scholarly journals Current State and Future Trends to Optimize the Care of Chronic Kidney Disease in African Americans

2017 ◽  
Vol 46 (2) ◽  
pp. 176-186 ◽  
Author(s):  
Kimberly Harding ◽  
Tesfaye B. Mersha ◽  
Joseph A. Vassalotti ◽  
Fern J. Webb ◽  
Susanne B. Nicholas
Keyword(s):  
Chronic Kidney Disease ◽  
Medication Adherence ◽  
African Americans ◽  
Kidney Disease ◽  
Kidney Failure ◽  
Social Determinant ◽  
Assessment Tools ◽  
Improve Medication Adherence ◽  
Outreach Programs ◽  
Caucasian Americans

Background: African Americans (AAs) suffer the widest gaps in chronic kidney disease (CKD) outcomes compared to Caucasian Americans (CAs) and this is because of the disparities that exist in both health and healthcare. In fact, the prevalence of CKD is 3.5 times higher in AAs compared to CAs. The disparities exist at all stages of CKD. Importantly, AAs are 10 times more likely to develop hypertension-related kidney failure and 3 times more likely to progress to kidney failure compared to CAs. Summary: Several factors contribute to these disparities including genetic and social determinants, late referrals, poor care coordination, medication adherence, and low recruitment in clinical trials. Key Messages: The development and implementation of CKD-related evidence-based approaches, such as clinical and social determinant assessment tools for medical interventions, more widespread outreach programs, strategies to improve medication adherence, safe and effective pharmacological treatments to control or eliminate CKD, as well as the use of health information technology, and patient-engagement programs for improved CKD outcomes may help to positively impact these disparities among AAs

scholarly journals Evaluation of medication adherence and predictors of sub-optimal adherence among pre-dialysis patients with chronic kidney disease

2020 ◽  
Vol 4 ◽  
pp. 239920262095408
Author(s):  
Roland Nnaemeka Okoro ◽  
Ibrahim Ummate ◽  
John David Ohieku ◽  
Sani Ibn Yakubu ◽  
Maxwell Ogochukwu Adibe ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Logistic Regression ◽  
Medication Adherence ◽  
Kidney Disease ◽  
Univariate Analysis ◽  
Binary Logistic Regression ◽  
Regression Analyses ◽  
Dialysis Patients ◽  
Improve Medication Adherence ◽  
Significant Independent Predictor

Background: Multiple medications are required to effectively manage chronic kidney disease (CKD) and associated complications, posing the risk of poor medication adherence. Objectives: To measure medication adherence levels and to investigate the potential predictors of sub-optimal medication adherence in pre-dialysis patients with CKD. Methods: A prospective study was conducted in the medical and nephrology outpatients’ clinics in Maiduguri. Non-dialysis patients with CKD stages 1–4 aged 18 years and above were recruited through their physicians. The level of medication adherence was determined using Morisky Medication Adherence Scale. Descriptive statistics were used to summarize patients’ background characteristics. Multivariate binary logistic regression analyses were performed to investigate the significantly potential predictors of sub-optimal medication adherence at a p < 0.05. Results: There were 107 participants (48.6%) who had high medication adherence, while 97 (44.1%), and 16 (7.3%) of them had moderate adherence, and low adherence, respectively. The univariate analysis revealed that medication adherence level differed significantly with the number of medications taken daily by patients ( p < 0.05). Multivariate logistic regression analyses did not reveal a significant independent predictor of sub-optimal medication adherence. Conclusion: A majority of the participants reported sub-optimal medication adherence. The independent variables considered did not significantly predict sub-optimal medication adherence in the study population. Nevertheless, the study findings highlight the importance of clinical pharmacists’ CKD management supportive care to help improve medication adherence.

