BackgroundEnd-stage kidney disease (ESKD) or kidney failure is a condition where the kidneys lose the ability to function. African American individuals are 4 times as likely to develop ESKD compared to White American individuals. In addition, African American patients are less likely to have an optimal dialysis start and to choose renal replacement therapy modalities that align with their goals and values. Our prior work shows that culturally tailored, in-person education improves patient outcomes. This is the foundation for our innovative intervention using an African American virtual patient educator as an option for hospitalized patients with chronic kidney disease (CKD). ObjectiveThe Interactive Computer-Adaptive Chronic Kidney Disease (I-C-CKD) study will determine whether the computerized adaptive education and usual hospital care impact the health literacy of African American patients with kidney disease. It will also assess how patients’ lifestyle and commitment to health goals are impacted by the method of health literacy education. MethodsWe will screen, recruit, and enroll hospitalized patients who self-identify as African American and have advanced CKD based on their estimated glomerular filtration rate. Eligible patients who verbally consented will be randomly assigned into either the computerized adaptive education intervention group or the control group (usual hospital care). Patients in the intervention group will receive a culturally tailored, adaptive education module. To analyze pretest, posttest, and follow-up survey results on patient CKD knowledge, ESKD treatment options, and health goals, we will use a paired, 2-tailed t test with a Bonferroni adjustment for multiple comparisons. ResultsRecruitment for the I-C-CKD study began on May 2, 2023. We are currently recruiting and have enrolled 96 patients who completed both pretest and posttest surveys as of December 2024. This includes 50 patients in the control group and 46 patients in the intervention group. Data analysis has not occurred. ConclusionsAfrican American individuals often receive less patient education about self-care and treatment options for CKD. We hope this study provides a solution to increase hospitalized African American patients’ knowledge of CKD and motivation for CKD self-care through computerized adaptive education, reduce disparities, and improve patient outcomes. Trial RegistrationClinicalTrials.gov NCT06364358; https://clinicaltrials.gov/study/NCT06364358 International Registered Report Identifier (IRRID)DERR1-10.2196/66846

Rationale & Objective:Higher chronic kidney disease (CKD) knowledge and health literacy (HL) are associated with improved CKD outcomes. We sought to determine if the CKD Report Card intervention increased CKD knowledge in patients regardless of HL level. Study Design:A block-randomized trial by clinic session. Setting & Participants:Patients with CKD 3 or above in an urban academic nephrology clinic. Intervention:The intervention group received the CKD Report Card, a 2-sided information sheet, before the clinic visit. Outcomes:Kidney Knowledge Survey pre-post-visit score change. Results:Of 91 participants, the average age was 66.2 years, 64.8% identified as African American, 41.8% were male, and 11.0% had inadequate HL. The control group's (n = 53) mean pre-visit knowledge score was 55.8% with a post-pre-score change of 0.9 (95% confidence intervals [CI], -1.3 to 3.2). The intervention group's (n = 38) mean pre-visit score was 60.2% with a score change of 19.2 (95% CI, 15.2-23.3). The difference in score change between the control group and intervention group was -18.4 (95% CI, -22.6 to -14.1). In addition, there was no significant difference in knowledge gained by adequate and inadequate HL for the control group (P = 0.6) or the intervention group (P = 0.6). In the fully adjusted multivariable model, the HL × group interaction term was not significant (β = -6.1; P = 0.4). Pre-visit score (β = -0.2; P < 0.01) and intervention group (β = 19.0; P < 0.001) were significant. Limitations:Limited generalizability because the study took place at 1 academic medical center and there were only a small proportion of patients with inadequate HL. Conclusions:The CKD Report Card is a low-touch, low-cost intervention that improved CKD knowledge for all patients in our urban nephrology clinic regardless of HL level.

BACKGROUND:Several studies have described the lack of diversity within cardiothoracic surgery (CTS). This study aims to describe Black medical students' perceptions of CTS. METHODS:A previously validated 23-question survey was administered to the Student National Medical Association chapters at 40 US medical schools via Qualtrics. RESULTS:Forty schools confirmed receipt of the survey, with a 15.5% (407 of 2616) response rate. Nearly all (99%; 401 of 402) respondents were Black; 72% (292 of 407) were women. Twenty-six percent (98 of 384) of respondents reported some interest in CTS. Students reported a lack of curricular exposure to CTS (210 of 341; 62%), a belief that CTS is a racially or ethnically biased field (250 of 342; 73%), and few believed that CTS was welcoming to their identities (35 of 342; 10%). Respondents cited a lack of minority role models in CTS (270 of 318; 85%), but noted that access to minority mentors would increase their interest in CTS (225 of 318; 71%). The ability to address healthcare disparities was the most important goal in selecting a specialty (224 of 371; 60%). Over half of respondents believed that CTS training was too long (184 of 342; 54%), with most students unaware of shorter training pathways for CTS (210 of 341; 62%). CONCLUSIONS:Black medical students report low interest in CTS owing to several factors including the perception of bias, low diversity in the profession, length of training, and limited access to mentors. Increased exposure to CTS, highlighting opportunities to address healthcare disparities within the specialty, and direct engagement with CTS mentors may increase the interest of Black medical students in the field of CTS.

