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Food Access, Chronic Kidney Disease, and Hypertension in the U.S.

ABSTRACT: Greater distance to full-service supermarkets and low income may impair access to healthy diets and contribute to chronic kidney disease (CKD) and hypertension. The study aim was to determine relationships among residence in a "food desert," low income, CKD, and blood pressure.Adults in the 2003-2010 National Health and Nutrition Examination Survey (N=22,173) were linked to food desert data (www.ers.usda.gov) by Census Tracts. Food deserts have low median income and are further from a supermarket or large grocery store (>1 mile in urban areas, >10 miles in rural areas). Weighted regression was used to determine the association of residence in a food desert and family income with dietary intake; systolic blood pressure (SBP); and odds of CKD. Data analysis was performed in 2014-2015.Compared with those not in food deserts, participants residing in food deserts had lower levels of serum carotenoids (p<0.01), a biomarker of fruit and vegetable intake, and higher SBP (1.53 mmHg higher, 95% CI=0.41, 2.66) after adjustment for demographics and income. Residence in a food desert was not associated with odds of CKD (OR=1.20, 95% CI=0.96, 1.49). Lower, versus higher, income was associated with lower serum carotenoids (p<0.01) and higher SBP (2.00 mmHg higher for income-poverty ratio ?1 vs >3, 95% CI=1.12, 2.89), but also greater odds of CKD (OR=1.76 for income-poverty ratio ?1 vs >3, 95% CI=1.48, 2.10).Limited access to healthy food due to geographic or financial barriers could be targeted for prevention of CKD and hypertension.

SUBMITTER: Suarez JJ

PROVIDER: S-EPMC4656149 | biostudies-literature | 2015 Dec

REPOSITORIES: biostudies-literature

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Food Access, Chronic Kidney Disease, and Hypertension in the U.S.

Suarez Jonathan J JJ Isakova Tamara T Anderson Cheryl A M CA Boulware L Ebony LE Wolf Myles M Scialla Julia J JJ

American journal of preventive medicine 20151201 6

<h4>Introduction</h4>Greater distance to full-service supermarkets and low income may impair access to healthy diets and contribute to chronic kidney disease (CKD) and hypertension. The study aim was to determine relationships among residence in a "food desert," low income, CKD, and blood pressure.<h4>Methods</h4>Adults in the 2003-2010 National Health and Nutrition Examination Survey (N=22,173) were linked to food desert data (www.ers.usda.gov) by Census Tracts. Food deserts have low median inc ...[more]

PMID: 26590940

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Project description:BackgroundLittle evidence has been available to support the use of thiazide diuretics to treat hypertension in patients with advanced chronic kidney disease.MethodsWe randomly assigned patients with stage 4 chronic kidney disease and poorly controlled hypertension, as confirmed by 24-hour ambulatory blood-pressure monitoring, in a 1:1 ratio to receive chlorthalidone at an initial dose of 12.5 mg per day, with increases every 4 weeks if needed to a maximum dose of 50 mg per day, or placebo; randomization was stratified according to previous use of loop diuretics. The primary outcome was the change in 24-hour ambulatory systolic blood pressure from baseline to 12 weeks. Secondary outcomes were the change from baseline to 12 weeks in the urinary albumin-to-creatinine ratio, N-terminal pro-B-type natriuretic peptide level, plasma renin and aldosterone levels, and total body volume. Safety was also assessed.ResultsA total of 160 patients underwent randomization, of whom 121 (76%) had diabetes mellitus and 96 (60%) were receiving loop diuretics. At baseline, the mean (±SD) estimated glomerular filtration rate was 23.2±4.2 ml per minute per 1.73 m2 of body-surface area and the mean number of antihypertensive medications prescribed was 3.4±1.4. At randomization, the mean 24-hour ambulatory systolic blood pressure was 142.6±8.1 mm Hg in the chlorthalidone group and 140.1±8.1 mm Hg in the placebo group and the mean 24-hour ambulatory diastolic blood pressure was 74.6±10.1 mm Hg and 72.8±9.3 mm Hg, respectively. The adjusted change in 24-hour systolic blood pressure from baseline to 12 weeks was -11.0 mm Hg (95% confidence interval [CI], -13.9 to -8.1) in the chlorthalidone group and -0.5 mm Hg (95% CI, -3.5 to 2.5) in the placebo group. The between-group difference was -10.5 mm Hg (95% CI, -14.6 to -6.4) (P<0.001). The percent change in the urinary albumin-to-creatinine ratio from baseline to 12 weeks was lower in the chlorthalidone group than in the placebo group by 50 percentage points (95% CI, 37 to 60). Hypokalemia, reversible increases in serum creatinine level, hyperglycemia, dizziness, and hyperuricemia occurred more frequently in the chlorthalidone group than in the placebo group.ConclusionsAmong patients with advanced chronic kidney disease and poorly controlled hypertension, chlorthalidone therapy improved blood-pressure control at 12 weeks as compared with placebo. (Funded by the National Heart, Lung, and Blood Institute and the Indiana Institute of Medical Research; CLICK ClinicalTrials.gov number, NCT02841280.).

Project description:BackgroundRoutine primary care visits provide an educational opportunity for African-Americans with chronic kidney disease (CKD) and CKD risk factors such as hypertension. The nature of patient-physician discussions about CKD and their impact on CKD awareness in this population have not been well explored.ObjectiveTo characterize patient CKD awareness and discussions about CKD between patients and primary care physicians (PCPs).DesignMixed methods study.PatientsAfrican-American patients with uncontrolled hypertension (? 140/90 mmHg) and CKD (albuminuria or eGFR < 60 ml/min/1.73 m2) recruited from an urban primary care clinic.Main measuresWe assessed patient CKD awareness with questionnaires and audio-recorded patients-PCP discussions during a routine visit. We characterized discussions and used multivariate regression analysis to identify independent patient and visit predictors of CKD awareness or CKD discussions.ResultsAmong 48 African-American patients with uncontrolled hypertension and CKD, 29% were aware of their CKD. After adjustment, CKD awareness was associated with moderate-severe CKD (stages 3-4) (vs. mild CKD [stages 1-2]) (prevalence ratio [PR] 2.82; 95% CI 1.18-6.78) and inversely associated with diabetes (vs. without diabetes) (PR 0.28; 95% CI 0.10-0.75). CKD discussions occurred in 30 (63%) visits; most focused on laboratory assessment (n = 23, 77%) or risk factor management to delay CKD progression (n = 19, 63%). CKD discussions were associated with moderate-severe CKD (vs. mild CKD) (PR 1.57; 95% CI 1.04-2.36) and diabetes (vs. without diabetes) (PR 1.42; 95% CI 1.09-1.85), and inversely associated with uncontrolled hypertension (vs. controlled) (PR 0.58; 95% CI 0.92-0.89). In subgroup analysis, follow-up CKD awareness did not change by presence or absence of CKD discussion (10.5% vs. 7.7%, p = 0.8).ConclusionsIn patients at risk of CKD progression, few were aware of CKD, and CKD discussions were not associated with CKD awareness. More resources may be needed to enhance the clarity of clinical messages regarding CKD and its significance for patients' health.Trial registrationClinicalTrials.gov Identifier: NCT01902719.

Dataset Information

Food Access, Chronic Kidney Disease, and Hypertension in the U.S.

Publications

Food Access, Chronic Kidney Disease, and Hypertension in the U.S.

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