKD progression, knowledge of the billing procedures for CKD screening, and differences in emerging mineralocorticoid receptor antagonists (MRAs) compared to traditional MRAs.
And when nephrologists were asked how satisfied they were with current approaches to treating CRF in patients with type 2 diabetes, 74% said “moderately – mostly satisfied” while 16% were “slightly dissatisfied”.
Health literacy fallout
A lack of health literacy could explain why people with high blood pressure do not adhere to the DASH (Dietary Approaches to Stop Hypertension) diet, reported Sophia Lou of Johns Hopkins University in Baltimore and colleagues.
In a cross-sectional analysis of 1,073 hypertensive adults – those who themselves reported high blood pressure or took antihypertensive drugs – from the study “Healthy Aging in Neighborhoods with Diversity Across the Whole Lifespan”, a third had “insufficient” health literacy as measured by the quick estimate adult literacy in medicine. In addition, it was assumed that 14.5% of these hypertensive patients had an insufficient health score, as measured by the corresponding sub-item in the test of functional health literacy in adults.
Of this patient population, only 6.9% followed a DASH diet. A higher health literacy was associated with a higher DASH score. Similarly, a higher health score was associated with a higher DASH score, but only for white and not black patients.
Of the total cohort, 39% were men, 66% black, and around 40% lived in poverty, with around 30% reporting food insecurity.
“In my study, we found that education explains this relationship between health literacy and DASH,” Lou explained during a virtual presentation of her results. Other factors that can affect health literacy and adherence to an antihypertensive diet could include stable sources of health care, health insurance and a primary care provider, she added.
