Experimental strategies that reduce cell death or reverse epigenetic changes in kidney cells are being studied to help protect the kidneys in patients with diabetes.
Treatment options for diabetic kidney disease have grown in recent years with the availability of 2 new classes of drugs, the sodium-glucose cotransporter 2 inhibitors (SGLT2) and the glucagon-like peptide 1 agonists (GLP1), noted a recent review in Nature Reviews Nephrology. These agents help lower a patient’s blood sugar levels and are used alongside renin angiotensin system inhibitors (RAS) and other traditional diabetes management methods.
The final report from the American Board of Medical Specialties’ (ABMS) Continuing Board Certification: Vision for the Future Commission recommends shifting the focus of ongoing certification from high-stakes exams while still maintaining a role for ABMS’s 24 specialty boards in determining physicians’ certification status.
The final recommendations address one of the primary concerns ASN and other physicians’ organizations raised about basing a physician’s ability to continue practicing on a single high-stakes exam. Instead, it recommends ongoing formative assessments be combined with other data on a physician’s professional standing, continuing education, and practice improvement efforts in certification decisions. It also requires
Members of Congress and regulators are keenly focused on kidney healthcare and the policies around it. With more than 40 million people in the United States living with kidney diseases and 700,000 Americans with kidney failure, Medicare costs topped more than $114 billion in managing kidney diseases in 2016, which accounts for 23% of all Medicare spending. With such a growing burden both on patients and their families and on taxpayers, the pressure is on policymakers to realign the incentives and priorities to achieve better outcomes.
A new vision for kidney care
Department of Health and Human Services (HHS) Secretary
Dozens of volatile organic compounds (VOCs) are found at elevated concentrations in expired gas from critically ill patients with acute kidney injury (AKI), reports a study in Critical Care Medicine.
The study included 20 mechanically ventilated patients with AKI, along with a control group of critically ill patients without AKI. The mechanically ventilated patients also had indications for dialysis.
Intensities of VOCs in breath samples were measured using multicapillary column ion-mobility spectrometry. Each patient’s “exhalome” was evaluated from 30 minutes before they started continuous venovenous hemodialysis through 7 hours after the start of dialysis.
Terry Litchfield, MPH, draws on five decades of experience when she argues for a more patient-centered approach to developing new vascular access options. Her experience stretches back to when her late husband Gerald started dialysis in 1968, and it continues in her current role as a consultant on patient-centered vascular access and as a Kidney Health Initiative (KHI) Patient and Family Partnership Council member.
“It was newsworthy in 1968 when someone started dialysis,” Litchfield said. “I’m very pleased to say dialysis sustained his life for a long time. We lived overseas; have machine, will travel.”
New studies point to the importance of diet for kidney health in the general population as well as for the longevity of patients on dialysis. The studies, which are both published in the Clinical Journal of the American Society of Nephrology (CJASN), suggest that more research is needed to fine-tune certain dietary recommendations.
The first study, by Casey Rebholz, PhD, MPH, of the Johns Hopkins Bloomberg School of Public Health, and her colleagues, was conducted to clarify the effects of certain beverages on kidney health.
“There is a lack of comprehensive information on the health implications
A hallmark of medical care is the unwavering dedication of physicians and other health professionals to commit to lifelong learning. How physicians in the United States fulfill and document that commitment, however, has created growing concern among many clinicians.
A reflection of that concern is the decision by the American Board of Medical Specialties (ABMS) in December 2017 to establish a Vision Commission to “bring together multiple partners to vision a system of continuing board certification that is meaningful, relevant, and of value, while remaining responsive to patients, hospitals, and others who expect that physician specialists are maintaining their knowledge
Measures of the burden of chronic kidney disease (CKD) have risen dramatically in the 21st century—including more than 50% increases in rates of premature death and disability-adjusted life-years due to CKD. Those are among the alarming findings of a new analysis of changes in the health impact of CKD, published in late 2018 in JAMA Network Open (1).
The rising burden of CKD has occurred at a time when the United States has seen declining health burdens overall and from noncommunicable diseases in particular, according to the analysis of national and state-level data.
The mix of bacteria in the gut may predispose some kidney transplant patients to urinary tract infections, according to a study presented at Kidney Week 2018.
About one in five patients experience a urinary tract infection after kidney transplantation, said John Lee, MD, MS, a transplant nephrologist at New York Presbyterian Hospital—Weill Cornell Medical Center. These infections can usually be successfully treated with antibiotics, but in rare circumstances they can have serious consequences like graft loss and death, he noted. Finding ways to prevent such infections could help improve outcomes.
To examine how gut bacteria may contribute to the risk
The merger between pharmacy giant CVS and health insurer Aetna is among the latest shake-ups in the healthcare industry that are likely to have ripple effects on nephrologists and patients with kidney diseases. The merger was finalized on November 28, 2018.
For nephrologist Bruce Culleton, MD, vice president of CVS Health, the CVS-Aetna merger offers the prospect of a new care delivery model that better meets patients’ needs.
“We believe this type of consolidation encourages the development of business models that are more patient-centric and more holistic than the current paradigm, which is focused on in-center dialysis care,” Culleton said.