Little is known about the population of Medicare beneficiaries with both chronic kidney disease (CKD) and Alzheimer’s disease and related dementias (ADRD). Using data from Medicare fee-for-service (FFS) beneficiaries aged 65 and over identified through 2011–2019 Master Beneficiary Summary File (MBSF), we estimated the size, growth, and racial-ethnic characteristics of the ADRD and CKD populations. Individuals were classified as having ADRD and CKD based on CMS Chronic Conditions Data Warehouse (CCW) indicators in the MBSF Chronic Conditions file. Among FFS beneficiaries, the prevalence of CKD has increased from 17.5

Key PointsAmong US preemptively waitlisted patients with CKD, deceased donor transplants increased for Black and Hispanic patients, comparable with White patients.Dialysis initiation was higher for waitlisted Asian, Black, and Hispanic patients compared with White patients, mirroring lower living donor transplants.Organ Procurement and Transplantation Network wait time credit and Increasing Organ Transplant Access metric could expand preemptive transplantation.BackgroundPreemptive kidney transplantation (before dialysis initiation) is the optimal therapy for most transplant-eligible advanced patients with CKD. Although prior research has documented racial and ethnic disparities in preemptive referrals, less is known about distinct outcomes after preemptive waitlisting. This study examines the association between race and ethnicity and outcomes for preemptively waitlisted patients.MethodsWe conducted a secondary analysis of a prospectively maintained US cohort using data from the Scientific Registry of Transplant Recipients. The study population included 98,863 adult first-time kidney transplant candidates who were preemptively waitlisted from January 1, 2009, to December 31, 2020, and followed through December 31, 2024. The exposure of interest was race and ethnicity. The primary outcome was 3-year preemptive deceased donor kidney transplantation, living donor kidney transplantation, or dialysis initiation. We used competing risk models to estimate adjusted subdistribution hazard ratios (aSHRs). Data were stratified into 3-year intervals (2009-2011, 2012-2014, 2015-2017, and 2018-2020).ResultsBlack and Hispanic patients received preemptive deceased donor kidney transplants as often as White patients (era 2018-2020, aSHRs [95% confidence interval (CI)]: 0.99 [95% CI, 0.92 to 1.07] and 1.02 [95% CI, 0.93 to 1.12], respectively), while Asian patients had lower rates (0.78 [95% CI, 0.69 to 0.88]). However, Asian, Black, and Hispanic patients were more likely to initiate dialysis (aSHRs: 1.50 [95% CI, 1.39 to 1.61]; 1.41 [95% CI, 1.34 to 1.49]; and 1.21 [95% CI, 1.14 to 1.29], respectively) and were less likely to receive preemptive living donor kidney transplants than White patients (era 2018-2020, aSHRs: 0.49 [95% CI, 0.44 to 0.54]; 0.31 [95% CI, 0.29 to 0.34]; and 0.61 [95% CI, 0.56 to 0.66], respectively).ConclusionsAmong waitlisted patients with CKD in the United States between 2009 and 2020, rates of preemptive deceased donor kidney transplantation improved for Black and Hispanic patients and became comparable with White patients. However, Asian, Black, and Hispanic patients experienced higher rates of dialysis initiation and lower rates of preemptive living donor kidney transplantation.

