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
Barry I. Freedman, Lijun Ma, and Marva M. Moxey-Mims
Discovery of the genetic association between apolipoprotein L1 (APOL1) gene kidney-risk variants and chronic kidney disease in individuals with recent African ancestry dramatically altered the landscape in nephrology (1). This observation accounted for much of the threefold higher incidence rate of end stage kidney disease (ESKD) in African Americans (AAs) compared with other populations. APOL1 genotypes also underlie a portion of the disparity in outcomes after deceased donor kidney transplantation (DDKT). Kidneys transplanted from deceased donors with African ancestry fail more rapidly than those from non-African ancestry donors (2). A
The US health care workforce is facing a shortage impacting those seeking kidney care. In 2019, the Association of American Medical Colleges projected that demand for physicians will continue to outpace supply, and the United States will see a shortage of up to 122,000 physicians by 2032 (1). Although this threat facing the US health care workforce has been exacerbated by the COVID-19 pandemic, the kidney care workforce is already facing shortage challenges. Just one practicing nephrologist is available for every 3427 people living with kidney diseases in the United States. As a talented and diverse kidney care
In patients with advanced chronic kidney disease (CKD), the decision to pursue invasive strategies for treatment of coronary artery disease involves careful consideration. Data from the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA)-CKD trial may better inform these decisions. The National Heart, Lung, and Blood Institute (NHLBI)-funded ISCHEMIA-CKD trial was a randomized clinical trial that included 777 patients from 30 countries, predominantly in the United States, Russia, Poland, India, and China. Inclusion criteria included aged ≥21 years, kidney failure on maintenance dialysis or estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2, and at
As the health care community looks to home hemodialysis to improve the quality of life and overall management of patients with kidney diseases, all work should start by centering patient experiences and realities. I was diagnosed with kidney failure at the age of 2 in 1968 and luckily fell into the care of pioneer pediatric nephrologist Richard Fine, MD, who saved my life more than once with his innovative spirit. I was the first child to experience peritoneal dialysis in California, and I successfully managed my own home dialysis for 10 years. I have since founded the Renal Support Network
Although allogeneic hematopoietic stem cell transplant (HSCT) is the curative treatment for many patients with hematologic conditions, these patients are at a higher risk of acute kidney injury (AKI) and chronic kidney disease (CKD) as a result of conditioning therapies, exposure to radiation therapy, and chronic treatment with calcineurin inhibitors (Figure 1). CKD and albuminuria increase the risk of hypertension and end stage kidney disease, which ultimately impact mortality (1, 2). Many studies have evaluated the incidence of CKD post-HSCT, and the incidence of CKD ranges from 4% to 66% (3–9
The short period of 2020 to 2022 has felt like its own era in the field of kidney transplantation, with significant advances in the field on various fronts. The next two editions of Kidney News will highlight some of these advances in kidney transplantation, which push the barriers of science and society. This first and current edition will focus on racial inequities in transplantation and measures to address them, the new kidney transplant allocation system, updates from the Apolipoprotein L1 (APOL1) Long-term Kidney Transplantation Outcomes (APOLLO) study, and groundbreaking advances in xenotransplantation and finally,
The kidney allocation policy within the United States was initially established in 1987 to promote the equitable and utilitarian distribution of deceased donor kidneys (1). The policy, managed by the United Network for Organ Sharing (UNOS)/Organ Procurement and Transplantation Network (OPTN), was extensively revised in 2014 to increase the utilization of available kidneys, reduce regional variability in access to transplantation, and improve posttransplant outcomes. Major changes at the time included the introduction of the Kidney Donor Profile Index (KDPI) and Estimated Post Transplant Survival (EPTS) scores as estimates of kidney quality and projected recipient survival, respectively, and also
Oxalate or oxalic acid is a dicarboxylic acid formed in the human body from exogenous dietary sources and endogenous metabolism of ascorbic acid and some amino acids. It is essentially a terminal metabolic product that is produced by the liver, absorbed by the intestine from dietary sources, and freely filtered by the kidneys (Figure 1) (1). There is no human enzyme that can degrade it further.
Regional disparity in deceased donor kidney transplant rates
Hepatic metabolism and dietary oxalate absorption generate plasma oxalate, which is then primarily excreted by kidneys into urine.
During the past few months, I have participated in several meetings that included in-depth discussions about the future of the health care workforce in the United States. Each time, the discussion started with predictions about shortages of every kind of health professional—from physicians to nurses to physician assistants/associates to other clinicians—and then shifted to concerns about the ability to provide high-quality patient care in the future as a result.
Although this editorial will focus on the future of nephrologists in the United States, I recognize that the situation is dire throughout the world, particularly for nurses. Earlier this year, the