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Kidney Week

Abstract: TH-PO596

Association Between Social Vulnerability, Environmental Burden, and Kidney Outcomes Among Individuals with Glomerular Disease: Results from the Cure Glomerulopathy Network (CureGN)

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Dass, Loryn Wilson, Duke University School of Medicine, Durham, North Carolina, United States
  • Smith, Abigail R., University of Michigan, Ann Arbor, Michigan, United States
  • Krissberg, Jill, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
  • Wang, Chia- Shi, Emory University School of Medicine, Atlanta, Georgia, United States
  • Robinson, Bruce M., University of Michigan, Ann Arbor, Michigan, United States
  • Gbadegesin, Rasheed A., Duke University School of Medicine, Durham, North Carolina, United States
  • Dave, Gaurav, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Gibson, Keisha L., The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
Background

The CDC Environmental Justice Index Social-Environmental Ranking (EJI-SER) combines a Social Vulnerability Module (SV) with an Environmental Burden Module (EB) to characterize cumulative environmental and social burden at the census tract level. With this analysis, we evaluate the association between EJI-SER and kidney outcomes in patients with glomerular disease (GD).

Methods

CureGN is an observational cohort study of adults and children with biopsy-proven GD. EJI-SER is percentile ranking by census tract, with higher score indicating more severe SV and EB burden. Associations between EJI-SER and its components with kidney failure (initiation of kidney replacement therapy, transplant, or 2 eGFRs <15ml/min/1.73m2) 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 1,131 participants with census tract data, median follow-up was 5.1 years (IQR 3.0-6.6) and median age at biopsy was 24 with 5% Asian, 18% Black, and 70% White. Median EJI-SER was 0.49 (IQR 0.26-0.75). EJI-SER was associated with higher hazard of kidney failure (adjusted HR 1.12 per 10 percentile increase [95% CI, 1.04-1.20]) and lower eGFR (mean eGFR 9.3 ml/min/1.73m2 lower for EJI-SER >75th versus ≤25th percentile, p<0.001).

Conclusion

As captured by EJI-SER, higher environmental and social burden are associated with lower eGFR and higher risk of kidney failure in the CureGN cohort. This first use of the EJI-SER in GD demonstrates the need for additional investigation into drivers of disparities in GD and policies and resources that address these structural inequities.