African American individuals with CKD are less likely to receive early CKD education and care than their White counterparts and have a more rapid progression to kidney failure. To determine if a brief inpatient intervention increased CKD knowledge. Pre-post evaluation of a pilot intervention. The PREP-RRT pilot study recruited hospitalized adult African American patients with an estimated glomerular filtration rate (GFR) ≤ 45 from a general medicine inpatient service at a Midwestern academic medical center. A social worker provided CKD patient education and motivational interviewing for behavior change. The primary outcome was change in patient knowledge about CKD, using the Kidney Knowledge Survey (KiKS), and kidney failure treatment options. Out of the 60 patients, 52

Background: Adults with chronic kidney disease (CKD) face a higher risk of hospitalization than the general population. Self-efficacy, an individual’s belief in their ability to manage their health, is a potentially modifiable factor that may reduce this risk. Research Question/Hypothesis: We examined the association between self-efficacy and hospitalization risk in adults with CKD, hypothesizing that higher self-efficacy would be linked to lower hospitalization risk. Methods: We analyzed data from the Chronic Renal Insufficiency Cohort study. Self-efficacy was assessed using the 5-item Manage Disease in General Scale, between 2013–2018. This scale evaluates participants’ confidence in managing tasks and activities related to their condition, seeking medical care, and coping with health-related emotional stress. Participants were followed until death, study withdrawal, or October 2024. Poisson regression was used to examine the association between self-efficacy and hospitalization risk, with stratification by sex and race/ethnicity. Models were adjusted for clinical center, age, sex, race/ethnicity, education, income, hypertension, diabetes, cardiovascular disease, estimated glomerular filtration rate, proteinuria, and frailty. Results: Among 3,862 participants who completed the self-efficacy assessment (mean age [SD]: 65 [10] years; 44% female; 41% White, 42% Black, 13% Hispanic), 44% reported high self-efficacy (score ≥9 out of 10). Those with high self-efficacy were less likely to have low income, diabetes, or frailty. Over a mean follow-up of 7.2 years, 18,939 hospitalizations occurred (21% cardiovascular-related, 79% non-cardiovascular). In fully adjusted models, higher self-efficacy was associated with a lower risk of hospitalization in the full cohort (Incidence Rate Ratio [IRR]: 0.87; 95% CI: 0.84–0.91), as well as in men (IRR: 0.77; 95% CI: 0.74–0.81), and in Black (IRR: 0.90; 95% CI: 0.86–0.94), Hispanic (IRR: 0.82; 95% CI: 0.71–0.96), and White (IRR: 0.84; 95% CI: 0.79–0.89) subgroups. Conclusion: In this large, diverse cohort of adults with CKD, higher self-efficacy was independently associated with a lower risk of hospitalization, even after adjusting for confounders. While these findings suggest a potential protective role of self-efficacy, residual confounding cannot be ruled out. Further research is needed to determine whether enhancing self-efficacy can causally reduce hospitalization risk in this high-risk population.

Rationale & Objective: In the general population, neighborhood socioeconomic status (SES) has been found to be associated with cardiovascular risk, but this relationship has not been well studied among patients with chronic kidney disease (CKD). This study seeked to evaluate the association between neighborhood SES and cardiovascular outcomes in a CKD cohort. Study Design: Multicenter prospective cohort. Setting & Participants: In total, 3,197 participants in the Chronic Renal Insufficiency fi ciency Cohort Study without cardiovascular disease at baseline. Exposure: Neighborhood SES quartiles using a validated neighborhood-level SES summary measure for 6 census-derived variables. Outcome: Incident heart failure, myocardial infarction, and all-cause death. Analytical Approach: Cox proportional hazards. Results: During median follow-up of 8.8 years, there were 465 incident heart failure events, 297 myocardial infarctions, and 891 deaths. In a fully adjusted model, among individuals with estimated glomerular fi ltration rate >= 45 mL/min/1.73 m(2),lowest neighborhood SES quartile was associated with higher risk of heart failure (HR, 1.96 [95% CI, 1.04-3.67]) compared with the highest quartile. This association was not significant fi cant among those with estimated glomerular fi ltration rate < 45 mL/min/1.73 m(2) (P P for interaction < 0.1). There was no association between neighborhood SES and myocardial infarction; however, in the same multivariableadjusted model, less than high school education was associated with higher risk of myocardial infarction (HR, 1.52 [95% CI, 1.06-2.17]). Among those aged greater than 60 years, there was a significant fi cant association between the lowest neighborhood SES quartile and death (HR, 1.72 [95% CI, 1.06-2.78]), but this association was not significant fi cant among those aged 60 years and younger (P P for interaction < 0.05). Limitations: Findings are subject to residual confounding and bias. Conclusions: In a CKD cohort, neighborhood-level SES was associated with incident heart failure among individuals with more preserved kidney function and death in those younger than 60 years. Policies and public health and health system interventions are needed to address individual- and neighborhood-level SES factors to improve outcomes for patients with CKD residing disadvantaged communities.

