Racial and Ethnic Disparities in Acute Care Utilization Among Patients With Glomerular Disease.

RATIONALE & OBJECTIVE: The effects of race, ethnicity, socioeconomic status, and disease severity on acute care utilization (ACU) in patients with glomerular disease (GD) are unknown. STUDY DESIGN: A prospective cohort study. SETTING: & Participants: 1,456 adults and 768 children with biopsy proven GD enrolled in the Cure Glomerulonephropathy cohort. EXPOSURE: Race and ethnicity as a participant-reported social factor. OUTCOME: ACU defined as hospitalizations or emergency department visits. ANALYTICAL APPROACH: Multivariable recurrent event proportional rate models were used to estimate associations between race and ethnicity and ACU. RESULTS: Black or Hispanic participants had lower socioeconomic status and more severe GD compared to White or Asian participants. ACU rates were 45.6, 29.5, 25.8, and 19.2 per 100 person-years in Black, Hispanic, White, and Asian adults, respectively, and 55.8, 42.5, 40.8, and 13.0, respectively, for children. Compared to White race (reference group): Black race was significantly associated with ACU in adults (rate ratio (RR) 1.76, 95% Confidence Interval (CI) 1.37-2.27), although this finding was attenuated after multivariable adjustment (RR 1.31, 95% CI 1.03-1.68). Black race was not significantly associated with ACU in children; Asian race was significantly associated with lower ACU in children (RR 0.32, 95% CI 0.14-0.70); no significant associations between Hispanic ethnicity and ACU were identified. LIMITATIONS: We used proxies for socioeconomic status and lacked direct information on income, household unemployment or disability. CONCLUSIONS: Significant differences in ACU rates were observed across racial and ethnic groups in persons with prevalent GD, although many of these difference were explained by differences in socioeconomic status and disease severity. Measures to combat socioeconomic disadvantage in Black patients, and more effectively prevent and treat glomerular disease, are needed to reduce disparities in ACU, improve patient wellbeing, and reduce healthcare costs

Association of COVID-19 Versus COVID-19 Vaccination With Kidney Function and Disease Activity in Primary Glomerular Disease: A Report of the Cure Glomerulonephropathy Study

Patients with glomerular disease (GN) may be at increased risk of severe COVID-19, yet concerns over vaccines causing disease relapse may lead to vaccine hesitancy. We examined the associations of COVID-19 with longitudinal kidney function and proteinuria and compared these to similar associations with COVID-19 vaccination. Observational cohort study from July 1, 2021 to Jan. 1, 2023. & Participants: A prospective observational study network of 71 centers from North America and Europe (CureGN) with children and adults with primary minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy. COVID-19 and COVID-19 vaccination. Repeated measure of estimated glomerular filtration rate (eGFR); recurrent time-to-event outcome of GN disease worsening as defined by doubling of UPCR to at least 1.5g/g or increase in dipstick urine protein by two ordinal levels to 3+ (300mg/dL) or above. Interrupted time series analysis for eGFR. Prognostic matched sequential stratification recurrent event analysis for GN disease worsening. Among 2,055 participants, 722 (35%) reported COVID-19; of these, 92 (13%) were hospitalized and 3 died (<1%). eGFR slope pre-COVID-19 was -1.40ml/min/1.73m2 (SD 0.29), and -4.26ml/min/1.73m2 (SD 3.02) within 6 months post-COVID-19, which were not significantly different (p=0.34). COVID-19 was associated with increased risk of worsening GN disease activity (HR 1.35, 95% CI 1.01-1.80). Vaccination was not associated with change in eGFR (-1.34ml/min/1.73m2, SD 0.15 vs -2.16ml/min/1.73m2, SD 1.74; p=0.6) or subsequent GN disease worsening (HR 1.02, 95% CI 0.79–1.33) in this cohort. Infrequent or short follow-up. Among patients with primary GN, COVID-19 was severe for 1 in 8 cases and was associated with subsequent worsening of GN disease activity, as defined by proteinuria. In contrast, vaccination against COVID-19 was not associated with change in disease activity or kidney function decline. These results support COVID-19 vaccination for patients with GN. In this cohort study of 2,055 patients with minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy, COVID-19 resulted in hospitalization or death for 1 in 8 cases and was associated with a 35% increase in risk for worsening proteinuria. In contrast, vaccination did not appear to adversely affect kidney function or proteinuria. Our data support vaccination for COVID-19 in patients with glomerular disease