Dr. Charuhas V. Thakar hits the target squarely in his June 2022 article, Essential versus Necessary: The Ongoing Story of Physician Burnout (1): “This paradigm of care delivery is simply not sustainable.”
His critique of the current relative value unit (RVU) treadmill that is the “traditional business plan” is couched in terms of physician burnout. Let me change the perspective: It amounts to patient abandonment. Despite billions of federal and insurer dollars poured into kidney care, more than 134,000 Americans entered end stage kidney disease (ESKD) in 2019. Is that success? Is that good return on investment?
Recognizing the ongoing challenges affecting health care workers nationwide, leading to burnout and moral distress, the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience has devised the National Plan for health workforce well-being.
“It is critical for us to have a coordinated plan at the national level to help shift US health care from the current reality of a workforce shortage and burnout crisis to a future where every health worker is able to experience joy in their workplace and knows that they are valued,” said NAM President Victor Dzau, MD, in a prepared statement. The
Thrombotic microangiopathy (TMA) is a clinicopathological entity characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ injury, occurring due to endothelial damage and microthrombi formation in small vessels (1, 2). It can affect up to 15% of transplanted patients and is associated with significant morbidity and mortality (3).
TMA is primary when a genetic or acquired defect is identified (as in atypical hemolytic uremic syndrome [aHUS] and thrombotic thrombocytopenic purpura) or secondary when occurring in the context of another disease process, such as infection, autoimmune disease, malignancy, or drugs (4) (Table 1
Infection remains a major cause of morbidity and mortality in dialysis and kidney transplantation. Despite dramatic improvements over the last 3 decades, peritoneal dialysis (PD)-associated peritonitis remains a common complication, occurring at an incidence of approximately 0.25 episodes per patient-year, and is the leading cause of technique failure with catheter removal, the eventual outcome in approximately 20% of infectious episodes (1). The causative agents of peritonitis are generally skin organisms introduced into the system by “touch contamination” or enteric organisms entering the glucose-rich dialysate via translocation.
Early diagnosis and prompt administration of antibiotics improve the clinical outcome and
The ASN Task Force on the Future of Nephrology was established in April 2022 to evaluate the specialty and develop a recommendation to ensure nephrologists are best prepared to provide care to people with kidney diseases. The ASN task force (see box) has been meeting weekly to discuss core and evolving elements of nephrology that must be considered in future training requirements. Additionally, the task force has hosted a series of listening sessions with various constituencies or partner organizations to understand the changing needs of the community as well as the evolution of medical education.
The House Appropriations Committee on Labor, Health and Human Services, Education, and Related Agencies released its draft funding bill for fiscal year (FY) 2023 on June 22. The report language in the bill bolsters the nation's public health infrastructure and strengthens biomedical research and innovation. The bill allocates funding for and directions to agencies and programs on policy priorities for which ASN and the broader kidney health community have advocated. Key policies are highlighted here.
Centers for Disease Control and Prevention (CDC)
The committee includes a total of $10.5 billion for the CDC, which is $2 billion more than the
A dual immune/solid organ transplant procedure has been successfully used to perform kidney transplantation without the need for long-term immunosuppressive therapy in three children with a rare genetic disorder, according to a brief report in The New England Journal of Medicine (1). The study was led by Alice Bertaina, MD, PhD, of the Division of Stem Cell Transplantation and Regenerative Medicine and associate professor of pediatrics at Stanford University.
The patients were three children (two siblings) with Schimke immuno-osseous dysplasia (SIOD), an autosomal recessive disease associated with short stature due to bone dysplasia, glucocorticoid-resistant nephrotic syndrome,
Belatacept is a soluble recombinant fusion protein composed of the constant fragment of human immunoglobulin G1 and modified extracellular domain of cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). It inhibits T-lymphocyte activation by blocking costimulation, the requisite signal that T-lymphocytes must receive through interactions between proteins expressed on antigen-presenting cells and T-lymphocytes in addition to signal from engagement of the antigen receptor (Figure 1).
Belatacept mechanism of action
In 2011, the US Food and Drug Administration (FDA) approved belatacept for prophylaxis against acute rejection in de novo adult kidney transplant recipients based on randomized trials that showed better
Optimal management of immunosuppression in patients returning to dialysis after kidney transplant failure is an area of active investigation. It is common practice to start weaning immunosuppression over the first year after graft failure. To date, most literature on the effects of immunosuppression on those with transplant failure comes from single-center studies and expert opinion based on these studies. Maintaining immunosuppression after transplant failure is driven by the desire to reduce sensitization and prevent acute rejection of the failed transplant while preserving residual kidney function (1–3). However, this has to be balanced by the higher risk
For dialysis patients with nonvalvular atrial fibrillation (AF), anti-coagulation with apixaban—at both standard and below-label doses—lowers the risk of bleeding events compared with warfarin, concludes a study in the American Journal of Kidney Diseases.
Using US Renal Data System data from 2013 to 2018, the researchers identified 17,156 Medicare beneficiaries with nonvalvular AF receiving maintenance hemodialysis. All patients (12,517) had a new prescription for warfarin, and 2382 patients had apixaban at a label-concordant dose of 5 mg twice daily, or 2257 patients had apixaban at a lower dose of 2.5 mg twice daily. Outcomes, including stroke or systemic