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Chronic kidney disease in the urban poor
Yoshio N Hall1, Andy I Choi, Glenn M Chertow
1Kidney Research Institute, University of Washington, 325 Ninth Avenue, Box 359606, Seattle, WA 98104, USA. ynhall@u.washington.edu
Summary
Vulnerable populations with chronic kidney disease (CKD) in public health systems are younger and more likely to be nonwhite. These factors increase the risk of end-stage renal disease (ESRD), highlighting the need for targeted interventions.
Area of Science:
- Nephrology
- Public Health
- Health Disparities
Background:
- Limited data exists on clinical outcomes for vulnerable populations with chronic kidney disease (CKD) within US public health systems.
- Understanding CKD progression in safety-net settings is crucial for addressing health inequities.
Purpose of the Study:
- To characterize patient demographics, incidence of end-stage renal disease (ESRD), and mortality in adults with nondialysis-dependent CKD receiving care within a public health system.
- To identify risk factors associated with CKD progression in a safety-net population.
Main Methods:
- A cohort of 15,353 ambulatory adults with nondialysis-dependent CKD was analyzed.
- Time to ESRD and time to death were the primary outcomes examined.
- Adjusted analyses were performed to account for demographic and socioeconomic factors.
Main Results:
- The CKD cohort was relatively young (mean age 59.0 years), predominantly nonwhite (72%), indigent (73%), and uninsured (18%).
- Blacks, Hispanics, and Asians/Pacific Islanders had significantly higher risks of progression to ESRD compared to non-Hispanic whites.
- Higher risk of ESRD progression in nonwhite individuals was not attributed to lower relative mortality.
Conclusions:
- Adults with CKD stages 3-5 in urban public health systems are often young and nonwhite, correlating with increased ESRD risk.
- Findings underscore the necessity for targeted strategies to manage CKD burden and progression in safety-net healthcare settings.
- Further research is needed to assess CKD outcomes across diverse public and safety-net health systems.
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