Month: May 2022

Race Multiplier in the eGFR Equation: What’s the impact for African-Americans?

Written by Amanda Russo, DO
This post first appeared on REBEL EM

Background: Race is a sociological construct that affects how clinicians deliver health care to various racial/ethnic groups.  This in turn affects clinical outcomes.  Thus, African Americans with chronic kidney disease have worse outcomes with respect to hypertension control, timely nephrology referral, dialysis fistula/graft placement, adequate dialysis treatment, and access to transplantation. The precise reason for this difference is unclear but one proposed cause is the race multiplier term in estimated glomerular filtration rate (eGFR) equations.

The MDRD and CKD-EPI studies developed the equations most commonly used for eGFR in hospitals today. This article aims to illuminate how the race multiplier in the eGFR equations impacts care for African Americans with chronic kidney disease. 

Clinical Question: What is the impact of the race multiplier for African-Americans in the CKD-EPI eGFR equation on CKD classification and healthcare delivery?

READ MORE

The INSPIRATION Trial: Intermediate Dose Anticoagulation in Critically Ill Patients with COVID-19

Written by Jessica DiPeri, MD
This post first appeared on REBEL EM

Background: COVID-19 infection increases the risk of thrombosis due to multiple factors. (Rico-Mesa, 2020). Over the last 2 years, researchers have published 12 RCTs investigating various anticoagulation strategies among patients diagnosed with COVID-19 in multiple clinical settings. To date, only a multiplatform trial in noncritically ill patients, the HEP-COVID trial, and the MICHELLE trial have shown a benefit.

Severely ill patients with COVID-19 in the intensive care setting have an increased risk of thromboembolism, with an incidence reported as high as 31% (Klok, 2020). It remains unclear what the optimal prophylactic anticoagulation strategy is in critically ill patients.

Does intermediate-dose anticoagulation improve clinical outcomes compared to standard prophylactic anticoagulation in patients with COVID-19 treated in the intensive care unit?

READ MORE