Predictors of CKD Care in African American and American Indian or Alaska Native Patients in Two Large Health Systems

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Background: Racially minoritized populations in the United States, including African American (AA) and American Indian/Alaska Native (AI/AN), experience disproportionately higher rates of CKD and CKD risk factors compared to other populations. The study aim was to assess predictors of CKD care provided to AA and AI/AN populations. Methods: The Center for Kidney Disease Research, Education, and Hope Registry identified AA (n=25,589), AI/AN (n=4,391), and reference (White, n=351,031) populations with CKD in 2015-2020. CKD was defined by ICD-9/10 codes, CKD-EPI 2021 estimated glomerular filtration rate <60 mL/min/1.73 m2, urine albumin/creatinine ratio (UACR) ≥30 mg/g, or urine protein/creatinine ratio (UPCR) ≥0.15 g/g ≥90 days apart. Patients were assessed during 1 year for: CKD guideline-directed medical therapy (GDMT) and testing for UACR/UPCR. Adjusted logistic regression identified care predictors. Results: AA (62±17 years) and AI/AN (57±18 years) patients with CKD were younger than the reference population (68 ±17 years). Prevalence of GDMT (AA: 46%, AI/AN: 38%, reference: 40%) and UACR/UPCR testing (AA: 22%, AI/AN: 13%, reference: 14%) was suboptimal across populations. The AA population had higher odds of GDMT compared to reference. AI/AN had higher odds of GDMT, but lower odds of UACR/UPCR testing (Figure). Women had lower odds of receiving GDMT or UACR/UPCR testing compared to men. Conclusion: The disproportionate burden of CKD in AA and AI/AN populations is not solely attributable to disparities in CKD care. Women consistently experienced these disparities across race groups. Funding: Other NIH Support - AIM-AHEAD Consortium - OT2OD032581

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