Trends in Chronic Kidney Disease Care in the US by Race and Ethnicity, 2012-2019

• DOI: 10.1001/jamanetworkopen.2021.27014
• Publication Date: 2021-09-27T15:50:43Z
• Authors: Chi D. Chu; Neil R. Powe; Charles E. McCulloch; Deidra C. Crews; Yun Han; Jennifer L. Bragg...; Rajiv Saran; Alain Koyama; Nilka R. Burrows; Delphine S. Tuot; ; Neil Powe; Rajiv Saran; Vahakn Shahinian; Michael Heung; Brenda Gillespie; Hal Morgenstern; William Herman; Kara Zivin; Debbie Gipson; Zubin Modi; Jennifer Bragg-Gr...; Diane Steffick; Yun Han; Xiaosong Zhang; April Wyncott; Tanushree Banerjee; Delphine Tuot; Chi Chu; Chi-yuan Hsu; Josef Coresh; Charles McCulloch; Deidra Crews; Janet Pella; Nilka Ríos Burrows; Mark Eberhardt; Alain Koyama; Juanita Mondesire; Meda Pavkov; Deborah Rolka; Sharon Saydah
• Keywords: Albuminuria; Guideline

Significant racial and ethnic disparities in chronic kidney disease (CKD) progression outcomes are well documented, as is low use of guideline-recommended CKD care.To examine care delivery by race ethnicity a large, diverse population.In this serial cross-sectional study, adult patients with that did not require dialysis, defined persistent estimated glomerular filtration rate less than 60 mL/min/1.73 m2 or urine albumin-creatinine ratio 30 mg/g higher for at least 90 days, were identified 2-year cross-sections from January 1, 2012, to December 31, 2019. Data the OptumLabs Warehouse, national data set administrative electronic health record commercially insured Medicare Advantage patients, used.The independent variables ethnicity, reported linked records.On basis care, study examined process measures (angiotensin-converting enzyme inhibitor angiotensin II receptor blocker prescription albuminuria, statin prescription, albuminuria testing, nephrology stage 4 higher, avoidance nonsteroidal anti-inflammatory drug prescription) outcome (blood pressure diabetes control).A total 452 238 met inclusion criteria (mean [SD] age, 74.0 [10.2] years; 262 089 [58.0%] female; 7573 [1.7%] Asian, 49 970 [11.0%] Black, 15 540 [3.4%] Hispanic, 379 155 [83.8%] White). Performance on was among Hispanic compared White angiotensin-converting (79.8% Asian 76.7% Black 79.9% 72.3% 2018-2019), (72.6% 69.1% 74.1% 61.5% patients), (64.8% 72.9% 69.4% 58.3% testing (53.9% 41.0% 52.6% 30.7% patients). Achievement blood control 140/90 mm Hg similar lower (71.8%), (63.3%), (69.8%) (72.9%). hemoglobin A1c 7.0% 50.1% 49.3% 46.0% 50.3% patients.Higher performance suggests differences medication diagnostic unlikely fully explain known failure. Improving processes alone may be inadequate reducing these disparities.