Abstract P097: Low Medication Adherence is Related to Poor Hypertension Control among Patients with Chronic Kidney Disease

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Suma Vupputuri ◽  
Paul Muntner ◽  
Wolfgang C Winkelmayer ◽  
David H Smith ◽  
Gregory A Nichols
Keyword(s):  
Chronic Kidney Disease ◽  
Medication Adherence ◽  
Kidney Disease ◽  
Angiotensin Receptor Blockers ◽  
Medication Possession Ratio ◽  
Uncontrolled Hypertension ◽  
Improve Medication Adherence ◽  
Antihypertensive Medications ◽  
Converting Enzyme Inhibitors ◽  
The Mean

Inadequately controlled blood pressure (BP) is an important risk factor for the progression of chronic kidney disease (CKD). Few data are available on the association between adherence to antihypertensive medications and BP control among patients with CKD. We investigated the association of adherence to angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) with BP levels and BP control among CKD patients (n=3077) at Kaiser Permanente Georgia (an insurer and health care provider). Patients were required to have 2 outpatient diagnoses of CKD in 2008-2009, at least 2 fills of ACEi/ARBs, be 18+ years of age, with at least 1 year of continuous membership and prescription benefits prior to 01/01/08 and have no history of end-stage renal disease. We defined uncontrolled BP as systolic/diastolic of ≥140/90 mmHg and also ≥130/80 mmHg. As a measure of adherence we calculated the medication possession ratio (MPR): # of days medication supplied between the first and last prescription fills Duration from first to last prescription date + days supply from last prescription The mean age of our sample was 64.1 ±11.9 years; 53.1% were female, and 57.6% African-American. In this sample, 22.6% and 8.9% had low and very low medication adherence, respectively; while 25.6% and 58.6% had systolic/diastolic BP of ≥140/90 and ≥130/80 mmHg, respectively. The mean BPs and odds ratios (ORs) for uncontrolled BP associated with level of adherence to antihypertensive medications are given in the table . In conclusion, among patients with CKD, poor medication adherence to antihypertensive medications was consistently associated with uncontrolled hypertension. Targeting interventions to improve medication adherence among patients with CKD may be an important strategy to improve BP control and, in turn, slow the progression of CKD. Medication Adherence p-trend High (MPR: ≥0.8) N=2109 Low (MPR: 0.5 to <0.8) N=694 Very low (MPR: <0.5) N=274 Mean systolic BP, mmHg 131.3 (13.0) 134.0 (14.7) 137.5 (15.4) <0.0001 Mean diastolic BP, mmHg 72.5 (8.12) 75.7 (9.21) 78.7 (10.1) <0.0001 OR for SBP/DBP ≥140/90 mmHg Age, race, sex adjusted 1.0 (ref) 1.40 (1.14, 1.73) 2.30 (1.73, 3.06) <0.0001 Multivariate adjusted * 1.0 (ref) 1.24 (0.97, 1.57) 1.96 (1.40, 2.75) <0.0001 OR for SBP/DBP ≥130/80 mmHg Age, race, sex adjusted 1.0 (ref) 1.21 (1.00, 1.46) 1.81 (1.33, 2.45) <0.0001 Multivariate adjusted * 1.0 (ref) 1.11 (0.89, 1.38) 1.43 (1.01, 2.01) 0.04 * Adjusted for age, race, sex, socioeconomic status, co-morbidities, clinical measures, and number of medication classes.

scholarly journals Mineralocorticoid receptor antagonists for nephroprotection and cardioprotection in patients with diabetes mellitus and chronic kidney disease

2021 ◽  
Author(s):  
Alberto Ortiz ◽  
Charles J Ferro ◽  
Olga Balafa ◽  
Michel Burnier ◽  
Robert Ekart ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Failure ◽  
Mineralocorticoid Receptor ◽  
Diabetic Kidney Disease ◽  
Renin Angiotensin System ◽  
Cardiovascular Death ◽  
Mineralocorticoid Receptor Antagonists ◽  
Receptor Antagonists ◽  
Diabetic Kidney

