In the United States (US), the rates of end-stage renal disease (ESRD), hospitalization and 30-day hospital readmission differ markedly by age, race-ethnicity, socioeconomic status and site of care. Despite the disproportionate burden of ESRD observed among persons of racial-ethnic minority groups and low-income populations, few US-based studies in chronic kidney disease (CKD) have successfully examined the health processes and outcomes of persons receiving care within public hospitals and safety-net health systems. The primary aims of this proposal are (1) to develop and validate an ESRD risk prediction instrument and compare its performance to existing ESRD risk prediction tools using data from persons with moderate to advanced CKD who received ambulatory care within public health systems;and (2) to estimate rates of, and identify factors associated with, 30-day hospital readmission among persons with moderate to advanced CKD within a large public hospital system. This proposal will utilize a retrospective cohort study design to develop risk prediction tools to enable health providers and health systems to systematically identify persons at highest risk for CKD-related morbidity. Such high-risk patients could receive more intensive surveillance, intervention, and earlier nephrology and transitional care. The long-term objective of this research is to reduce the burden of CKD among traditionally underserved populations using effective interventions that can be used to slow progression and prevent complications of CKD.

Public Health Relevance

The overarching objective of this proposal is to better treat subjects with chronic kidney disease who may experience progressive disability and incur high public costs from America's healthcare safety-net. The results of this project will assist health providers and health systems in identifying patients who are at highest risk for experiencing progression to end-stage kidney disease and hospital readmission from medically underserved populations.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Small Research Grants (R03)
Project #
1R03DK099487-01
Application #
8569549
Study Section
Special Emphasis Panel (ZDK1-GRB-G (M2))
Program Officer
Rankin, Tracy L
Project Start
2013-07-19
Project End
2015-06-30
Budget Start
2013-07-19
Budget End
2014-06-30
Support Year
1
Fiscal Year
2013
Total Cost
$77,250
Indirect Cost
$27,250
Name
University of Washington
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
605799469
City
Seattle
State
WA
Country
United States
Zip Code
98195
Wilhelm-Leen, Emilee R; Hall, Yoshio N; Horwitz, Ralph I et al. (2014) Phase angle, frailty and mortality in older adults. J Gen Intern Med 29:147-54
Maziarz, Marlena; Chertow, Glenn M; Himmelfarb, Jonathan et al. (2014) Homelessness and risk of end-stage renal disease. J Health Care Poor Underserved 25:1231-44
Hall, Yoshio N; Xu, Ping; Chertow, Glenn M et al. (2014) Characteristics and performance of minority-serving dialysis facilities. Health Serv Res 49:971-91
Kurella-Tamura, Manjula; Goldstein, Benjamin A; Hall, Yoshio N et al. (2014) State medicaid coverage, ESRD incidence, and access to care. J Am Soc Nephrol 25:1321-9