OBJECTIVES:To detail patient challenges, and how technology support addressed them, in a remote patient activation intervention for hemodialysis patients (n = 93) from trained patient mentors (n = 26). MATERIALS AND METHODS:Using digital divide theory-derived codes, content analysis of: technology support program delivery data, hemodialysis clinic staff interviews, and support staff reflection papers. Descriptive statistics from postintervention mentee/mentor surveys. RESULTS:All mentees and 46.2% of mentors received support. Motivational access was targeted with explanations, rapport, and support availability. Study-provided, data-capable tablets enhanced material access, but internet access barriers persisted. Skills access was addressed by training; password-related challenges initially dominated. For usage access, on-demand technology support was balanced by engagement support: proactive prementoring session calls and login monitoring. DISCUSSION:Interventionists should examine internet coverage in targeted areas, potentially using multiple carriers. A balance between password usability and security is required. Engagement support may be needed. CONCLUSION:Technology support can close patient digital divides.

KEY POINTS:Most of the nephrology fellows express concern about health care disparities. A significant proportion of nephrology fellows do not feel well-trained to reduce care disparities. We highlight an opportunity to optimize nephrology education about disparities and equip future nephrologists to reduce inequities in kidney care. BACKGROUND:Equity in kidney care is clinically and ethically important. We conducted a national survey of nephrology fellows to assess their attitudes toward, and perceptions of, health equity in fellow training and kidney care. METHODS:We administered a 13-question survey in 2022 to all nephrology trainees through the American Society of Nephrology in-service training exam. We asked fellows about their perceptions of training and confidence in caring for underserved patients, their level of concern about health disparities, and the sense of responsibility they felt to address these disparities. Baseline characteristics were summarized, and survey responses were analyzed using factor analysis and multivariate modeling. RESULTS:The response rate was 84% (689 of 816). The survey reliability factor was 0.77, i.e ., very good to excellent. Respondents were a mean (SD) of 34 (4) years, 57% were men, and 11% Hispanic. Most (72%) reported working with underserved populations "often/always". Over 80% of fellows "agreed/strongly agreed" that they were concerned about health care disparities. Only 61% "agreed/strongly agreed" they were well-trained to reduce disparities. Individuals of self-reported Hispanic and Black race, as well as US Medical School-based graduates, were more likely to report working with underserved patients. Black trainees demonstrated greater concern for addressing health disparities and higher confidence in their ability to work effectively with underserved populations ( P = 0.04). Nonetheless, they reported feeling less well-trained in cross-cultural communication compared with White trainees ( P = 0.01). In factor-weighted, multivariate analysis, concern in women versus men was not significantly different, yet confidence to address disparities, cross-cultural communication, and self-efficacy caring for underserved patients was lower in women (all P ≤ 0.05 compared with men). CONCLUSIONS:Although a physician's skills in cross cultural communication, and abilities to care for underserved individuals and to address health disparities are critically important, a significant proportion of nephrology fellows reported not feeling confident and/or lacking experience in these areas. There is an urgent need to optimize nephrology training in these areas, to empower the next generation of nephrologists to provide disease-specific communication and care for the diverse populations they serve.

When chronic kidney disease (CKD) progresses to end-stage kidney disease (ESKD), many patients receive in-center hemodialysis. Although lifesaving, hemodialysis is associated with intradialytic hypotension (IDH), a common complication that can cause distressing symptoms and lead to organ and tissue damage. Peer mentoring and patient activation have supported self-management in other chronic illnesses, but their use to improve hemodialysis session stability has not been well studied. The Dialysafe Study combined patient education and peer mentoring to promote health behaviors supporting hemodialysis session stability. We aimed to describe intervention recruitment, engagement, completion, and attrition; assess participants’ health goals and self-reported behavior changes; and evaluate satisfaction and recommendations for improvement. Ten Dialysafe hemodialysis centers were assigned to patient activation, and all eligible English-speaking patients were invited. The intervention included 5 tablet-based educational modules and 5 corresponding videoconference peer mentoring sessions. Analyses integrated electronic health record demographic and clinical data, intervention-platform usage data, postintervention surveys, and qualitative notes from clinic Operations Committee meetings. A weighted engagement score ranging from 0-50 summarized completion of mentoring sessions, goal-setting, videos, quizzes, and patient stories, with greater weight assigned to the more interactive mentoring and goal-setting elements. Descriptive statistics, t-tests, chi-square tests and regression models assessed recruitment, completion (defined as completing all 5 mentoring sessions), and engagement. Qualitative data were inductively coded in NVivo and integrated with quantitative findings via joint displays. Approximately one-quarter (155/639, 24.3%) of eligible patients were recruited to the intervention. Recruitment was more likely among younger, college-educated patients and those with sleep disorders. Of recruited patients, 46.5% (72/155) met with a peer mentor at least once. The average engagement score was 18.37 out of 50 possible points. Overall engagement was higher among men, Black patients, patients newer to dialysis, and those with more comorbidities. Attrition was concentrated before mentoring sessions began, and younger age and more comorbidities predicted completion. Communication with the care team was the most frequently patient-selected behavior change goal and the most frequently identified behavior change. Both mentees and mentors identified peer mentoring sessions as the most valuable part of the intervention, and both were highly satisfied with the intervention activities. Participants in the patient activation intervention were a self-selecting group who likely were already more engaged in their care than others in their clinics. However, that “communication with care team” was the most frequently selected health behavior goal and health behavior change demonstrates the importance and challenge of patient-clinician communication, even among highly activated patients. Mentees and mentors described the mentoring relationship as a highlight of the intervention. Digital patient activation interventions using peer mentoring may promote personal connection and improvements in communication with healthcare providers among the dialysis patient population, though reach is limited. ClinicalTrials.gov NCT03171545 RR2-10.2196/46187