Abstract Diabetic kidney disease develops in about 40% of patients with diabetes and is the commonest cause of chronic kidney disease worldwide. Patients with chronic kidney disease, especially those with diabetes mellitus, are at high risk of both developing kidney failure and cardiovascular death. The use of renin-angiotensin system blockers to reduce the incidence of kidney failure in patients with diabetic kidney disease dates back to studies that are now 20 or more years old. During the last few years sodium-glucose co-transporter-2 inhibitors have shown beneficial renal effects in randomized trials. However, even in response to combined treatment with renin-angiotensin system blockers and sodium-glucose co-transporter-2 inhibitors, the renal residual risk remains high with kidney failure only deferred, but not avoided. The risk of cardiovascular death also remains high even with optimal current treatment. Steroidal mineralocorticoid receptor antagonists reduce albuminuria and surrogate markers of cardiovascular disease in patients already on optimal therapy. However, their use has been curtailed by the significant risk of hyperkalaemia. In The FInerenone in reducing kiDnEy faiLure and dIsease prOgression in Diabetic Kidney Disease (FIDELIO-DKD) study comparing the actions of the non-steroidal mineralocorticoid receptor antagonist finerenone with placebo, finerenone reduced the progression of diabetic kidney disease and the incidence of cardiovascular events with a relatively safe adverse event profile. This document presents in detail the available evidence on the cardioprotective and nephroprotective effects of mineralocorticoid receptor antagonists, analyses the potential mechanisms involved and discusses their potential future place in the treatment of patients with diabetic chronic kidney disease.

scholarly journals Sickle Cell Trait and Renal Function in Hispanics in the United States: the Northern Manhattan Study

2017 ◽  
Vol 27 (1) ◽  
pp. 11 ◽  
Author(s):  
Nicole D. Dueker ◽  
David Della-Morte ◽  
Tatjana Rundek ◽  
Ralph L. Sacco ◽  
Susan H. Blanton
Keyword(s):  
United States ◽  
Chronic Kidney Disease ◽  
African Americans ◽  
Kidney Disease ◽  
Sickle Cell ◽  
Sickle Cell Trait ◽  
The United States ◽  
Genetic Mutation ◽  
Single Mutation ◽  
Increased Risk

<p class="Pa7">Sickle cell anemia (SCA) is a common hematological disorder among individu­als of African descent in the United States; the disorder results in the production of abnormal hemoglobin. It is caused by homozygosity for a genetic mutation in HBB; rs334. While the presence of a single mutation (sickle cell trait, SCT) has long been considered a benign trait, recent research suggests that SCT is associated with renal dysfunction, including a decrease in estimated glomerular filtration rate (eGFR) and increased risk of chronic kidney disease (CKD) in African Americans. It is currently unknown whether similar associations are observed in Hispanics. Therefore, our study aimed to determine if SCT is associated with mean eGFR and CKD in a sample of 340 Dominican Hispanics from the Northern Manhattan Study. Using regression analyses, we tested rs334 for association with eGFR and CKD, adjusting for age and sex. eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equa­tion and CKD was defined as eGFR &lt; 60 mL/min/1.73 m2. Within our sample, there were 16 individuals with SCT (SCT carriers). We found that SCT carriers had a mean eGFR that was 12.12 mL/min/1.73m2 lower than non-carriers (P=.002). Additionally, SCT carriers had 2.72 times higher odds of CKD compared with non-carriers (P=.09). Taken together, these novel results show that Hispanics with SCT, as found among African Americans with SCT, may also be at increased risk for kidney disease.</p><p class="Pa7"><em>Ethn Dis. </em>2017; 27(1)<strong>:</strong>11-14; doi:10.18865/ed.27.1.11.</p><p class="Pa7"> </p>

Abstract 113: Pharmacists' Perspectives of an Intervention to Improve Medication Adherence after ACS Hospitalization A Qualitative Analysis

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Kelty B Fehling ◽  
Anne Lambert-Kerzner ◽  
Ryan Davis ◽  
Jennifer Weaver ◽  
Casey Barnett ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Patient Education ◽  
Patient Adherence ◽  
Clinical Care ◽  
Qualitative Inquiry ◽  
Educational Process ◽  
Assessment Tools ◽  
Personal Contact ◽  
Improve Medication Adherence ◽  
Coronary Syndrome