Objective African Americans are more likely to develop end-stage kidney disease (ESKD) than whites and face multiple inequities regarding ESKD treatment, renal replacement therapy (RRT), and overall care. This study focused on determining gaps in participants' knowledge of their chronic kidney disease and barriers to RRT selection in an effort to identify how we can improve health care interventions and health outcomes among this population. Methods African American participants undergoing hemodialysis were recruited from an ongoing research study of hospitalized patients at an urban Midwest academic medical center. Thirty-three patients were interviewed, and the transcribed interviews were entered into a software program. The qualitative data were coded using template analysis to analyze text and determine key themes. Medical records were used to obtain demographic and additional medical information. Results Three major themes emerged from the analysis: patients have limited information on ESKD causes and treatments, patients did not feel they played an active role in selecting their initial dialysis unit, and interpersonal interactions with the dialysis staff play a large role in overall unit satisfaction. Discussion Although more research is needed, this study provides information and suggestions to improve future interventions and care quality, specifically for this population.

Rationale & ObjectiveThe US Kidney Allocation System (KAS) prioritizes candidates with ≤20% Estimated Post-Transplant Survival (EPTS) for high longevity kidneys defined by a ≤20% Kidney Donor Profile Index (KDPI). Use of EPTS in the KAS deprioritizes candidates with older age, diabetes, and longer dialysis durations. We assessed whether this use also disadvantages racial-ethnic minority candidates, who are younger but more likely to have diabetes and longer durations of kidney failure requiring dialysis.Study DesignObservational cohort study.Setting& Participants: Adult candidates for and recipients of kidney transplantation represented in the Scientific Registry of Transplant Recipients from January 2015 through December 2020.ExposureRace and ethnicity.OutcomesAge-adjusted assignment to ≤20% EPTS, transplantation of a ≤20% KDPI kidney, and post-transplant survival in longevity matched recipients by racial-ethnicity.Analytic ApproachMultivariable logistic regression, Fine-Gray competing risks survival analysis, and Kaplan-Meier and Cox Proportional Hazards methods.ResultsThe cohort included 199,444 candidates (7% Asian, 29% Black, 19% Hispanic/Latino, 43% White) listed for deceased donor kidney transplantation. Non-White candidates had significantly higher rates of diabetes, longer dialysis duration, and were younger than White candidates. Adjusted for age, Asian, Black, and Hispanic/Latino candidates had significantly lower odds of having a ETPS score ≤20% (OR 0.86, [0.81, 0.91], 0.52 [0.50, 0.54], and 0.49, [0.47, 0.51]), and were less likely to receive a ≤20% KDPI kidney (subHR 0.70 [0.66, 0.75], 0.89 [0.87, 0.92], and 0.73 [0.71, 0.76]), compared to White candidates. Among recipients with ≤20% EPTS scores transplanted with a ≤20% KDPI deceased donor kidney, Asian and Hispanic recipients had lower post-transplant mortality (HR 0.45 [0.27, 0.77], and 0.63 [0.47, 0.86]) and Black recipients had higher but not statistically significant post-transplant mortality (HR 1.22 [0.99, 1.52]) compared to White recipients.LimitationsProvider reported race-ethnicity data and 5-year post transplant follow-up period.ConclusionsThe US kidney allocation system is less likely to identify racial-ethnic minority candidates as having a ≤20% EPTS score which triggers allocation of high longevity deceased donor kidneys. These findings should inform the OPTN about how to remedy racial/ethnic disparities introduced through KAS’s current approach of allocating allografts with longer predicted longevity to recipients with longer estimated post-transplant survival.

