Kidney international reports · 2025
The Impact of Homelessness on Kidney Outcomes Among Adults With Diabetes.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Wiens Kathryn, Tariq Saania, Reed Tucker, Bai Li, Ronksley Paul E, Hwang Stephen W, Austin Peter C, Booth Gillian L, Spackman Eldon, Campbell David J T
Аннотация
INTRODUCTION: People with diabetes experiencing homelessness face barriers to self-management, contributing to suboptimal glycemia and reduced screening for microvascular complications. The objective of the study was to assess whether a history of homelessness is associated with kidney-related outcomes among people with diabetes.
METHODS: A propensity-matched cohort study using administrative health data from Ontario, Canada, was conducted, including residents with diabetes who had ≥1 hospital encounter during the study period (2008-2020). Having a history of homelessness was identified using a validated algorithm. Outcomes of interest included nephrologist visits, reduction in estimated glomerular filtration rate (eGFR), initiation of renal replacement therapy, and acute care visits for kidney-related ambulatory care-sensitive conditions. Negative binomial regression and Cox proportional hazard models were used to assess outcomes.
RESULTS: Of 659,877 eligible people with diabetes living in Ontario, 3366 had a history of homelessness, with 2650 successfully matched to non-homeless controls. People with a history of homelessness had similar rates of nephrologist visits compared with those with no history of homelessness (rate ratio [RR] = 1.27; 95% confidence interval [CI]: 0.82-1.97), but had higher rates of hospitalization for chronic kidney disease (CKD)-related conditions, including volume overload (RR = 3.13; 95% CI: 1.62-6.04), hyperkalemia (RR = 3.01; 95% CI: 2.07-4.39), and heart failure (RR = 2.06; 95% CI: 1.62-2.63). They had a higher hazard of eGFR decline (hazard ratio [HR] = 1.71; 95% CI: 1.56-1.88), and renal replacement therapy (HR = 1.65; 95% CI: 1.04-2.60) compared with nonhomeless controls.
CONCLUSION: Homelessness is associated with higher rates of kidney-related adverse events in people living with diabetes, supporting the need for tailored approaches that reduce barriers to accessing diabetes care.
METHODS: A propensity-matched cohort study using administrative health data from Ontario, Canada, was conducted, including residents with diabetes who had ≥1 hospital encounter during the study period (2008-2020). Having a history of homelessness was identified using a validated algorithm. Outcomes of interest included nephrologist visits, reduction in estimated glomerular filtration rate (eGFR), initiation of renal replacement therapy, and acute care visits for kidney-related ambulatory care-sensitive conditions. Negative binomial regression and Cox proportional hazard models were used to assess outcomes.
RESULTS: Of 659,877 eligible people with diabetes living in Ontario, 3366 had a history of homelessness, with 2650 successfully matched to non-homeless controls. People with a history of homelessness had similar rates of nephrologist visits compared with those with no history of homelessness (rate ratio [RR] = 1.27; 95% confidence interval [CI]: 0.82-1.97), but had higher rates of hospitalization for chronic kidney disease (CKD)-related conditions, including volume overload (RR = 3.13; 95% CI: 1.62-6.04), hyperkalemia (RR = 3.01; 95% CI: 2.07-4.39), and heart failure (RR = 2.06; 95% CI: 1.62-2.63). They had a higher hazard of eGFR decline (hazard ratio [HR] = 1.71; 95% CI: 1.56-1.88), and renal replacement therapy (HR = 1.65; 95% CI: 1.04-2.60) compared with nonhomeless controls.
CONCLUSION: Homelessness is associated with higher rates of kidney-related adverse events in people living with diabetes, supporting the need for tailored approaches that reduce barriers to accessing diabetes care.