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Previous Spotlights 

Review previous publication spotlights below:

Authors

Assistant Professor, School of Medicine - Surgery, University of Alabama Birmingham Medical Center

Obesity as an isolated contraindication to kidney transplantation in the end-stage renal disease population: A cohort study.​

What question did your study aim to answer?

We sought to estimate the number of people on dialysis who have obesity as the sole contraindication to listing for kidney transplant.

What inspired you to conduct this study?

With the growing number of patients on dialysis and the rising obesity epidemic, by 2030 nearly 50% of U.S. adults will have obesity and nearly 25% will have severe obesity—many patients have obesity as a major barrier to transplantation. In my practice, I am increasingly encountering the clinical challenge of assisting patients with both end-stage renal disease and obesity achieving the benefits of kidney transplantation. 

Which USRDS datasets did you use to conduct your study?

1/1/2012-12/31/2014. We used information from the Patient file to identify and then exclude patients who within 90 days after their first ESRD service date: died, received a kidney transplant or were added to the kidney/KP waitlists. Among the ESRD patients that remained eligible for inclusion, USRDS identifiers linked to the ESRD CORE RXHIST file identified patients that had recovered, discontinued dialysis, or been lost to follow-up within 90 days after their first ESRD service date. Further exclusions based on patients' comorbidities identified within 90 days of first ESRD service date that contraindicated transplantation. We identified psychological, medical, and functional status comorbidities based on information in the USRDS Core SAF dataset's MEDEVID file, and diagnosis codes from the 2012-2014 Physician/Supplier claims data.

Our primary exposure was BMI at first ESRD service date from the USRDS Core SAF dataset's MEDEVID file. Primary outcome information, e.g., wait-listing, transplantation, death, and information on most potential confounders were from the 2019 USRDS Core SAF dataset's Patient file; however, among those added to the waitlist and analyzed for time to transplantation, we obtained PRA information from the kidney and kidney-pancreas waitlist files.

Using plain language, please summarize your study conclusions in two or three points.

Nearly 40,000 incident dialysis patients from 2012-2014 had obesity as the only contraindication to wait-listing for kidney transplant. These patients were more likely to be Black, female, and younger.

Please share a specific insight about working with USRDS data that you learned during the completion of this study.

Many of the challenges of working with USRDS data can be managed by first referring to and understanding the available documentation, e.g., the "2019 Researcher’s Guide to the USRDS Database." Nonetheless, some of the data files, e.g., claims data, are quite large and require adequate computer resources.

Beini Lyu, PhD, Research Associate, Johns Hopkins Bloomberg School of Public Health

Arteriovenous Access Type and Risk of Mortality, Hospitalization, and Sepsis Among Elderly Hemodialysis Patients: A Target Trial Emulation Approach.​

What question did your study aim to answer?

We aimed to compare the effect of arteriovenous fistula (AVF) vs. arteriovenous graft (AVG) creation on several critical outcomes among elderly patients on hemodialysis.

What inspired you to conduct this study?

It is not clear whether AVF or AVG is more appropriate for elderly patients on hemodialysis. Results from previous observational studies are inconsistent and may suffer from bias. Ideally, this question would be answered by RCT, but we don’t have such data, yet. We aimed to emulate a RCT using data from USRDS to answer this question.

Which USRDS datasets did you use to conduct your study?

We used the Core, Hospital, CROWNWEb Clinical Data, Institutional Claims, Physician/Supplier Claims, pre-ESRD Institutional Claims, and pre-ESRD Physician/Supplier Claims data.

Using plain language, please summarize your study conclusions in two or three points.

We found no differences between AVGs and AVFs with respect to mortality, sepsis, or all-cause, cardiovascular-related, and infection-related hospitalization after accounting for potential bias and confounding factors. Our work supports equipoise between creation of AVFs versus AVGs among elderly patients who initiate hemodialysis with a catheter.

Please share a specific insight about working with USRDS data that you learned during the completion of this study.

USRDS data are very well-organized and documented. The USRDS Researcher's Guide and appendix and analytic methods were extremely helpful when I started exploring USRDS data.

Nilka Rios Burrows, MPH, MT (ASCP), CKD Initiative Acting Team Lead, CDC Division of Diabetes Translation

Sustained Lower Incidence of Diabetes-Related End-Stage Kidney Disease Among American Indians and Alaska Natives, Blacks, and Hispanics in the U.S., 2000-2016

What question did your study aim to answer?

From 1996 to 2013, the incidence of diabetes-related end-stage kidney disease (ESKD-D) among American Indian and Alaska Native (AIAN) and Black adults declined. In light of the leveling off in ESKD-D incidence in the US diabetic population since 2010 and the significant decline in diagnosed diabetes prevalence among AIANs, we explored whether recent trends in ESKD-D incidence by race or ethnicity had changed.

