Missing data constitute a problem present in all studies of medical research. The most common approach to handling missing data-complete case analysis-relies on assumptions about missing data that rarely hold in practice. The implications of this approach are biased and inefficient descriptions of relationships of interest. Here, various approaches for handling missing data in clinical studies are described. In particular, this work promotes the use of multiple imputation methods that rely on assumptions about missingness that are more flexible than those assumptions relied on by the most common method in use. Furthermore, multiple imputation methods are becoming increasingly more accessible in mainstream statistical software packages, making them both a sound and practical choice. The use of multiple imputation methods is illustrated with examples pertinent to kidney research, and concrete guidance on their use is provided.

This study examines COVID-19 infections among 4791 vaccinated and unvaccinated patients receiving dialysis and describes the longitudinal antibody-based response up to 5 to 6 months after full vacc... Visual SARS-CoV-2 Vaccine Response and Breakthrough Infection in Patients Receiving Dialysis. This study examines COVID-19 infections among 4791 vaccinated and unvaccinated patients receiv... Background: Whether breakthrough SARS-CoV-2 infections after vaccination are related to the level of postvaccine circulating antibody is unclear. Objective: To determine longitudinal antibody-based...

Significance Statement: High uptake of the SARS-COV-2 vaccine among patients on dialysis is critical to mitigating the devastating rates of COVID-19–related complications and deaths observed in the dialysis population. In a nationwide vaccine acceptability survey involving 150 dialysis facilities in the United States and broadly representative of this patient population, the authors found that, overall, one in five patients had vaccine hesitancy, as did one in four Black patients or patients aged 18–44 years. One in three responders identified dialysis staff as key sources of information about COVID-19 vaccines. Patients on hemodialysis who were vaccine hesitant were chiefly concerned about side effects. These findings highlight the opportunities available to dialysis networks in facilitating vaccine uptake among patients on dialysis and identify specific subgroups for which additional outreach is necessary. Background: Patients on dialysis are at increased risk for COVID-19–related complications. However, a substantial fraction of patients on dialysis belong to groups more likely to be hesitant about vaccination. Methods: With the goal of identifying strategies to increase COVID-19 vaccine uptake among patients on hemodialysis, we conducted a nationwide vaccine acceptability survey, partnering with a dialysis network to distribute an anonymized English and Spanish language online survey in 150 randomly selected facilities in the United States. We used logistic regression to evaluate characteristics of vaccine-hesitant persons. Results: A total of 1515 (14% of eligible) patients responded; 20% of all responders, 29% of patients aged 18–44 years, and 29% of Black responders reported being hesitant to seek the COVID-19 vaccine, even if the vaccine was considered safe for the general population. Odds of vaccine hesitancy were higher among patients aged 18–44 years versus those 45–64 years (odds ratio [OR], 1.5; 95% confidence interval [95% CI], 1.0 to 2.3), Black patients versus non-Hispanic White patients (OR, 1.9; 95% CI, 1.3 to 2.7), Native Americans or Pacific Islanders versus non-Hispanic White patients (OR, 2.0; 95% CI, 1.1 to 3.7), and women versus men (OR, 1.6; 95% CI, 1.2 to 2.0). About half (53%) of patients who were vaccine hesitant expressed concerns about side effects. Responders’ main information sources about COVID-19 vaccines were television news and dialysis staff (68% and 38%, respectively). Conclusions: A substantial proportion of patients receiving in-center hemodialysis in the United States are hesitant about seeking COVID-19 vaccination. Facilitating uptake requires outreach to younger patients, women, and Black, Native American, or Pacific Islander patients, and addressing concerns about side effects. Podcast: This article contains a podcast at https://www.asn-online.org/media/podcast/JASN/2021_07_07_JASN2021010104.mp3

Significance Statement: The adjustment for Black race in equations to estimate GFR is controversial. We found that the prevalence of CKD among US Black adults would double if race adjustment were removed. The change could affect up to 40% of Black adults using common medications for which dose adjustments are recommended on the basis of kidney function. Accuracy of a prognostic model for kidney failure remained high without race adjustment, and was improved at higher levels of predicted risk. This study suggests that estimating GFR without race adjustment could lead to sizable changes in clinical care and population health strategies for Black adults. Background: The implications of removing the adjustment for Black race in equations to eGFR on the prevalence of CKD and management strategies are incompletely understood. Methods: We estimated changes in CKD prevalence and the potential effect on therapeutic drug prescriptions and prediction of kidney failure if race adjustment were removed from the CKD-EPI GFR estimating equation. We used cross-sectional and longitudinal data from adults aged ≥18 years in the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2016, and the Veterans Affairs (VA) Health Care System in 2015. In the VA cohort, we assessed use of common medications that require dose adjustment on the basis of kidney function, and compared the prognostic accuracy of the Kidney Failure Risk Equation with versus without race adjustment of eGFR. Results: The prevalence of CKD among Black adults increased from 5.2% to 10.6% in NHANES, and from 12.4% to 21.6% in the VA cohort after eliminating race adjustment. Among Black veterans, 41.0% of gabapentin users, 33.5% of ciprofloxacin users, 24.0% of metformin users, 6.9% of atenolol users, 6.6% of rosuvastatin users, and 5.8% of tramadol users were reclassified to a lower eGFR for which dose adjustment or discontinuation is recommended. Without race adjustment of eGFR, discrimination of the Kidney Failure Risk Equation among Black adults remained high and calibration was marginally improved overall, with better calibration at higher levels of predicted risk. Conclusions: Removal of race adjustment from CKD-EPI eGFR would double the estimated prevalence of CKD among Black adults in the United States. Such a change is likely to affect a sizeable number of drug-dosing decisions. It may also improve the accuracy of kidney failure risk prediction among higher-risk Black adults.