title: A varying patient safety profile between black and nonblack adults with decreased estimated GFR.
abstract: BACKGROUND
  Chronic kidney disease is a high-risk condition for a variety of adverse safety events, yet little is known about differential rates of safety events across racial groups with decreased kidney function. We sought to examine the incidence of an array of disease-specific adverse safety events in black versus nonblack patients with decreased estimated glomerular filtration rate (eGFR).
  
  
  METHODS
  Retrospective observational study of a national US Veterans Affairs cohort.
  
  
  METHODS
  Veterans with eGFR <60 mL/min/1.73 m(2) and one or more hospitalization during federal fiscal year 2005 (n = 70,154).
  
  
  METHODS
  Self-reported race/ethnicity dichotomized as black or nonblack.
  
  
  RESULTS
  Hospital discharge coding for Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs), laboratory records for detection of hyperkalemia and hypoglycemia, and pharmacy records to determine dosing of 4 selected medications.
  
  
  METHODS
  Relationship between race and disease-specific patient safety events.
  
  
  RESULTS
  Black veterans were more likely than nonblack veterans to experience one type of safety event (33% vs 32%, respectively) and multiple types of safety events (32% vs 23%, respectively; both P < 0.001). After adjustment, black veterans were 11% and 36% more likely to have at least one episode of hyperkalemia and hypoglycemia, respectively, than nonblack veterans, but were 14% less likely to experience a medication error (all P < 0.001). There was no association between the occurrence of AHRQ PSIs and race after adjustment.
  
  
  CONCLUSIONS
  Use of administrative data has a risk of imprecision in coding; Veterans Affairs cohort may limit generalizability.
  
  
  CONCLUSIONS
  Black veterans with decreased eGFR are more likely to experience a broad array of safety events than nonblacks with decreased eGFR, with a preponderance of metabolic disturbances rather than medication errors or AHRQ PSIs. The differential safety phenotype in blacks versus nonblacks may have implications for preventive strategies to improve patient safety in an integrated health care system.
authors.affiliation: Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD, USA. cdiamantidis@medicine.umaryland.edu
authors.forename: Clarissa J
authors.initials: CJ
authors.lastname: Diamantidis
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Seliger
authors.forename: Min
authors.initials: M
authors.lastname: Zhan
authors.forename: Loreen
authors.initials: L
authors.lastname: Walker
authors.forename: Gail B
authors.initials: GB
authors.lastname: Rattinger
authors.forename: Van Doren
authors.initials: VD
authors.lastname: Hsu
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Fink
mesh_terms: D001741:Black or African American; D000368:Aged; D015897:Comorbidity; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data; D061214:Patient Safety; D011785:Quality Assurance, Health Care; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy / Q000208:ethnology* / Q000503:physiopathology; D012189:Retrospective Studies; D014481:United States; D014728:Veterans