Background: Despite the success of pharmacist-led interventions to improve medication adherence, pharmacists’ perspectives of these interventions are unknown. Our objective was to understand the pharmacists’ perspectives of a successful multifaceted intervention to improve medication adherence after acute coronary syndrome (ACS) hospitalization. Methods: We ascertained pharmacist perspectives’ through qualitative inquiry that included an open-ended survey, semi-structured interviews, and a focus group with the four pharmacists who participated in the intervention. Transcripts of surveys and interviews were analyzed using a content analysis approach. The intervention components included: 1) patient education; 2) assessment tools for potential medication adherence barriers; 3) collaborative care; and 4) automated medication refill reminders and educational messages. Pharmacists’ perspectives on each of these components were evaluated. Results: The pharmacists felt the intervention could be sustained in routine clinical care and identified key themes that facilitated intervention success. Pharmacists believed educating patients about their cardiovascular medications filled a gap in usual care. In addition, assessment tools that identified medication discrepancies and gaps in knowledge were helpful in tailoring patient education, while face-to-face conversations were more helpful in identifying mental and cognitive deficits that were barriers to adherence. Pharmacists also noted that the intervention led to the development of bi-directional relationships with patients through increased in-person and tele-health communication. As a result, poor adherence related to medication side effects was more readily addressed. Potential areas for improvement identified by the pharmacists included 1) emphasizing in-person visits to build relationships (begin the educational process while the patient is hospitalized and schedule both the follow-up clinic appointment and pharmacy visit at the same time); 2) utilizing the patient centered medical home concept to improve access to providers; 3) allowing sites to determine provider type to support the personal contact (i.e. pharmacist, nurse practitioner, registered nurse); and 4) employing interactive voice response (IVR) technology to facilitate communication. Conclusions: Pharmacists’ perspectives of a medication adherence intervention gave insights into reasons for the intervention success and suggestions for improvements and dissemination. We found that in-person meetings between pharmacists and patients led to bi-directional conversations and relationships with providers, which positively influenced patient adherence behavior. Future interventions designed to improve medication adherence should incorporate these pharmacist-identified factors.

scholarly journals Trajectory of Estimated Glomerular Filtration Rate and Malnourishment Predict Mortality and Kidney Failure in Older Adults With Chronic Kidney Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Shuo-Chun Weng ◽  
Chyong-Mei Chen ◽  
Yu-Chi Chen ◽  
Ming-Ju Wu ◽  
Der-Cherng Tarng
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Kidney Failure ◽  
Quadratic Term ◽  
Mixed Effect ◽  
Risk Of Death ◽  
Nutritional Risk Index ◽  
Prospective Longitudinal

Objective: The trajectory patterns of estimated glomerular filtration rates (eGFR) in chronic kidney disease (CKD) older adults with malnourishment and their association with subsequent patient outcomes have not been elucidated. We aimed to assess the eGFR trajectory patterns for predicting patient survival and kidney failure in the elderly without or with malnourishment.Materials and Methods: Based on a prospective longitudinal cohort, CKD patients aged 65 years or older were enrolled from 2001 to 2013. Among the 3,948 patients whose eGFR trajectory patterns were analyzed, 1,872 patients were stratified by the absence or presence of malnourishment, and 765 patients were identified and categorized as having malnourishment. Four eGFR trajectory patterns [gradual decline (T0), early non-decline and then persistent decline (T1), persistent increase (T2), and low baseline and then progressive increase (T3)] were classified by utilizing a linear mixed-effect model with a quadratic term in time. The malnourishment was defined as body mass index &lt; 22 kg/m2, serum albumin &lt; 3.0 mg/dL, or Geriatric Nutritional Risk Index (GNRI) &lt; 98. This study assessed the effectiveness of eGFR trajectory patterns in a median follow-up of 2.27 years for predicting all-cause mortality and kidney failure.Results: The mean age was 76.9 ± 6.7 years, and a total of 82 (10.7%) patients with malnourishment and 57 (5.1%) patients without malnourishment died at the end of the study. Compared with the reference trajectory T0, the overall mortality of T1 was markedly reduced [adjusted hazard ratio (aHR) = 0.52, 95% confidence interval (CI) 0.32–0.83]. In patients with trajectory, T3 was associated with a high risk for kidney failure (aHR = 5.68, 95% CI 3.12–10.4) compared with the reference, especially higher risk in the presence of malnourishment. Patients with high GNRI values were significantly associated with a lower risk of death and kidney failure, but patients with malnourishment and concomitant alcohol consumption had a higher risk of kidney failure.Conclusions: Low baseline eGFR and progressively increasing eGFR trajectory were high risks for kidney failure in CKD patients. These findings may be attributed to multimorbidity, malnourishment, and decompensation of renal function.

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