NKF 2021: Skewed Transplant Waitlists; Daft Diabetes Care

Some of the latest research advancements in the field of nephrology presented at the virtual National Kidney Foundation Spring Clinical Meeting included post-marketing safety data on patiromer (Veltassa), metformin for polycystic kidney disease, and kidney care during the COVID-19 pandemic. Below are a few more research highlights:

Disparities in Kidney Transplants

Significant racial/ethnic and sex disparities exist across end-stage renal disease (ESRD) networks when it comes to waiting for a kidney transplant, reported Reem Hamoda, MPH, of the University of Chicago, and colleagues.

Looking at over 1.3 million incident adult dialysis patients in the U.S. Renal Data System from 2005 to 2016, women were far less likely to get a spot on the renal transplant waitlist. Among these patients, 19.4% were waitlisted.

Across the 18 ESRD networks in the U.S., white women were 18% (HR 0.82, 95% CI 0.80-0.83) less likely to get waitlisted and Black women were 26% (HR 0.74, 95% CI 0.72-0.75) less likely to get on the waitlist compared with white men.

The only two networks for which this disparity wasn't pronounced were network 4, including Delaware and Pennsylvania, and network 16, which included Alaska, Idaho, Montana, Oregon, and Washington. But in almost every network, Black women were at the biggest disadvantage when it came to access to the renal transplant waitlist.

"I really think simply saying that women are just not being referred enough could be part of the answer, but I don't think it's the complete answer," Hamoda said during a virtual poster presentation. "I do think that a multi-level, multifactorial scope is important so that we can most comprehensively adjust these disparities."

Comorbid Diabetes & CKD Gaps

Physicians may not have all the answers when it comes to managing patients with comorbid type 2 diabetes and chronic kidney disease (CKD), reported George Bakris, MD, also of the University of Chicago, and colleagues.

Looking at results from a CME-certified activity given to 193 diabetologists and endocrinologists on clinical decision-making questions regarding CKD and type 2 diabetes, there were some notable gaps in knowledge.

The survey consisted of 25 multiple choice case-based questions given from February to April 2020. Overall, 89% of physicians responded incorrectly to questions about SGLT2 inhibitors -- including canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance) -- and their cardiovascular outcomes trials data comparisons. In a similar vein, 87% of physicians responded incorrectly when asked about the mechanism of cardiorenal syndrome.

Additionally, 73% weren't aware of evidence-based strategies to delay progression of CKD in patients with diabetes.

About two-thirds of physicians also incorrectly answered questions on topics relating to fibrosis as a component of progression of CKD, knowledge of billing procedures for CKD screening, and differences in emerging mineralocorticoid receptor antagonists (MRAs) compared with traditional MRAs.

And when nephrologists were asked about how satisfied they were with the current treatment approaches for managing CKD in patients with type 2 diabetes, 74% said "moderately-mostly satisfied," while 16% were "slightly unsatisfied."

Health Literacy Fallout

Lack of health literacy may explain why people with hypertension don't adhere to the Dietary Approaches to Stop Hypertension (DASH) diet, reported Sophia Lou, of Johns Hopkins University in Baltimore, and colleagues.

In a cross-sectional analysis of 1,073 hypertensive adults -- those who self-reported hypertension or who were taking anti-hypertensive medication -- from the Healthy Aging in Neighborhoods of Diversity Across the Life Span study, a third had "inadequate" health literacy measured by the Rapid Estimate of Adult Literacy in Medicine. Additionally, 14.5% of these hypertensive patients were deemed to have inadequate health numeracy, as measured by the corresponding subscore in the Test of Functional Health Literacy in Adults.

Among this patient population, only 6.9% followed a DASH diet. Greater health literacy was associated with a higher DASH score. Similarly, greater health numeracy was tied to a higher DASH score, but only for white, not Black, patients.

Of the total cohort, 39% were men, 66% were Black, and about 40% lived in poverty with roughly 30% reporting food insecurity.

"In my study, we found that education explained this relationship between health literacy and DASH," Lou stated during a virtual presentation of her findings. Other factors that may influence health literacy and adherence to an anti-hypertensive diet may include stable sources of healthcare, health insurance, and having a primary care provider, she added.