Researcher Spotlight: Featuring Yoshio Hall
What started as an observation about chronic kidney disease (CKD) in medically underserved populations during residency has turned into the focus of the research of Dr. Yoshio Hall, an Associate Professor in the University of Washington’s Division of Nephrology and Core Investigator in the Kidney Research Institute. As a result of his work, public health systems are now getting closer to being able to identify and target high-risk CKD patients for interventions to prevent progression to end stage renal disease (ESRD).
CKD affects approximately 26 million Americans, according to Dr. Hall, with recent studies showing annual treatment costs at more than $50 billion. Of those afflicted, individuals from socially disadvantaged populations carry the disproportionate burden of ESRD, yet very little progress has been made among these groups in the last several decades.
“Most epidemiologic studies indicate that traditionally underserved populations don’t have a higher prevalence of chronic kidney disease,” said Dr. Hall. “These studies suggest that underserved patients progress through the disease stages more quickly than counterparts from traditionally less disadvantaged groups.”
His desire to arrest this accelerated progression of CKD to ESRD in traditionally underserved groups became the focus of his research while based at San Francisco General Hospital during his nephrology fellowship and early faculty years at the University of California, San Francisco (UCSF), and continued upon moving to the UW.
Dr. Hall’s recent research has focused on creating comprehensive clinical databases to better understand the structure, process, and outcome of CKD among patients receiving public healthcare. The goal of these data is to help him and others to identify patients at high risk for progressing to ESRD and to potentially modify risk factors influencing their CKD progression.
“This work is ultimately about system-level estimation and developing a better understanding of the burden and mediators of CKD in the healthcare safety net in order to improve the effectiveness of care to underserved groups,” shared Dr. Hall.
To develop his database, Dr. Hall turned to software engineers from the biomedical informatics team at the Institute of Translational Health Sciences for support acquiring data. ITHS coded queries into the UW Medicine Clinical Data Repository to extract a specific set of patient lab results, demographics, diagnoses, ambulatory measures, and clinic visit details. Dr. Hall was able to then use that data to identify approximately 12,000 underserved patients with moderate to severe CKD who frequented Harborview Medical Center and its ambulatory clinics over a 10-year period.
Dr. Hall and his research team, including former colleagues at UCSF, connected the identified data to records in national registries to determine which patients had progressed to ESRD and death. The end result was that Dr. Hall and his team developed and validated several risk estimation models that accurately predicted most cases of ESRD within five years. They were also able to characterize visit frequency, acute care utilization, and management of key risk factors that mediate CKD progression, such as blood pressure, diabetes control, and prescriptions for non-steroidal anti-inflammatory agents.
Dr. Hall believes this research will eventually be translatable into scalable strategies that will help to guide public health systems to improve the effectiveness of CKD-related care delivery for disadvantaged populations.
“I didn’t have the expertise to understand the raw data structure or acquire the actual data, which were obviously necessary to make the next step to more ambitious projects and grants,” concluded Dr. Hall. “This is where ITHS really helped me.”