scholarly journals Recovery of kidney function after dialysis initiation in children and adults in the US: A retrospective study of United States Renal Data System data

PLoS Medicine ◽  
2021 ◽  
Vol 18 (2) ◽  
pp. e1003546
Author(s):  
Elaine Ku ◽  
Raymond K. Hsu ◽  
Kirsten L. Johansen ◽  
Charles E. McCulloch ◽  
Mark Mitsnefes ◽  
...  
Keyword(s):  
United States ◽  
Kidney Disease ◽  
Kidney Function ◽  
Temporal Trends ◽  
The United States ◽  
Outpatient Setting ◽  
Recovery Rates ◽  
Factors Associated ◽  
The Us ◽  
Adults And Children

Background Little is known about factors associated with recovery of kidney function—and return to dialysis independence—or temporal trends in recovery after starting outpatient dialysis in the United States. Understanding the characteristics of individuals who may have the potential to recover kidney function may promote better recognition of such events. The goal of this study was to determine factors associated with recovery of kidney function in children compared with adults starting dialysis in the US. Methods and findings We determined factors associated with recovery of kidney function—defined as survival and discontinuation of dialysis for ≥90-day period—in children versus adults who started maintenance dialysis between 1996 and 2015 according to the United States Renal Data System (USRDS) followed through 2016 in a retrospective cohort study. We also examined temporal trends in recovery rates over the last 2 decades in this cohort. Among 1,968,253 individuals included for study, the mean age was 62.6 ± 15.8 years, and 44% were female. Overall, 4% of adults (83,302/1,953,881) and 4% of children (547/14,372) starting dialysis in the outpatient setting recovered kidney function within 1 year. Among those who recovered, the median time to recovery was 73 days (interquartile range [IQR] 43–131) in adults and 100 days (IQR 56–189) in children. Accounting for the competing risk of death, children were less likely to recover kidney function compared with adults (sub-hazard ratio [sub-HR] 0.81; 95% CI 0.74–0.89, p-value <0.001; point estimates <1 indicating increased risk for a negative outcome). Non-Hispanic black (NHB) adults were less likely to recover compared with non-Hispanic white (NHW) adults, but these racial differences were not observed in children. Of note, a steady increase in the incidence of recovery of kidney function was noted initially in adults and children between 1996 and 2010, but this trend declined thereafter. The diagnoses associated with the highest recovery rates of recovery were acute tubular necrosis (ATN) and acute interstitial nephritis (AIN) in both adults and children, where 25%–40% of patients recovered kidney function depending on the calendar year of dialysis initiation. Limitations to our study include the potential for residual confounding to be present given the observational nature of our data. Conclusions In this study, we observed that discontinuation of outpatient dialysis due to recovery occurred in 4% of patients with end-stage kidney disease (ESKD) and was more common among those with ATN or AIN as the cause of their kidney disease. While recovery rates rose initially, they declined starting in 2010. Additional studies are needed to understand how to best recognize and promote recovery in patients whose potential to discontinue dialysis is high in the outpatient setting.

scholarly journals Hospitalizations among adults with chronic kidney disease in the United States: A cohort study

PLoS Medicine ◽  
2020 ◽  
Vol 17 (12) ◽  
pp. e1003470
Author(s):  
Sarah J. Schrauben ◽  
Hsiang-Yu Chen ◽  
Eugene Lin ◽  
Christopher Jepson ◽  
Wei Yang ◽  
...  
Keyword(s):  
United States ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
The United States ◽  
Hospitalization Rate ◽  
Factors Associated ◽  
Hospitalization Rates ◽  
Wide Range

