New Index Demonstrates Association between Social Vulnerability, Environmental Burden, and Kidney Failure Risk among Individuals with Glomerular Disease.

KEY POINTS: More tools are needed to explore upstream drivers of racial and ethnic disparities in kidney disease outcomes. The Centers for Disease Control and Prevention Environmental Justice Index is a new tool which characterizes cumulative social and environmental burden at the census tract level. This study is the first application of the Environmental Justice Index to understanding glomerular disease outcomes. BACKGROUND: The Centers for Disease Control and Prevention Environmental Justice Index Social-Environmental Ranking (EJI-SER) combines a Social Vulnerability Module with an Environmental Burden Module to characterize cumulative environmental and social burden at the census tract level. This analysis evaluates the association between EJI-SER and kidney outcomes in patients with glomerular disease (GD). METHODS: Cure Glomerulopathy is an observational cohort study of adults and children with biopsy-proven GD. EJI-SER is a percentile ranking by census tract, with a higher score indicating a more severe burden. Associations between EJI-SER and its components with kidney failure (initiation of KRT, transplant, or two eGFRs <15 ml/min per 1.73 m2) and longitudinal eGFR were tested using multivariable Cox regression and linear mixed models, respectively, adjusted for demographics, histologic diagnosis, eGFR and urine protein to creatinine ratio at enrollment, and time from biopsy to enrollment. RESULTS: Among 1149 participants with census tract data, the median (interquartile range [IQR]) follow-up was 5.4 (3.0–7.0) years, the median (IQR) age at biopsy was 24 (10–48), and self-identified racial distribution was 5% Asian, 18% Black, and 70% White. Median (IQR) EJI-SER was 0.49 (0.26–0.75). EJI-SER scores in the lowest two quartiles were associated with a lower hazard of kidney failure compared with the highest quartile (adjusted hazard ratio [95% confidence interval], 0.62 [0.36 to 1.08] and 0.43 [0.25 to 0.76] for EJI-SER 0%–25% and >25%–50% versus >75%, respectively) and higher eGFR at enrolllment (adjusted mean 90.1 versus 87.1 ml/min per 1.73 m2 for 0%–25% versus >75%, P = 0.08). CONCLUSIONS: As captured by EJI-SER, higher environmental and social burdens are associated with lower eGFR and a higher risk of kidney failure in the Cure Glomerulopathy cohort. This first use of the EJI-SER in GD demonstrates the need for additional investigation into social drivers of disparities in GD and policies and resources that address these structural inequities.

Duke Scholars

Author Rasheed Adebayo Gbadegesin Pediatrics, Nephrology