BACKGROUND: African-American patients with end-stage renal disease are less likely than white patients to undergo renal transplantation. The development of strategies to address this disparity requires an evidence-based understanding of the barriers that impede access to renal transplantation among African Americans in the United States. METHODS: In September 2005, we searched MEDLINE, EMBASE, and CENTRAL for articles that identified the barriers that impeded African Americans' access to renal transplantation. Two reviewers independently extracted relevant data from the included studies. Barriers were broadly divided under two categories: (i) patient-related barriers; and (ii) healthcare-related barriers. RESULTS: We obtained 76 potentially relevant articles of which 11 studies were included in the final review. Several patient-related barriers--personal and cultural beliefs about transplantation, lower socioeconomic status and levels of education, and healthcare-related barriers--physician perception about survival of African Americans post-transplantation, inadequate transplant work-up despite being referred, and HLA-mismatching were identified at different stages of the transplantation process. Personal and cultural beliefs of African-American patients were consistently identified as patient-related barriers among several studies. Physicians' perception about post-transplantation survival of African Americans was the most commonly identified healthcare-related barrier. CONCLUSIONS: A wide spectrum of patient-related barriers including their personal and cultural beliefs about transplantation and several healthcare-related barriers at different stages of the transplant process impedes access to renal transplantation among African Americans in the United States. A multisectoral approach focusing on these barriers needs to be evaluated to reduce disparities in renal transplantation in the United States.

Black or African American↗

PubMedDate not supplied

Randomized trials stopped early for harm in HIV/AIDS: a systematic survey.

PURPOSE: The decision to stop trials early because of the harmful effects of the intervention is complex and requires weighing statistical, logistical, and ethical considerations. We assessed the prevalence of randomized clinical trials (RCTs) stopped early for harm in HIV/AIDS and determined the quality of reporting of methods to inform the decision to stop the trial. METHOD: We searched 11 electronic databases and major conference abstract databases, contacted trialist and advocacy groups, and searched the Internet. We selected RCTs stopped early for harm. We extracted data on journal and year of publication, reporting of methods and funding, planned sample size, number and planning of interim analyses, stopping rules, and effect size of the harm outcomes. RESULTS: We found 10 RCTs stopped early for harm (median, n = 85; range, 7-1227). Most interventions (n = 9) were antiviral drugs; one trial studied vitamins to prevent vertical transmission of HIV. Five studies reported a priori defined adverse events, and only 1 trial reported planned stopping guidelines. The primary harm outcomes reported across trials included toxicity, death, and increased mother-to-child transmission. Two trials were stopped due to sudden unanticipated adverse events (Stevens-Johnson syndrome, death, and encephalopathy). Relative risk point estimates for harm ranged from 1 to 6.18. Six studies reported the presence of a data safety and monitoring board. CONCLUSION: The reporting of methods to inform the decision to stop trials for harm in this population is deficient in a variety of ways, including lack of stopping guidelines. Clinicians should interpret RCTs stopped early for harm with caution and interpret the results in light of related evidence. Trialists should improve the transparency of their decision-making regarding early stopping for harmful effects.

Anti-HIV Agents↗

PubMedDate not supplied

Nodular glomerulosclerosis in a non-diabetic patient: case report and review of literature.

We report a unusual case of idiopathic nodular glomerulosclerosis mimicking changes that develop in diabetic nephropathy. A 66-year-old non-diabetic female developed nephrotic range proteinuria and the work up was unremarkable. Light and electron microscopy showed mesangial expansion with Kimmelsteil-Wilson nodules and diffuse glomerular basement membrane thickening without any electron dense deposits. Diabetes mellitus was excluded by repeated clinical and laboratory investigations. Forty two similar cases have been reported. Exact etiology for the development of non-diabetic glomerulosclerosis is unclear. But, hypertension, smoking, obesity, intermittent hyperglycemia predating the diagnosis of diabetes possibly explain the development of nodular glomerulosclerosis in these patients. Long-term follow-up to screen for the delayed onset of diabetes or its complications may be worthwhile.

Aged↗

PubMedDate not supplied

Possible cocaine-induced acute renal failure without rhabdomyolysis.

Cocaine-induced acute renal failure has been reported in association with rhabdomyolysis. We describe a case of a young African American male who developed acute renal failure, which possibly occurred after inhalation of cocaine without concomitant rhabdomyolysis. His renal function recovered with supportive hydration. The most likely mechanism was intense vasoconstriction. Clinicians need to be mindful of this unique feature of cocaine intoxication.

Acute Kidney Injury↗