Background Adults with chronic kidney disease (CKD) are hospitalized more frequently than those without CKD, but the magnitude of this excess morbidity and the factors associated with hospitalizations are not well known. Methods and findings Data from 3,939 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study between 2003 and 2008 at 7 clinical centers in the United States were used to estimate primary causes of hospitalizations, hospitalization rates, and baseline participant factors associated with all-cause, cardiovascular, and non-cardiovascular hospitalizations during a median follow up of 9.6 years. Multivariable-adjusted Poisson regression was used to identify factors associated with hospitalization rates, including demographics, blood pressure, estimated glomerular filtration rate (eGFR), and proteinuria. Hospitalization rates in CRIC were compared with rates in the Nationwide Inpatient Sample (NIS) from 2012. Of the 3,939 CRIC participants, 45.1% were female, and 41.9% identified as non-Hispanic black, with a mean age of 57.7 years, and the mean eGFR is 44.9 ml/min/1.73m2. CRIC participants had an unadjusted overall hospitalization rate of 35.0 per 100 person-years (PY) [95% CI: 34.3 to 35.6] and 11.1 per 100 PY [95% CI: 10.8 to 11.5] for cardiovascular-related causes. All-cause, non-cardiovascular, and cardiovascular hospitalizations were associated with older age (≥65 versus 45 to 64 years), more proteinuria (≥150 to <500 versus <150 mg/g), higher systolic blood pressure (≥140 versus 120 to <130 mmHg), diabetes (versus no diabetes), and lower eGFR (<60 versus ≥60 ml/min/1.73m2). Non-Hispanic black (versus non-Hispanic white) race/ethnicity was associated with higher risk for cardiovascular hospitalization [rate ratio (RR) 1.25, 95% CI: 1.16 to 1.35, p-value < 0.001], while risk among females was lower [RR 0.89, 95% CI: 0.83 to 0.96, p-value = 0.002]. Rates of cardiovascular hospitalizations were higher among those with ≥500 mg/g of proteinuria irrespective of eGFR. The most common causes of hospitalization were related to cardiovascular (31.8%), genitourinary (8.7%), digestive (8.3%), endocrine, nutritional or metabolic (8.3%), and respiratory (6.7%) causes. Hospitalization rates were higher in CRIC than the NIS, except for non-cardiovascular hospitalizations among individuals aged >65 years. Limitations of the study include possible misclassification by diagnostic codes, residual confounding, and potential bias from healthy volunteer effect due to its observational nature. Conclusions In this study, we observed that adults with CKD had a higher hospitalization rate than the general population that is hospitalized, and even moderate reductions in kidney function were associated with elevated rates of hospitalization. Causes of hospitalization were predominantly related to cardiovascular disease, but other causes contributed, particularly, genitourinary, digestive, and endocrine, nutritional, and metabolic illnesses. High levels of proteinuria were observed to have the largest association with hospitalizations across a wide range of kidney function levels.

scholarly journals Telomere attrition, kidney function, and prevalent chronic kidney disease in the United States

Oncotarget ◽  
2017 ◽  
Vol 8 (46) ◽  
pp. 80175-80181 ◽  
Author(s):  
Moshen Mazidi ◽  
Peyman Rezaie ◽  
Adriac Covic ◽  
Jolanta Malyszko ◽  
Jacek Rysz ◽  
...  
Keyword(s):  
United States ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
The United States ◽  
Telomere Attrition

scholarly journals Temporal and spatial variations in freeze warnings in the conterminous United States: 2005–2018

2019 ◽  
Vol 139 (3-4) ◽  
pp. 1379-1384
Author(s):  
Brandon Lawhorn ◽  
Robert C. Balling
Keyword(s):  
United States ◽  
Temporal Trends ◽  
The United States ◽  
Temporal Variations ◽  
Atmospheric Composition ◽  
Southeastern Us ◽  
The Us ◽  
Temporal And Spatial ◽  
Frost Free Period ◽  
Spatial And Temporal Trends

AbstractIt is well-documented that the United States (US), along with other mid-latitude land locations, has experienced warming in recent decades in response to changes in atmospheric composition. Among other changes, Easterling (2002) reported that the frost-free period is now longer across much of the US with the first frost in fall occurring later and the last freeze in spring occurring earlier. In this investigation, we explore spatial and temporal variations in all freeze warnings issued by the US National Weather Service. Freeze warning counts are highest in the southeastern US peaking overall in the spring and fall months. Freeze warnings tend to occur more toward summer moving northward and westward into more northerly states. Consistent with the warming in recent decades, we find statistically significant northward movements in freeze warning centroids in some months (December, February) across the study period (2005–2018). Detection of spatial and temporal trends in freeze warnings may be of interest to any number of scientists with applied climatological interests.

Hepatitis C Virus in Children: Trying to Overcome the Domestic and Global Challenges of Cases and Cost

2019 ◽  
Author(s):  
Chase Perfect ◽  
Ravi Jhaveri
Keyword(s):  
United States ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Global Health ◽  
The United States ◽  
Cost Of Treatment ◽  
Global Challenges ◽  
The Us ◽  
Adults And Children ◽  
Global Health Challenge

Abstract Over the last decade, Hepatitis C virus has persisted and evolved as a domestic and global health challenge for adults and children. The challenges involve both increased cases in the United States and cost of treatment both in the US and globally.

scholarly journals Viral And Antibody Testing For Coronavirus Disease 2019 (Covid-19): Factors Associated With Positivity In Electronic Health Records From The United States

2021 ◽  
Author(s):  
Lisa Lindsay ◽  
Matthew H. Secrest ◽  
Shemra Rizzo ◽  
Dan Keebler ◽  
Fei Yang ◽  
...  
Keyword(s):  
United States ◽  
Clinical Practice ◽  
Electronic Health Records ◽  
Temporal Trends ◽  
Antibody Test ◽  
The United States ◽  
Health Records ◽  
Factors Associated ◽  
Electronic Health ◽  
Antibody Tests

