Inner-City Nephrology (Inner-City Nephrolog)
|Event Date/Time: Sep 30, 2005||End Date/Time: Sep 30, 2005|
|Registration Date: Sep 30, 2005|
|Early Registration Date: Sep 15, 2005|
Our stimulus to conduct this educational symposia is the recognition of unique issues and problems generated by the effort of clinicians striving to provide comprehensive management for kidney diseases in the inner-city.1-10 Starting with suboptimal attention to and correction of pervasive risk factors (hypertension, hyperglycemia, hyperlipidemia) for progression to end-stage renal disease (ESRD) and extending to minimally structured continuing supervision of individuals encompassed by the pandemic of human immunodeficiency virus (HIV)-associated renal failure7,8, inner-city residents are frequently not included in outreach programs designed to optimize uremia therapy including ready access to kidney transplantation.
Suboptimal health of inner-city blacks, hispanics, and other minority populations in the United States is attributed to multivariate causes including inadequate access to good medical care, racial discrimination, alienation from the healthcare system as well as under utilization of medical care by those with health insurance.11,12 However, an overlooked variable is that healthcare providers in the inner-city overwhelmed by stresses of patient care, may be unaware of major unique issues and recent findings specific to inner-city health care that may affect the outcome and well-being of patients under their care.
This thesis may be especially particularly relevant in detection and management of kidney diseases because of unique problems associated with kidney diseases in the inner-city ranging from the incredibly large burden of diabetes and hypertension, through suboptimal preESRD care, dialysis care and drug use to problems associated with access and outcomes in kidney transplantation.1-10
For example, on the issue of race and ESRD, Dr. William F. Owen Jr., an internationally recognized authority on kidney diseases at Duke University, notes that "the U.S. population is about 13 percent African-American, but 35 percent of those on dialysis are African-American. African-Americans tend to have ESRD earlier, and it tends to be associated with declining socioeconomic status." He notes that â€œthe increased susceptibility of nonwhite populations to ESRD has not been fully explained and probably represents a complex interplay of genetic, cultural, and environmental influences.â€?13
On racial inequity in America's ESRD program, Dr Owen observes that â€œa number of disparities in outcomes and delivery of ESRD care have been noted for racial minority participants. These include possible overdiagnosis of hypertensive nephrosclerosis, decreased provision of renal replacement therapy, limited referral for home dialysis modalities, underprescription of dialysis, increased use of synthetic grafts rather than fistulas as permanent angioaccess, and delayed wait-listing for renal transplantation. Transplantation inequities mean that black patients are likely to remain on dialysis relatively longer, so that their susceptibility to less than optimal processes of care increases disproportionately. Improved survival and quality of life for blacks with ESRD may have encouraged provider complacency about racial disparities in the ESRD program and in particular about referral for transplantation. It is also apparent that minority ESRD patients may, similar to their non-ESRD counterparts, be referred less frequently for invasive cardiovascular procedures.â€?13
On efforts to increase minority organ donation, Professor Clive Callender, founder and principal investigator of the National Minority Organ Tissue Transplant Education Program (MOTTEP) observes that â€œattitudes, knowledge, beliefs, and behavioral intentions about organ/tissue donation and illness prevention can be affected by culturally appropriate health education programs designed for targeted population groups.â€?14
According to our analysis and program review over the past decade, issues specific to inner-city nephrology are minimally â€“ if at all â€“ addressed in-depth at national and international nephrology meetings. Accordingly, our conference intends to confront these admittedly difficult issues in a manner designed to construct strategies for improving outcomes in renal care among inner-city residents. Our target audience includes nonnephrologists, primary care providers, nephrologists, physicians assistants, administrators, nurse practitioners and nurses.
The objective of the conference is to examine and analyze unique issues related to nephrologic care in the inner-city with the goal of educating health providers and improving outcomes. Some key issues that will be addressed include:
a) Exploration of reasons for the disproportionate incidence of chronic kidney disease in blacks and examining whether highly active antiretroviral therapy (HAART) has modulated the epidemic of HIV nephropathy
b) The relative merits of continuous ambulatory peritoneal dialysis (CAPD) versus hemodialysis as treatment of choice for ESRD in the inner-city
c) Whether turf battles and managed care are to blame for late referral of ESRD patients
d) Strategies to increase organ donation in the inner-city and whether kidneys the sale of kidneys should be legalized
e) The truth about gender and race discrimination in US uremia therapy3,13,15
f) Must disruptive patients be dialyzed and are we doing enough to prevent infections in dialysis facilities ?
g) Whether for-profit dialysis companies care more about profits than patients ?16-18
h) The relative effects of biology vs socioeconomic factors in explaining racial difference in kidney transplant outcome
i) Effectiveness of dietary counseling in a multicultural setting and what nonnephrologists need to know about emergency room care of ESRD patients (CAPD, hemodialysis and kidney transplant patients)
On the question of appropriate dietary counselling in ESRD, Patel et al.19 note that â€œemphasis on culturally based and ethnically oriented food selection by nutrition health professionals is needed to effectively plan therapeutic diets. With the influx of numerous ethnic groups into the United States and the merging of cultural practices, it is important for dietitians to become familiar with specific ethnic foods and regional cooking techniques.â€?
Findings from studies in inner-city patients from the Renal Disease Division will also be shared with attendees, and specific efforts will be made to reach out to providers serving patients in the inner-city. A comprehensive group of speakers will include clinician researchers with requisite expertise in inner-city healthcare. Continuing medical education credits will be offered and the proceedings of the conference will be published as a book. For further information and registration call (718) 270-2422 or visit our website www.downstate.edu