CureGN

University Of Michigan At Ann Arbor, Ann Arbor MI

Investigators

Linked publications & trials

Abstract

(PLEASE KEEP IN WORD, DO NOT PDF) Chronic kidney disease (CKD) affects 15% of women, however their outcomes may vary based on their geographic location, race, ethnicity, and at different points across the lifespan. Black women are at high risk for poor outcomes including progression to end stage kidney disease (ESKD) due a variety of factors, including healthcare access, environmental factors, and genetic variants such as APOL1 mutations that contribute to a higher burden of hypertension and CKD. Women living in rural areas may also have poor outcomes due to difficulty accessing specialty care. Menopausal status may also impact rates of disease progression. Primary glomerulonephropathies (GN) are the third leading cause of end-stage kidney disease (ESKD), but with rapidly expanding treatment options. Understanding health disparities in treatments and outcomes is necessary to develop interventions to improve health for all. CureGlomerulonephropathy (CureGN) is longitudinal prospective cohort study of people with GN with over 1160 women and girls enrolled. In this supplement to CureGN, we will use longitudinal analytic approaches to characterize the health of women and girls over time, with particular attention to factors that may result in differences in treatments and outcomes. The long-term goal of this work is specifically to translate our findings to solution-oriented approaches that target barriers to achieving the best possible health outcomes among girls and women with GN. In pursuit of this goal, we propose: Aim 1: To test the hypothesis that Black race, Hispanic ethnicity, rural residence, and post-menopausal status are associated with higher risk of adverse kidney and cardiovascular outcomes compared to white race, urban dwelling, and pre-menopausal status, we will assess differences in longitudinal kidney and cardiovascular outcomes (incident kidney failure, 40% decline in kidney function, eGFR slope, cardiovascular events, and death from any cause) among girls and women in CureGN by age, race, ethnicity, and rural-urbanicity. Kaplan-Meier curves and multivariable mixed models will be adjusted for GN diagnosis, eGFR and proteinuria at enrollment, hypertension, smoking, BMI, insurance, education, and prior adverse pregnancy outcomes. We will perform strata-specific models by age to further investigate differences across the lifespan. Aim 2: To test the hypothesis that the aforementioned groups are less likely to receive standard of care medications compared to white race and urban-dwelling populations and this disparity will be greatest among women of childbearing age, we will examine differences in treatments prescribed to women and girls considering disease activity over the lifespan. Multivariable logistic and Poisson regression models will be fit to examine treatment differences, with similar adjustments for covariates as described in Aim 1. With comprehensive data on outcomes, medications, healthcare utilization, environmental exposures, and reproductive events, CureGN is uniquely capable of improving our understanding of health disparities among girls and women with GN with the long-term goal of developing interventions that improve outcomes for all.