What inspired you to conduct this study?

We first published the remarkable decline in ESKD-D incidence among AIANs in the CDC’s Vital Signs in January 2017. We wanted to update this report with more years of data to assess whether ESKD-D incidence in AIANs had continued to decline.

Which USRDS datasets did you use to conduct your study?

Patient Core dataset.

Using plain language, please summarize your study conclusions in two or three points.

  • From 2000 to 2016, the rate of new cases of kidney failure from diabetes declined significantly for AIAN (-53%), Hispanic (-33%), and Black adults (-20%); for White adults, however, the rate increased by 10%.
  • Despite these significant declines, kidney failure from diabetes for AIAN, Hispanic, and Black adults in 2016 remained nearly twice as high or higher than for White adults. Continued efforts in diabetes and kidney disease management are very important to sustain the declining trend in these populations.
  • The significant reduction (-53%) in kidney failure from diabetes among AIAN adults parallels sustained improvements in glycemic, lipid, and blood pressure control for AIANs and likely resulted from improvements in patient care and services funded by the Special Diabetes Program for Indians.

Please share a specific insight about working with USRDS data that you learned during the completion of this study. (No detail is too small.)

USRDS data and the publication findings were instrumental in documenting improved outcomes among AIANs with diabetes and in reauthorizing Congressional funding for the Special Diabetes Program for Indians. The Indian Health Service experience serves as a model for diabetes management in other healthcare systems, especially those serving populations at high risk for diabetes complications and as inspiration to replicate their success and impact on kidney disease outcomes.

Thomas Mavrakanas, MD, MSc, Assistant Professor, Department of Medicine, Division of Experimental Medicine, McGill University

Prasugrel and Ticagrelor in Patients with Drug-Eluting Stents and Kidney Failure

What question did your study aim to answer?

To determine whether prasugrel or ticagrelor is associated with improved cardiovascular outcomes compared with clopidogrel in patients with kidney failure on maintenance dialysis treated with drug-eluting stents.

What inspired you to conduct this study?

The high incidence of cardiovascular disease and major bleeding among patients with kidney failure on maintenance dialysis.

Which USRDS datasets did you use to conduct your study?

Core, Institutional Claims 2011-2015, Physician Supplier Claims 2011-2015, Part D 2011-2015, Pre-ESRD Institutional Claims 2011-2015, Pre-ESRD Physician Supplier Claims 2011-2015, Pre-ESRD Part D 2011-2015.

Using plain language, please summarize your study conclusions in two or three points.

The newer, more potent antiplatelet agents, prasugrel and ticagrelor, were of similar effectiveness as clopidogrel in patients on maintenance dialysis treated with a drug-eluting stent, and they were relatively well tolerated, with no significant increase in clinically significant bleeding.  

Both agents could be considered in selected patients on maintenance dialysis with anatomically complex coronary disease treated with drug-eluting stents. The potential benefit should be balanced against a potentially higher risk of clinically relevant bleeding.

Please share a specific insight about working with USRDS data that you learned during the completion of this study.

USRDS is a comprehensive database offering probably the largest dataset of its kind in the world. Although the database is relatively complex to work with, it provides very important information in an understudied population and is an invaluable tool for researchers in kidney failure.

Jesse Schold, PhD, MStat, MEd, Department of Quantitative health Sciences, Cleveland Clinic

Failure to Advance Access to Kidney Transplantation over Two Decades in the United States

What question did your study aim to answer?

Our primary aims were to evaluate rates of patients placed on the kidney transplant waiting list over the past two decades in the United States. In addition, we sought to understand whether rates of waitlist placement had changed over time among groups with historically lower rates.

What inspired you to conduct this study?

Considerable efforts, resources, and research have tried to identify barriers to transplant among patients with end-stage kidney disease in the United States. Our motivation for the study was to evaluate how the culmination of these efforts has led to significant changes in this important process of care for this population.

Which USRDS datasets did you use to conduct your study?

We used the USRDS core research files, including the patient, medevid, waitlist, and transplant files.

Using plain language, please summarize your study conclusions in two or three points.

Despite broad recognition of barriers to transplant and substantial efforts to improve access to transplant, rates of placement on the transplant waiting list have not improved over a two-decade period in the United States. In addition, marked disparities in access to the waiting list among patients have remained stagnant over the same period.  Cumulatively, results suggest that more prominent efforts may be needed to improve access to transplant and attenuate disparities in care in this population.

Please share a specific insight about working with USRDS data that you learned during the completion of this study.

There are unlimited numbers of important research questions to address with these data to inform healthcare policy, clinical care, and the research community. Other extensions of this research and the ability to merge these data with other epidemiologic data would provide additional important insights.

USRDS Coordinating Center (CC)

Tel: 1.888.99USRDS
      (1.888.998.7737)

Email: usrds@usrds.org