AbstractBackgroundInsufficient information on SARS-CoV-2 testing results exists in clinical practice from the United States.MethodsWe conducted an observational retrospective cohort study using Optum® de-identified COVID-19 electronic health records from the United States to characterize patients who received a SARS-CoV-2 viral or antibody test between February 20, 2020 and July 10, 2020. We assessed temporal trends in testing and positivity by demographic and clinical characteristics; evaluated concordance between viral and antibody tests; and identified factors associated with positivity via multivariable logistic regression.ResultsOur study population included 891,754 patients. Overall positivity rate for SARS-CoV-2 was 9% and 12% for viral and antibody tests, respectively. Positivity rate was inversely associated with the number of individuals tested and decreased over time across regions and race/ethnicities. Among patients who received a viral test followed by an antibody test, concordance ranged from 90%-93% depending on the duration between the two tests which is notable given uncertainties related to specific viral and antibody test characteristics. The following factors increased the odds of viral and antibody positivity in multivariable models: male, Hispanic or non-Hispanic Black and Asian, uninsured or Medicaid insurance, Northeast residence, dementia, diabetes, and obesity. Charlson Comorbidity Index was negatively associated with test positivity. We identified symptoms that were positively associated with test positivity, as well as, commonly co-occurring symptoms / conditions. Pediatric patients had reduced odds of a positive viral test, but conversely had increased odds of a positive antibody test.ConclusionsThis study identified sociodemographic and clinical factors associated with SARS-CoV-2 testing and positivity within routine clinical practice from the United States.

scholarly journals Investigating associations between COVID-19 mortality and population-level health and socioeconomic indicators in the United States: A modeling study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (7) ◽  
pp. e1003693
Author(s):  
Sasikiran Kandula ◽  
Jeffrey Shaman
Keyword(s):  
United States ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Nursing Homes ◽  
Spatial Autocorrelation ◽  
Population Level ◽  
The United States ◽  
County Level ◽  
Socioeconomic Indicators ◽  
The Us

Background With the availability of multiple Coronavirus Disease 2019 (COVID-19) vaccines and the predicted shortages in supply for the near future, it is necessary to allocate vaccines in a manner that minimizes severe outcomes, particularly deaths. To date, vaccination strategies in the United States have focused on individual characteristics such as age and occupation. Here, we assess the utility of population-level health and socioeconomic indicators as additional criteria for geographical allocation of vaccines. Methods and findings County-level estimates of 14 indicators associated with COVID-19 mortality were extracted from public data sources. Effect estimates of the individual indicators were calculated with univariate models. Presence of spatial autocorrelation was established using Moran’s I statistic. Spatial simultaneous autoregressive (SAR) models that account for spatial autocorrelation in response and predictors were used to assess (i) the proportion of variance in county-level COVID-19 mortality that can explained by identified health/socioeconomic indicators (R2); and (ii) effect estimates of each predictor. Adjusting for case rates, the selected indicators individually explain 24%–29% of the variability in mortality. Prevalence of chronic kidney disease and proportion of population residing in nursing homes have the highest R2. Mortality is estimated to increase by 43 per thousand residents (95% CI: 37–49; p < 0.001) with a 1% increase in the prevalence of chronic kidney disease and by 39 deaths per thousand (95% CI: 34–44; p < 0.001) with 1% increase in population living in nursing homes. SAR models using multiple health/socioeconomic indicators explain 43% of the variability in COVID-19 mortality in US counties, adjusting for case rates. R2 was found to be not sensitive to the choice of SAR model form. Study limitations include the use of mortality rates that are not age standardized, a spatial adjacency matrix that does not capture human flows among counties, and insufficient accounting for interaction among predictors. Conclusions Significant spatial autocorrelation exists in COVID-19 mortality in the US, and population health/socioeconomic indicators account for a considerable variability in county-level mortality. In the context of vaccine rollout in the US and globally, national and subnational estimates of burden of disease could inform optimal geographical allocation of vaccines.

scholarly journals Decoding the Risk of Accepting Online Misinformation Using Intelligence Quotient and Income

2021 ◽  
Author(s):  
Azad Kabir ◽  
Raeed Kabir ◽  
Jebun Nahar ◽  
Ritesh Sengar
Keyword(s):  
United States ◽  
Low Income ◽  
Intelligence Quotient ◽  
The United States ◽  
Demographic Groups ◽  
Factors Associated ◽  
The Us ◽  
Surrogate Measure ◽  
Lower Intelligence ◽  
The Impact

Abstract: The object of the study was to evaluate the risk factors associated with accepting online misinformation about COVID-19 vaccination in the United States. The percentages of fully vaccinated people, with regards to COVID-19, were considered as a surrogate measure of accepting online misinformation. The study evaluated the impact of the US state's average intelligence quotient (IQ) and per capita income on accepting misinformation. The study found that socio-demographic groups with lower income along with lower intelligence quotient (IQ) are more vulnerable to online misinformation theories surrounding COVID-19. Further study is needed to evaluate how to increase the intelligence quotient among low-income individuals and whether such an effort will reduce the acceptance of misinformation among the vulnerable population in the United States.

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