Diabetes mellitus (DM) is a chronic disease characterized by persistent hyperglycemia, which is a major contributing factor to chronic kidney disease (CKD), end-stage renal disease (ESRD), and cardiovascular-related deaths. There are several mechanisms leading to kidney injury, with hyperglycemia well known to stimulate oxidative stress, inflammation, tissue remodeling, and dysfunction in the vascular system and organs. Increased reactive oxygen species (ROS) decrease the bioavailability of vasodilators while increasing vasoconstrictors, resulting in an imbalance in vascular tone and the development of hypertension. Treatments for diabetes focus on controlling blood glucose levels, but due to the complexity of the disease, multiple drugs are often required to successfully delay the development of microvascular complications, including CKD. In this context, naringenin, a flavonoid found in citrus fruits, has demonstrated anti-inflammatory, anti-fibrotic, and antioxidant effects, suggesting its potential to protect the kidney from deleterious effects of diabetes. This review aims to summarize the scientific evidence of the effects of naringenin as a potential therapeutic option for diabetes-induced CKD. 

Naringenin – a potential nephroprotective agent for diabetic kidney disease: A comprehensive review of scientific evidence

Diabetes is associated with significant economic burden. Moreover, cardiovascular disease (CVD), including heart failure, and chronic kidney disease (CKD) are common comorbidities, leading to premature mortality. We conducted a systematic review to assess the humanistic and economic burden of cardio-renal-metabolic (CRM) conditions in individuals ≥ 18 years with CVD, CKD, and type 2 diabetes mellitus.We searched Embase® and Medline® databases from 2011 to January 10, 2022 for English publications reporting humanistic and economic burden outcomes from observational studies, real-world evidence, and economic model studies. Intervention and validation studies were excluded. Study quality was assessed using the Newcastle-Ottawa Scale. Abstracts/posters were identified from four conferences (2020-2022).Of 1804 studies identified, 22 (including four conference publications) were selected involving 351,296,930 participants (one modeled the US population); eight reported healthcare resource utilization (HCRU), seven only cost data, six HCRU and cost data, one reported quality-of-life data (11/18 and 7/18 had estimated low and medium risk of bias, respectively). Participants were predominantly ≥ 65 years and identified as having White ethnicity. Higher costs and HCRU were observed in patients with all three conditions compared to those with two or none. Urban/metropolitan and insured patients had higher healthcare expenditure and service utilization compared to uninsured and racial/ethnic minority populations. Comorbidities were associated with increased hospitalizations, higher costs, and more emergency department visits. In general, patients identified as having Black ethnicity had low odds of using healthcare services, possibly due to disparities in healthcare access and distrust in the system. Limitations included no adjustment for inflation and a predominance of retrospective studies.This review showed a greater economic burden for patients with CRM conditions, with a clear trend between increasing numbers of comorbidities and increasing healthcare costs/resource use. Comparisons between countries are complicated and the scarcity of evidence from minority racial and ethnic groups and lack of data from non-US geographies warrant further investigation. 

Humanistic and Economic Burden of Patients with Cardiorenal Metabolic Conditions: A Systematic Review

Kidney transplantation is the ideal treatment for people with kidney failure as it offers longer survival, better quality of life, reduced hospitalization, and lower cost relative to dialysis.1 However, a relative donor shortage means not all kidney failure patients will receive a lifesaving transplant, and it is in this setting that sex and gender disparities in access remain prevalent. Women have a higher prevalence of chronic kidney disease (CKD) yet are less likely to receive appropriate care and initiate dialysis as compared with men. 

Women's Access to Kidney Transplantation.

Optimal Education: Paving the Way for True Optimal Start Dialysis

Abstract (350 words) Background: A retrospective, non-experimental, non-interventional study was conducted at 3 health care organizations to identify clinical gaps in care for patients with stage 3 or 4 chronic kidney disease (CKD), and financial opportunity from risk adjustment payment systems. Lack of evaluation for CKD in patients with diabetes was also assessed. Methods: Outpatient longitudinal laboratory results and patient metadata available in the electronic medical record, laboratory information system, and/or laboratory billing or facility claims data for the calendar year 2021 were evaluated. Laboratory results were compared to billing data (ICD-10 codes) and risk adjustment scores including Hierarchical Condition Categories (HCCs) to determine if laboratory-identified CKD was coded as a disease condition in the electronic medical record. Adults 18 to 75 years of age were included; inpatient laboratory results and pregnant women were excluded. Results: At the 3 institutions, 12478 of 16063 (78%), 487 of 1511 (32%) and 19433 of 29277 (66%) of patients with laboratory evidence of stage 3 or 4 CKD did not have a corresponding ICD10 or HCC code for CKD in the electronic medical record. For patients with diabetes on the basis of an HbA1c value of &gt;6.5%, 34384 of 58278 (59%), 2274 of 2740 (83%) and 40378 of 52440 (77%) had not undergone guideline-recommended laboratory testing for CKD during the same 12 months. Using publicly available information for calendar year 2021, we estimated that of 39907 patients at the three institutions with stage 3 or stage 4 CKD documented by laboratory values only, 3937 (9.9%) would be enrolled in Medicare Advantage or Affordable Care Act Market programs. The imputed lost reimbursement under risk-adjusted payment systems for this under-documentation of CKD was $3.3M for the three institutions combined, representing lost opportunity for both identification and proactive clinical management of these patients, and financial recovery for the costs of providing that care. Conclusions: We conclude that clinical laboratories can provide value beyond routine diagnostics, for identification of gaps in care for identification and management of CKD, stratifying subgroups of patients to identify risk, and capturing missed reimbursement through risk adjustment factors not documented in the billing system. 

