Significant racial and ethnic disparities in chronic kidney disease (CKD) progression and outcomes are well documented, as is low use of guideline-recommended CKD care.To examine guideline-recommended CKD care delivery by race and ethnicity in a large, diverse population.In this serial cross-sectional study, adult patients with CKD that did not require dialysis, defined as a persistent estimated glomerular filtration rate less than 60 mL/min/1.73 m2 or a urine albumin-creatinine ratio of 30 mg/g or higher for at least 90 days, were identified in 2-year cross-sections from January 1, 2012, to December 31, 2019. Data from the OptumLabs Data Warehouse, a national data set of administrative and electronic health record data for commercially insured and Medicare Advantage patients, were used.The independent variables were race and ethnicity, as reported in linked electronic health records.On the basis of guideline-recommended CKD care, the study examined care delivery process measures (angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker prescription for albuminuria, statin prescription, albuminuria testing, nephrology care for CKD stage 4 or higher, and avoidance of chronic nonsteroidal anti-inflammatory drug prescription) and care delivery outcome measures (blood pressure and diabetes control).A total of 452 238 patients met the inclusion criteria (mean [SD] age, 74.0 [10.2] years; 262 089 [58.0%] female; a total of 7573 [1.7%] Asian, 49 970 [11.0%] Black, 15 540 [3.4%] Hispanic, and 379 155 [83.8%] White). Performance on process measures was higher among Asian, Black, and Hispanic patients compared with White patients for angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker use (79.8% for Asian patients, 76.7% for Black patients, and 79.9% for Hispanic patients compared with 72.3% for White patients in 2018-2019), statin use (72.6% for Asian patients, 69.1% for Black patients, and 74.1% for Hispanic patients compared with 61.5% for White patients), nephrology care (64.8% for Asian patients, 72.9% for Black patients, and 69.4% for Hispanic patients compared with 58.3% for White patients), and albuminuria testing (53.9% for Asian patients, 41.0% for Black patients, and 52.6% for Hispanic patients compared with 30.7% for White patients). Achievement of blood pressure control to less than 140/90 mm Hg was similar or lower among Asian (71.8%), Black (63.3%), and Hispanic (69.8%) patients compared with White patients (72.9%). Achievement of diabetes control with hemoglobin A1c less than 7.0% was 50.1% in Asian patients, 49.3% in Black patients, and 46.0% in Hispanic patients compared with 50.3% for White patients.Higher performance on CKD care process measures among Asian, Black, and Hispanic patients suggests that differences in medication prescription and diagnostic testing are unlikely to fully explain known disparities in CKD progression and kidney failure. Improving care delivery processes alone may be inadequate for reducing these disparities.
Patients with end stage renal disease have markedly reduced levels of physical functioning (PF). Little is known of the levels of PF in patients with chronic kidney disease (CKD) prior to renal replacement therapy or how PF is related to the level of renal function as measured by glomerular filtration rate (GFR). PURPOSE To document levels of PF in patients with chronic renal insufficiency using both objective laboratory measures and performance tests. METHODS Thirty one patients with stage 3 CKD (GFR < 60 ml/min/1.73 m2) (26 males/5 females; mean age 57.1±14.9 yr) were recruited for the study. Testing included symptom limited treadmill testing with measurement of VO, 6 minute walk test (6MW), sit to stand to sit (10 cycles) (STS10), and 20 foot gait speed (GS)(comfortable and fast speed). All measures except for the 6MW were converted to % of age predicted values. RESULTS VO2peak was markedly reduced (x = 17.9±6.77 ml/kg/min) and averaged 59.4±20.2% of age predicted values. Performance measures were not as markedly reduced as a percentage of normal age-predicted values: comfortable GS: 123.7±15.3%; fast GS: 86.0±16.6%; STS10: 60.9±47.3%. The only PF measure that was correlated to GFR was fast GS (r=.37; p.=05). Although the performance tests results were not as reduced compared to age-predicted values as VO2peak there were significant correlations between VO2peak and 6MW (r=.68; p < .001), comfortable GS (r=.413; p.=02) and fast GS (r=.611; p < .001). CONCLUSION Basic functioning of normal gait speed appears to be preserved in patients with CKD, with more impairments noted in activities requiring greater energy expenditure, such as fast gait speed, sit to stand tasks and symptom-limited exercise testing. Exercise training may be warranted in this population with the goal of maintaining overall functioning.