Short-term heat exposure has been linked with increased risks of AKI and CKD, but the effect on the incidence or prevalence of CKD is unknown. This study examines the association of high temperatures with CKD prevalence and ESKD incidence at county level in the United States (US). County-level diagnosed CKD prevalence data (2005-2019) among Medicare enrollees aged ≥65 years from the US Kidney Disease Surveillance System and ESKD incidence data (2010-2019) from the United States Renal Data System were analyzed. County-specific heat exposure measurements included annual average temperature (AAT) and annual heat wave days from nClimGrid-Daily dataset (US National Centers for Environmental Information). We used a linear mixed model to assess associations between heat exposure and diagnosed CKD prevalence as well as ESKD incidence, while geographically weighted regression assessed spatial variations, adjusting for time-trend, county-specific factors and demographics. Stratified analysis compared associations across socioeconomic subgroups. AAT had significantly positive associations with diagnosed CKD prevalence and ESKD incidence. Each 1°C increase in AAT was associated with a 0.23 (95% confidence interval, 0.20 to 0.27) percentage point increase in the prevalence of diagnosed CKD. Similarly, each 1°C increase in AAT was associated with an additional 1.37 (95% confidence interval, 1.08 to 1.65) ESKD cases/100,000 population. Heat wave days were positively associated with both kidney outcomes, and the strength of these associations increased with higher temperature thresholds and longer duration. Stronger associations between heat exposure and both kidney outcomes were observed in high poverty and nonmetropolitan counties ( P < 0.05). The strength of associations was greater in counties in southern and northwestern regions. The associations between ambient temperature and kidney health, with socioeconomic and regional differences, may have implications for interventions aimed at reducing the potential effects of high temperatures on kidney health, particularly in vulnerable populations.

Short-term heat exposure has been linked with increased risks of AKI and CKD, but the effect on the incidence or prevalence of CKD is unknown. This study examines the association of high temperatures with CKD prevalence and ESKD incidence at county level in the United States (US). County-level diagnosed CKD prevalence data (2005–2019) among Medicare enrollees aged ≥65 years from the US Kidney Disease Surveillance System and ESKD incidence data (2010–2019) from the United States Renal Data System were analyzed. County-specific heat exposure measurements included annual average temperature (AAT) and annual heat wave days from nClimGrid-Daily dataset (US National Centers for Environmental Information). We used a linear mixed model to assess associations between heat exposure and diagnosed CKD prevalence as well as ESKD incidence, while geographically weighted regression assessed spatial variations, adjusting for time-trend, county-specific factors and demographics. Stratified analysis compared associations across socioeconomic subgroups. AAT had significantly positive associations with diagnosed CKD prevalence and ESKD incidence. Each 1°C increase in AAT was associated with a 0.23 (95% confidence interval, 0.20 to 0.27) percentage point increase in the prevalence of diagnosed CKD. Similarly, each 1°C increase in AAT was associated with an additional 1.37 (95% confidence interval, 1.08 to 1.65) ESKD cases/100,000 population. Heat wave days were positively associated with both kidney outcomes, and the strength of these associations increased with higher temperature thresholds and longer duration. Stronger associations between heat exposure and both kidney outcomes were observed in high poverty and nonmetropolitan counties ( P < 0.05). The strength of associations was greater in counties in southern and northwestern regions. The associations between ambient temperature and kidney health, with socioeconomic and regional differences, may have implications for interventions aimed at reducing the potential effects of high temperatures on kidney health, particularly in vulnerable populations.

