The Center for Chronic Disease Research and Policy is proud to feature a talk by James Lash, “Disparities in Kidney Care Management and Outcomes: Lessons Learned from the CRIC Study,” at our 12th Annual Symposium: Intersections of Policy, Innovation, Healthcare, and Financialization for Kidney Disease: Where Are We in America Today? on October 16, 2024. REGISTER HERE.
Dr. James Lash is the Robert Wood Keeton Professor of Medicine and Chief of the Division of Nephrology at the University of Illinois College of Medicine. His research focuses on the epidemiology of chronic kidney disease (CKD) and interventional trials in the treatment of kidney disease, particularly in racial and ethnic minority populations in the United States. He has particular expertise in evaluating the impact of patient-centered factors and lifestyle on the development and progression of kidney disease. Lash is the UIC Principal Investigator on the National Institute of Diabetes and Digestive and Kidney Diseases-sponsored Chronic Renal Insufficiency Cohort (CRIC) and Hispanic CRIC Studies and the University of Illinois Chicago Kidney Precision Medicine Project CKD Recruitment Site. His clinical practice focuses on the treatment of kidney disease and hypertension.
Can you tell us about your research?
My research is primarily focused on chronic kidney disease, mostly the epidemiology of chronic kidney disease, as well as trials. CKD, compared to other chronic diseases, has been understudied in terms of understanding risk and patterns of who’s more likely to progress and have problems and who isn’t.
What do you think are the greatest problems in kidney health today?
Lack of awareness and lack of screening are both problems. It’s often a silent disease that first becomes evident by laboratory tests. Those who are aware of it often are very advanced or at the point of kidney failure. It’s a health system problem.
The two most common causes of kidney disease are diabetes and hypertension, so those are easy criteria for screening. Add family history, and those are three no-brainers for higher risk population. It’s been shown over and over again when people have looked at health system data that the proportion of people who are receiving screening is lower than it should be.
Could you share a little bit about your upcoming talk?
There have been a large number of observational studies that have been done over 40 or 50 years, mostly funded by the National Heart, Lung, and Blood Institute. The most famous was the Framingham Heart Study, a multi-generational study in Framingham, Massachusetts. That study was largely responsible for us understanding the major risk factors for cardiovascular disease. Those studies produced many risk equations factoring in smoking , diabetes, hypertension, physical activity, hyperlipidemia, and so on.
In chronic kidney disease there was nothing like that, so the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) put out an RFA recognizing this gap. UIC was funded as one of seven sites in the US in their large multicenter epidemiologic study 21 years ago to do the Chronic Renal Insufficiency Cohort (CRIC) Study. It was a wonderful opportunity because it was a newly charted area and so much was to be learned.
The seven sites recruited about 5100 individuals, 1200 in Chicago. Our site, due to our location in Chicago, has a substantial proportion of Hispanic patients, so we also were funded to do a parallel study of just Hispanic patients, which was basically embedded into the other study. The primary two goals of the study were to look at risk for progression of CKD as well as cardiovascular disease and to understand patterns of illness in this population.
The beautiful thing about epidemiologic research is, with robust data collection, there’s so many different questions that you can ask. Particularly because we have a large minority population—a large African-American and Hispanic population—we’re very interested in health disparities.
We have a sister study in Mexico City, so we’re able to compare Mexicans living with chronic kidney disease living in Mexico City compared to those in Chicago. What’s the impact of immigration and adopting the norms and cultural behaviors of the population of a country that you move to? We’re seeing large differences in risk factors, health behavior, and psychosocial health. Everything’s much worse.
My talk will discuss what we’ve learned from the study regarding health and equity in chronic kidney disease.
Are there any policy changes that you would recommend based on what you found?
A lot of them are very obvious. In terms of health insurance coverage and having a regular doctor, we saw major differences in what happens to people. People who rely on the emergency room for their regular care (about 15% of the study participants reported going to the emergency room as their major place of care) had much poorer outcomes and super high rates of hospitalization. We also looked at rehospitalization, which we think is largely preventable. We need programs like the heart failure programs hospitals have in place for prevent repeated hospitalizations from heart failure.