A Retrospective Multi-site Examination of Chronic Kidney Disease Using Longitudinal Laboratory Results and Metadata to Identify Clinical and Financial Risk

Background: Diabetes and hypertension are prevalent in CKD. The association of coordinated care with outcomes in the setting of these coexisting comorbidities is not well understood. This study evaluated the association between well-managed care and healthcare resource utilization (HCRU) and costs. Methods: Using the Humana Research Database, this retrospective cohort study identified 241,628 patients with CKD Stage ≥ 3a (3% diabetes, 40% hypertension, 50% diabetes and hypertension, 7% neither diabetes nor hypertension) in 2017. Eligible patients were indexed on first evidence of CKD and required to be enrolled in a Medicare Advantage Prescription Drug plan for ≥ 12 months pre-and post-index date. Patients who had kidney transplant or hospice election pre-index were excluded. Well-managed care measures included hemoglobin A1c (HbA1c) monitoring, adherence to glucose medications, cardiovascular (CV) therapy, angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers (ACEi/ARBs), and routine primary care provider (PCP)/ nephrologist visits. HCRU and costs were evaluated within 12-months post-index. Results: The cohort was 55% female, 77% White, average age of 75 years, and comprised of 67%, 23%, 10%, and 1% patients with Stages 3a, 3b, 4 and 5 CKD, respectively. Patients with diabetes and hypertension who were adherent to well-managed care were significantly less likely to experience an inpatient (IP) admission or emergency department (ED) visit (Table 1) and incurred lower mean monthly costs compared with patients who were not adherent to well-managed care. Similar results were observed for patients with diabetes only, hypertension only, or neither condition. Conclusions: Well-managed diabetes and/or hypertension in patients with CKD was associated with lower HCRU and costs. Findings may inform innovative models of CKD care coordination.

Well-Managed CKD and Its Association with Healthcare Resource Utilization and Costs

Effective management of comorbid diabetes and hypertension in patients with chronic kidney disease (CKD) is important for optimal outcomes. However, little is known about this relationship from a health plan perspective. The objective of this study was to evaluate the association of effective management of comorbid diabetes and/or hypertension with healthcare resource utilization (HCRU) in patients with chronic kidney disease (CKD).This retrospective cohort study used the Humana Research Database to identify patients with CKD Stage ≥ 3a in 2017. Eligible patients were enrolled in a Medicare Advantage Prescription Drug plan for ≥ 12 months before and after the index date (first observed evidence of CKD). Patients with end-stage renal disease, kidney transplant, or hospice election preindex were excluded. Recommended comorbid disease management included hemoglobin A1c monitoring; adherence to glucose-lowering, cardiovascular, and angiotensin-converting enzyme inhibitors/angiotensin receptor blocker medications; and nephrologist/primary care provider (PCP) visits. HCRU was evaluated for 12 months postindex.The final cohort of 241,628 patients was 55% female and 77% White, with an average age of 75 years. Approximately 90% of patients had Stage 3 CKD. Half had both diabetes and hypertension, and most of the remaining half had hypertension without diabetes. Patients meeting the criteria for good disease management, compared with patients not meeting those criteria, were less likely to experience an inpatient hospitalization, by as much as 40% depending on the criterion and the comorbidities present, or an emergency department visit, by as much as 30%. Total monthly healthcare costs were as much as 17% lower.Management of comorbid diabetes and hypertension in patients with CKD was associated with lower HCRU and costs. Care coordination programs targeting patients with CKD must give careful attention to glucose and blood pressure control.Not applicable. 

Managing comorbidities in chronic kidney disease reduces utilization and costs

OBJECTIVES
To evaluate the association of dialysis transition planning factors (eg, nephrologist care, vascular access placement, place of dialysis) with inpatient (IP) stays, emergency department (ED) visits, and mortality.


STUDY DESIGN
Retrospective cohort study.


METHODS
We used the Humana Research Database to identify 7026 patients with a diagnosis of end-stage renal disease (ESRD) in 2017 who were enrolled in a Medicare Advantage Prescription Drug plan with at least 12 months preindex enrollment, with first ESRD evidence as the index date. Patients with kidney transplant, hospice election, or dialysis preindex were excluded. Transition-to-dialysis planning was defined as optimal (vascular access placed), suboptimal (nephrologist care, but no vascular access), or unplanned (first dialysis in IP stay or ED visit).


RESULTS
The cohort was 41% female and 66% White, with a mean age of 70 years. Optimally planned, suboptimally planned, and unplanned transition to dialysis occurred for 15%, 34%, and 44% of the cohort, respectively. Among patients with preindex chronic kidney disease (CKD) stages 3a and 3b, 64% and 55%, respectively, had an unplanned dialysis transition. For patients with preindex CKD stages 4 and 5, 68% and 84%, respectively, had a planned transition. In adjusted models, patients with a suboptimally or optimally planned transition were 57% to 72% less likely to die, 20% to 37% less likely to experience an IP stay, and 80% to 100% more likely to experience an ED visit than patients with an unplanned dialysis transition.


CONCLUSIONS
A planned transition to dialysis was associated with reduced odds of IP stays and lower mortality.

Transition-to-dialysis planning, health care use, and mortality in end-stage renal disease.

The Association of Transition-to-Dialysis Planning and Healthcare Resource Use and Mortality in Patients with ESRD

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Amal Agarwal

Author Tools

Chat about Author

Papers

Well-Managed CKD and Its Association with Healthcare Resource Utilization and Costs

Managing comorbidities in chronic kidney disease reduces utilization and costs

Transition-to-dialysis planning, health care use, and mortality in end-stage renal disease.

The Association of Transition-to-Dialysis Planning and Healthcare Resource Use and Mortality in Patients with ESRD