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Psyched for @HMS_DICP webinar on kidney health starting NOW!
Featuring @DrRayMD @Cervantes_Lily1 @AmakaEMD and @DineeMD!
Our @BID_NephFellows are tuning in. You can too at: https://dicp.hms.harvard.edu/events/2020/ESJ-Kidney-Health
Featuring @DrRayMD @Cervantes_Lily1 @AmakaEMD and @DineeMD!
Our @BID_NephFellows are tuning in. You can too at: https://dicp.hms.harvard.edu/events/2020/ESJ-Kidney-Health
Moderator @AMLandryMD starts by asking about the use-of-race-in-GFR debate.
@AmakaEMD laying out the data (there ain't much):
-one study in the mid-90s noted that Black participants had higher creatinine values, so a race coefficient was created.
@AmakaEMD laying out the data (there ain't much):
-one study in the mid-90s noted that Black participants had higher creatinine values, so a race coefficient was created.
. @AmakaEMD notes that eGFR provides a false sense of accuracy--up to 30% variability is inherent in the measurement. The "higher" eGFRs of Black patients can delay their access to appropriate care (particularly nephrology referral and transplant listing).
. @AmakaEMD notes that rates of/progression of kidney disease in Black people are higher/faster due to:
-social determinants of health (differential access to healthy environments, diet, careers)
-higher burden of comorbid conditions (DM, HTN)
-genetic risk factors like APOL1
-social determinants of health (differential access to healthy environments, diet, careers)
-higher burden of comorbid conditions (DM, HTN)
-genetic risk factors like APOL1
. @AmakaEMD Creatinine is a poor biomarker--it does not perform as well in older/frailer people, in more muscular people, in Black people.
Adjusting it over and over is not the right answer. Getting a better biomarker is.
Adjusting it over and over is not the right answer. Getting a better biomarker is.
. @DrRayMD notes that children aren't little adults:
-most kids with kidney disease have congenital, glomerular and/or genetic diseases.
-although these kids are cared for in "progressive" academic medical centers, the same racial disparities in care that plague adults persist
-most kids with kidney disease have congenital, glomerular and/or genetic diseases.
-although these kids are cared for in "progressive" academic medical centers, the same racial disparities in care that plague adults persist
. @DrRayMD highlights
-lower rates of peritoneal dialysis usage
-later transplant referral
-higher rates of graft loss
in Black kids.
-lower rates of peritoneal dialysis usage
-later transplant referral
-higher rates of graft loss
in Black kids.
Another stunner from @DrRayMD:
-African Americans are the only ethnic group that is less likely to donate a kidney now than a decade ago.
"Our health systems have induced an iatrophobia in Black patients, so that they fear engaging with medical care."
-African Americans are the only ethnic group that is less likely to donate a kidney now than a decade ago.
"Our health systems have induced an iatrophobia in Black patients, so that they fear engaging with medical care."
. @Cervantes_Lily1 takes the mic to talk about disparities in kidney care in the LatinX community.
I'm still floored by her 2018 study:
Undocumented people with ESRD who only dialyze emergently have a rate of death 14x higher than those w scheduled HD: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2665387
I'm still floored by her 2018 study:
Undocumented people with ESRD who only dialyze emergently have a rate of death 14x higher than those w scheduled HD: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2665387
. @Cervantes_Lily1's research was able to change the laws of the state of Colorado so that these patients can now get scheduled HD. https://www.cpr.org/2020/03/04/colorado-changed-its-rules-so-undocumented-people-can-get-regular-dialysis-its-saved-lives-and-dollars/
. @Cervantes_Lily1 describes:
-undocumented ESKD patients loading up on high K foods to get HD sooner.
-how children of these patients suffer mental health issues from caregiver burden.
-increased burnout symptoms among healthcare providers dealing with this population.
-undocumented ESKD patients loading up on high K foods to get HD sooner.
-how children of these patients suffer mental health issues from caregiver burden.
-increased burnout symptoms among healthcare providers dealing with this population.
. @Cervantes_Lily1 describes the political strategery that she needed to make the Colorado change a reality.
In short: go for the bureaucrats.
In short: go for the bureaucrats.
Thread continues here: https://twitter.com/Jwaitz/status/1308450652444438528
