The Impact of an Education Intervention to Improve Blood Pressure Control among Black Non-Hispanic Patients and Hispanic Patients with Chronic Kidney Disease

This project examined the effect of an educational intervention on blood pressure control among minority patients with chronic kidney disease (CKD). Adherence to a lowsodium diet is crucial for blood pressure control. It is also vital to assess food insecurity to improve diet adherence, especially among high-risk underrepresented populations. Participants were recruited from a public hospital renal clinic. Knowledge and food access was assessed using CKD and food insecurity questionnaires. Food frequency and 24-hour 3-day food diaries were completed and analyzed. Eighteen patients were enrolled (Black, nonHispanic = 66.6%, Hispanic = 27.7%, uninsured = 33.3%, and Medicaid recipients = 27.7%). Eighty-nine percent of participants screened positive for food insecurity and received vouchers for healthy food from a food depository. Paired t tests showed statistically significant increase in knowledge (p < 0.00) and self-efficacy, and systolic blood pressure improved post-intervention. This study suggests that Black non-Hispanic and Hispanic patients with CKD have limited access to healthy food and consume higher sodium. Patient education, screening for food insecurity, and access to a food depository enhanced adherence to low sodium diet and improved blood pressure control.

The Association of an Alpha-2 Adrenergic Receptor Agonist and Mortality in Patients With COVID-19.

There is a need for treatments to reduce coronavirus disease 2019 (COVID-19) mortality. Alpha-2 adrenergic receptor (α2 AR) agonists can dampen immune cell and inflammatory responses as well as improve oxygenation through physiologic respiratory parameters. Therefore, α2 AR agonists may be effective in reducing mortality related to hyperinflammation and acute respiratory failure in COVID-19. Dexmedetomidine (DEX) is an α2 AR agonist used for sedation. We performed a retrospective analysis of adults at Rush University System for Health hospitals between March 1, 2020 and July 30, 2020 with COVID-19 requiring invasive mechanical ventilation and sedation (n = 214). We evaluated the association of DEX use and 28-day mortality from time of intubation. Overall, 28-day mortality in the cohort receiving DEX was 27.0% as compared to 64.5% in the cohort that did not receive DEX (relative risk reduction 58.2%; 95% CI 42.4-69.6). Use of DEX was associated with reduced 28-day mortality on multivariable Cox regression analysis (aHR 0.19; 95% CI 0.10-0.33; p < 0.001). Adjusting for time-varying exposure to DEX also demonstrated that DEX was associated with reduced 28-day mortality (aHR 0.51; 95% CI 0.28-0.95; p = 0.03). Earlier DEX use, initiated <3.4 days from intubation, was associated with reduced 28-day mortality (aHR 0.25; 95% CI 0.13-0.50; p < 0.001) while later DEX use was not (aHR 0.64; 95% CI 0.27-1.50; p = 0.30). These results suggest an α2 AR agonist might reduce mortality in patients with COVID-19. Randomized controlled trials are needed to confirm this observation.