Duke University School of Medicine.
Department of Population Health Sciences.
Med Care. 2020 Nov;58(11):968-973. doi: 10.1097/MLR.0000000000001387.
African Americans are significantly more likely than non-African Americans to have diabetes, chronic kidney disease, and uncontrolled hypertension, increasing their risk for kidney function decline.
The objective of this study was to compare how African Americans and non-African Americans with diabetes responded to a multifactorial telehealth intervention designed to slow kidney function decline.
Secondary analysis of a randomized trial. Primary care patients (N=281, 56% African American) were allocated to either: (1) a multifactorial, pharmacist-delivered phone-based telehealth intervention focused on behavioral and medication management of diabetic kidney disease; or (2) an education control.
The primary study outcome was change in estimated glomerular filtration rate (eGFR). Linear mixed models were used to explore the moderating effect of race on the relationship between study arm and eGFR decline over time; the mean annual rate of eGFR decline was estimated by race and study arm.
Findings demonstrated a differential intervention effect on kidney function over time by race (Pinteraction=0.005). Among African Americans, the intervention arm had significantly greater preservation of eGFR over time than the control arm (difference in the annual rate of eGFR decline=1.5 mL/min/1.73 m; 95% confidence interval: 0.04, 3.02). For non-African Americans, the intervention arm had a faster decline in eGFR over time than the control arm (difference in the annual rate of eGFR decline=-1.7 mL/min/1.73 m; 95% confidence interval: -3.3, -0.02).
A multifactorial, pharmacist-delivered telehealth intervention for diabetic kidney disease may be more effective for slowing eGFR decline among African Americans than non-African Americans.
非裔美国人患糖尿病、慢性肾病和未控制的高血压的可能性明显高于非裔美国人，这增加了他们肾功能下降的风险。
本研究旨在比较患有糖尿病的非裔美国人和非裔美国人对多因素远程医疗干预措施的反应，该措施旨在减缓肾功能下降。
这是一项随机试验的二次分析。初级保健患者（N=281，56%为非裔美国人）被分配到以下两组之一：（1）多因素、由药剂师提供的基于电话的远程医疗干预，侧重于糖尿病肾病的行为和药物管理；或（2）教育对照组。
主要研究结果是估计肾小球滤过率（eGFR）的变化。线性混合模型用于探索种族对研究臂与随时间推移的 eGFR 下降之间关系的调节作用；按种族和研究臂估计 eGFR 每年的下降率。
研究结果表明，种族对肾功能随时间的变化存在不同的干预效果（P 交互=0.005）。在非裔美国人中，干预组的 eGFR 随时间的保留明显优于对照组（eGFR 每年下降率的差异=1.5 mL/min/1.73 m；95%置信区间：0.04，3.02）。对于非裔美国人，干预组的 eGFR 随时间的下降速度快于对照组（eGFR 每年下降率的差异=-1.7 mL/min/1.73 m；95%置信区间：-3.3，-0.02）。
多因素、由药剂师提供的远程医疗干预措施可能更有助于减缓非裔美国人而非非裔美国人的 eGFR 下降。