Importance:Given the growth of minoritized groups in the US and the widening racial and ethnic health disparities, improving diversity remains a proposed solution in the field of otolaryngology. Evaluating current trends in workforce diversity may highlight potential areas for improvement.Objective:To understand the changes in gender, racial, and ethnic diversity in the otolaryngology workforce in comparison with changes in the general surgery and neurosurgery workforces from 2013 to 2022.Design, Setting, and Participants:This cross-sectional study used publicly available data from the Accreditation Council for Graduate Medical Education and the Association of American Medical Colleges for 2013 to 2022, and included medical students and trainees in all US medical residency programs and allopathic medical schools.Main Outcomes and Measures:Average percentages of women, Black, and Latino trainees during 2 intervals of 5 years (2013-2017 and 2018-2022). Pearson χ2 tests compared demographic information. Normalized ratios were calculated for each demographic group in medical school and residency. Piecewise linear regression assessed linear fit for representation across time periods and compared rates of change.Results:The study population comprised 59 865 medical residents (43 931 [73.4%] women; 6203 [10.4%] Black and 9731 [16.2%] Latino individuals; age was not reported). The comparison between the 2 study intervals showed that the proportions of women, Black, and Latino trainees increased in otolaryngology (2.9%, 0.7%, and 1.6%, respectively), and decreased for Black trainees in both general surgery and neurosurgery (-0.4% and -1.0%, respectively). In comparison with their proportions in medical school, Latino trainees were well represented in general surgery, neurosurgery, and otolaryngology (normalized ratios [NRs]: 1.25, 1.06, and 0.96, respectively); however, women and Black trainees remained underrepresented in general surgery, neurosurgery, and otolaryngology (women NRs, 0.76, 0.33, and 0.68; Black NRs, 0.63, 0.61, and 0.29, respectively). The percentage of women, Black, and Latino trainees in otolaryngology all increased from 2020 to 2022 (2.5%, 1.1%, and 1.1%, respectively). Piecewise regression showed positive trends across all 3 specialties.Conclusions and Relevance:The findings of this cross-sectional study indicate a positive direction but only a modest increase of diversity in otolaryngology, particularly in the context of national demographic data. Novel strategies should be pursued to supplement existing efforts to increase diversity in otolaryngology.

Objectives To determine if rates of maternal diabetes vary by race, ethnicity, and neighborhood hardship. Methods We conducted a secondary analysis of live births in Chicago from 2010 to 2017. Our sample was restricted to Non-Hispanic White, Non-Hispanic Black, Mexican, Non-Hispanic Asian, and Other Hispanic mothers between the ages of 15 and 50, with singleton births. The addresses of mothers were geocoded to specific neighborhoods, which we stratified into tertiles using the Economic Hardship Index. We used generalized logit mixed models to examine the interaction between race/ethnicity, neighborhood economic hardship, and maternal diabetes. Results In our cohort of 299,053 mothers, 4.75% were diagnosed with gestational diabetes. Asian mothers had the highest frequency of gestational diabetes (8.3%), followed by Mexican mothers (6.8%). Within their respective racial/ethnic groups, Asian and Mexican mothers living in medium hardship neighborhoods had the highest odds of gestational diabetes compared to the reference group (OR 2.80, 95%CI 2.53, 3.19; OR 2.30, 95%CI 2.12, 2.49 respectively). Overall rates of preexisting diabetes were 0.9% and were highest among Mexican and Black mothers (1.26% and 1.06%, respectively). Asian mothers in medium hardship neighborhoods had the greatest odds of preexisting diabetes, among all Asian mothers and compared to the reference (OR 4.71 95% CI 3.60, 6.16). Conclusions For racial and ethnic minoritized mothers, gestational and preexisting diabetes do not increase in a step-wise fashion with neighborhood hardship; rates were often higher in low and medium hardship neighborhoods.

In the US, end-of-life health care (EOLHC) is often intensive and invasive, and at times may involve care that is inconsistent with patient values. US Muslims may not receive appropriate religious support, experience uncertainty around end-of-life decision-making, and under-utilize palliative and hospice care. As technological advancements and treatment options rise in EOLHC, Muslim American patients and their families need to understand more about the treatment options that are consistent with their beliefs. The objective of this study was to determine the efficacy of a pilot mosque-based educational workshop focused on increasing Muslim Americans’ religious bioethics knowledge about end-of-life healthcare. Intervention sites were four mosques with racially and ethnically diverse members, two in the Chicago metropolitan area and two in the Washington, D.C. area. Eligible participants were self-reported Muslims, aged 18 years or older, who were proficient in English. The intervention included a pre and post-test survey and a workshop focused on the Islamic bioethical perspectives on EOLHC. Knowledge was measured with six true-false questions. Baseline and post-intervention scores were analyzed by McNemar’s test and bivariate correlation. Overall, the analysis showed a significant improvement in post-intervention participant knowledge. There was increased knowledge of Islamic bioethical views on the moral status of seeking healthcare, brain death controversies, and religious perspectives on withholding or withdrawing life support near the end of life. Our pilot intervention successfully increased participant knowledge and underscores the need to improve the Muslim community’s knowledge about the bioethical dimensions of EOLHC.

Lisa M. McElroy, MD, MS; Tyler Schappe, MS; Dinushika Mohottige, MD, MPH; LaShara Davis, PhD; Sarah B. Peskoe, PhD; Virginia Wang, PhD; Jane Pendergast, PhD; L. Ebony Boulware, MD, MPH