BACKGROUND

Racially minoritized populations in the United States (US), notably African American (AA) and American Indian/Alaska Native (AI/AN), experience disproportionately higher rates of chronic kidney disease (CKD), diabetes, and hypertension compared to their White peers but are understudied. This real-world cohort study examines the standards of CKD care provided to these groups in two US health systems.

METHODS

Using electronic health record data from the Center for Kidney Disease Research, Education, and Hope (CURE-CKD) Registry (N = 381,011) collected between 2015 and 2020, adjusted binary logistic regression models were used to identify predictors of two CKD care outcomes: 1) prescriptions for CKD-related guideline-directed medical therapy (CKD-GDMT) in the form of angiotensin converting enzyme inhibitors or angiotensin receptor blockers and 2) testing for urine albumin-creatinine/urine protein-creatinine ratio (UACR/UPCR) among adult patients of AA and AI/AN race compared to the reference group (White, non-Hispanic).

RESULTS

AA (62 ± 17 years) and AI/AN (57 ± 18 years) patients with CKD were younger compared to the White, non-Hispanic reference group (68 ± 17 years). Diabetes and hypertension were the most important predictors for increased odds of CKD-GDMT and UACR/UPCR testing. Prevalence of CKD-GDMT was only 46%, 40% and 38% in AA, White, and AI/AN patients, respectively. AA patients were more likely to receive CKD-GDMT prescriptions (OR = 1.20, 95% CI: 1.17-1.23, p < 0.001) and UACR/UPCR testing (OR = 1.34, 95% CI: 1.29-1.38, p < 0.001) compared to White patients. AI/AN were also more likely to receive GDMT (OR = 1.07, 95% CI: 1.00-1.15, p = 0.046) compared to White patients but had lower odds of UACR/UPCR testing (OR = 0.73, 95% CI: 0.67-0.81, p < 0.001). However, the frequency or prescribing of CKD-GDMT and UACR/UPCR testing were suboptimal across all examined racial identity groups. Exploratory machine learning approaches, including logistic regression, lasso regression, and random forest found similar findings.

CONCLUSIONS

While there were modest racial differences in the prescription of CKD-GDMT and frequency of UACR/UPCR testing, rates were lower than expected in this high-risk population. Our findings suggest the disproportionate burden of CKD on AA and AI/AN individuals is not solely attributable to the current standards of care delivery. The relatively higher rates of CKD-GDMT for AA patients may be due to clinician recognition of their increased risk for progressing to kidney failure.

CLINICAL TRIAL NUMBER

Not applicable.