Kidney diseases are an important public health problem, rising in global significance. In place for nearly 2 decades, the Centers for Disease Control and Prevention's Kidney Disease Surveillance System is the first comprehensive surveillance system developed in the United States, focused exclusively on tracking kidney disease before ESKD. The Kidney Disease Surveillance System incorporates key data and trends from multiple, large national-level survey data sources (National Health and Nutrition Examination Survey), electronic medical record data (Military and Veterans Affairs Health Systems), health care claims (Medicare, Optum), and social determinants of health (American Community Survey). The prevalence of CKD among civilian US adults remains steady between 13% and 14%. The prevalence is higher among older, female, non-Hispanic Black adults and those with diabetes or hypertension. Among US veterans, the incidence of CKD and rates of diagnosis of AKI increased from 2008 to 2022 (incidence: 62.8 to 71.5/1000 person-years, AKI: 84.9 to 241.7 cases/1000 person-years). Awareness of the disease nationwide among persons with CKD has historically been low (<10%), but starting in 2013, has increased to approximately 25%. Persons with CKD self-report more problems with sleep, and those aged 65 years and older self-report a higher prevalence of functional limitations. Improvements in quality-of-care measures, including medication prescription and increase in both serum creatinine and albuminuria testing were observed. Increased self-reported physical activity was observed among persons with CKD. Food insecurity increased among persons with CKD, with the highest prevalence in young, female, non-Hispanic Black, and Hispanic adults. Although population-level prevalence of CKD remains stable, higher AKI and CKD rates are being observed in health systems settings. This project's website can be found at https://wwwn.cdc.gov/KDSS/ . Robust surveillance is key to raising awareness of kidney disease, its risk factors, care quality, and outcomes. Surveillance findings may inform policy and evidence-based practices that reduce premature morbidity and mortality, improve quality of life, and reduce cost.

Introduction:Consistent with evidence-based care for pediatric overweight (BMI between 85th to 94th percentile) and obesity (BMI ≥ 95th percentile), a clinical decision support system (CDSS) OurPractice Advisory (OPA) was designed and implemented in 18 pediatric primary care clinics to support documenting elevated body mass index (BMI) on electronic health record (EHR) problem lists and ordering comorbidity screening labs. Methods:For those whom the OPA fired, we assessed the odds of problem list BMI documentation and comorbidity screening based on demographics and weight status and generated statistical process control charts to evaluate improvements in care processes. Results:EHR data from 9,621 patients with overweight and obesity were collected from 2021-2023. Providers documented elevated BMI in the problem list for at least 44% of eligible encounters and performed comorbidity screening in at least 15% of eligible encounters. Providers were more likely to perform problem list BMI documentation for older children, non-Hispanic Black children, children with public insurance, and children with a higher BMI percentile. Providers were also more likely to perform comorbidity screening among the same groups. The mean percentage of patients with an elevated BMI diagnosis on their problem list increased from 9.2% to 64% and the mean percentage of patients who had comorbidity screening labs performed increased from 7.8% to 32%. Conclusion:The implementation of the CDSS intervention was associated with an increased likelihood of delivering evidence-based care processes.

This cross-sectional study examines adherence to guidelines for testing for kidney disease among persons receiving care at federally qualified health centers (FQHCs) vs non-FQHC institutions in Illinois.

The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation tends to overestimate glomerular filtration rate (GFR) in younger and older age groups. In contrast, the European Kidney Function Consortium (EKFC) full-age spectrum (FAS) provides a more accurate estimate of CKD burden across the age spectrum thereby providing a more accurate estimate of disease burden. We conducted a comparative analysis of the EKFC-FAS equations with the CKD-EPI equations on CKD prevalence and staging in Irish adults age 50 and over. We utilised data from The Irish Longitudinal Study on Ageing (2009–2011), for participants aged 50 to 79 years with kidney function assessment. Estimated GFR was calculated using the EKFC-FAS and CKD-EPI equations, with CKD defined as eGFR <60 ml/min/1.73 m². We compared median eGFR values, CKD prevalence, concordance correlation coefficient (CCC)s across a panel of estimating equations. We then evaluated the impact of the EKFC-FAS equations [FAS 2017Scr-CysC, EKFC 2021Scr and FAS 2021CysC] on eGFR category reclassification of CKD staging, using CKD-EPI 2012Scr-CysC and 2009Scr as referent equations. A total of 5,092 participants (53.3% women, median age 61 years) were included. CKD prevalence weighted to the population was significantly higher using the FAS equations as compared to the to the CKD-EPI -based equations and ranged from 7.53% [6.78%–8.35%] using CKD-EPI 2021Scr (race-free) to 18.14% [16.96%–19.39%] using FAS 2023CysC equations, P < 0.001 for each category. Median eGFR was 74.5 ml/min/1.73 m² for EKFC-FAS 2017Scr-CysC and 82.1 ml/min/1.73 m² for CKD-EPI 2012Scr-CysC, leading to a 5.9% difference in CKD prevalence [10.8% vs. 16.7%, P < 0.001]. The reclassification discrepancy towards a more severe CKD stage varied from 20.7% to 26.6% when the EKFC-FAS equations were compared to the CKD-EPI 2012Scr-CysC, and varied from 17.9% to 32.9% when compared to CKD-EPI 2009Scr. The CCC ranged from 0.82 to 0.89 (EKFC-FAS vs CKD-EPI 2012Scr-CysC) 0.61 to 0.82 (CKD-EPI 2009Scr). The prevalence of CKD in Irish adults differs significantly according to eGFR equation with higher prevalence predicted by EKFC-than the CKD-EPI derived equations. Discrepancies in CKD staging and lack of concordance are a cause for concern at the individual level and population level as these influence clinical decision making, care delivery, healthcare planning, resource allocation, and referral to nephrology services in Ireland.