Learn about the
2008T Fresenius Hemodialysis

Interview with
Jeffrey H. Burbank
Founder& CEO of NxStage

Hemodialysis.com: What are the main findings of the study?

In a population-based study of over 20,000 U.S. adults, we found that lower income had a trend towards a stronger association with albuminuria among blacks than among whites.

Hemodialysis.com: Were any of the findings unexpected?

Our main finding may be surprising to many, given that low socioeconomic status has been associated with CKD in many studies, worldwide, and across multiple racial/ethnic groups.

However, we actually found similar results to the current study in a smaller, urban cohort of adults when we examined the prevalence of eGFR <60 (Crews, et al. AJKD, 2010).

Low income might differentially affect blacks’ risk of developing albuminuria through several mechanisms, including: poor dietary availability and habits,  psychological stress of discrimination, low birth weight, and allostatic load (biological risk profile).

Also, in light of what is now known about racial differences in apolipoprotein L1 (APOL1) risk variant frequency and nondiabetic nephropathy, gene-environment interactions might be the cause of this differential influence of low income.

Hemodialysis.com: What should clinicians and patients take away from your report? 

Clinicians should be aware that their low income black patients may be at particularly high risk of albuminuria.

Low income individuals may wish to undergo CKD screening.

Hemodialysis.com : What recommendations do you have for future research as a result of this study?  

Future research is needed to tease apart the correlates of low income in order to better understand how it may influence risk of albuminuria.

Additionally, translational research is needed in order to determine how best to deliver tailored and sustainable interventions among this vulnerable population

Reference:

Low Income and Albuminuria Among REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study Participants
Deidra C. Crews, William M. McClellan, David A. Shoham, Liyan Gao, David G. Warnock, Suzanne Judd, Paul Muntner, Edgar R. Miller, Neil R. Powe
American Journal of Kidney Diseases - 13 June 2012 (10.1053/j.ajkd.2012.05.010)