Prediabetes after kidney transplantation is associated with an increased risk of cardiovascular events, similar to that seen with posttransplant diabetes mellitus (PTDM), reports a study in Kidney International.
The researchers present long-term follow-up data on 603 kidney transplant recipients, enrolled in a multicenter study of the clinical evolution of prediabetes and PTDM. Patients underwent serial oral glucose tolerance tests for up to 5 years; median follow-up was 8.38 years. The presence of prediabetes and PTDM was determined at 12 months after transplantation, due to the reversibility of these conditions at earlier times. The association of prediabetes with later
All across medicine, there is strong evidence that people who understand and are engaged in their own healthcare have better outcomes. There are several reasons for this, including being able to make quality healthcare choices, knowing when to seek help, and knowing how to reduce the risk for the development of complications (1). The body of literature in this area is large; diabetes mellitus care is a strong example. Indeed, it is not possible to deliver successful diabetes care without high levels of patient engagement, and there has been considerable interest and investment in patient training to improve
In 2020, the Advancing American Kidney Health (AAKH) executive order brought national attention to improving our care of chronic kidney disease. However, many of its components will not occur solely through national efforts. We need to keep watch on state initiatives, since healthcare and insurance are regulated at that level.
For example, in 2019 Oklahoma passed the living organ donor insurance coverage act. This law, effective November 1, 2019, prohibits insurers from refusing coverage for life, disability, or long-term care insurance to an individual solely because they have been a living organ donor. It also prohibits charging more for coverage
Decreased exercise capacity and cardiovascular risk are integral features of chronic kidney disease (CKD), with a debilitating impact on quality of life and survival.
Exercise capacity (VO2peak) is an objective assessment of physical functioning, which is the ability to perform physical activity. Physical activity (including exercise) is defined as any bodily movement produced by skeletal muscles resulting in energy expenditure (1). Both reduced physical functioning and physical activity are associated with an increased risk of adverse clinical outcomes in both non-dialysis–dependent (2) and dialysis-dependent people with CKD (3, 4).
Nephrology has constantly fought against, and sometimes succumbed to, a narrative of decline and stagnation. There is a complaint that new therapies are not being developed or approved, there has been a paucity of successful clinical trials, and in-center dialysis remains the standard of care for kidney failure. It is time to put this negative narrative to rest. Over the past year, I have had the privilege of leading the Kidney Health Initiative (KHI) and from that vantage point have seen firsthand that today is a new day for innovation in kidney diseases.
Research in nephrology has been on the rise over the past 5 years and data show that the future is bright for both innovators and people living with kidney diseases. This glimmer of hope was displayed throughout Kidney Week, during which both people living with kidney diseases and kidney health professionals came together to learn and discuss the current and future state of clinical research.
During a session titled Clinical Research in Nephrology: Trials, Trends and Tools, Uptal Patel, Senior Director at Gilead Sciences and nephrologist by training, reviewed a dataset of clinical trials by subspecialty between 1966 and 2002
Azathioprine (AZA) could provide comparable protection against transplant rejection to mycophenolate mofetil (MMF) for kidney transplant patients taking a lower dose of a new more powerful formulation of cyclosporine while substantially reducing costs, according to another trial presented during the High Impact Clinical Trials session.
Paolo Cravedi, MD, PhD, assistant professor of nephrology at the Icahn School of Medicine at Mount Sinai Hospital in New York City, explained that in the mid-1990s two trials suggested that MMF provided a significant reduction in acute rejection compared to AZA when used with older formulations of cyclosporine. As a result, MMF, which costs
Small dialysis chains and independent dialysis facilities continue to disappear, increasing the risk of monopolies, particularly in small markets, according to an abstract presented at Kidney Week 2019.
The dialysis industry has become increasingly consolidated over the past 15 years, with 2 major dialysis chains now controlling 85% of the market, said the abstract’s lead author, Caroline Sloan, MD, a general internist and chief resident at Duke University. About 300 small dialysis chains and independent facilities disappeared between 2006 and 2016 either through closure or acquisition by larger firms, according to the analysis. The number of such small or independent
Seamlessly carrying on the energy of change and transformation in the kidney sphere captured during plenary sessions at Kidney Week 2019, two sessions brought the potential for such transformation to life: Disruptors on the Move and Organs-on-Chips: Human Kidney Microphysiological Systems.
The panel of innovators and experts in healthcare innovation for the Disruptors on the Move session included current PCORI Interim Executive Director and CJASN Editor-in-Chief Josephine P. Briggs, MD, former Department of Health and Human Services CTO and current Kaiser Permanente VP of Medicaid Transformation Bryan Sivak, CVS Kidney Care CMO Bruce Culleton, MD, Cricket Health CMO
Very few patients who begin urgent in-center hemodialysis transition to home dialysis early, and the survival of those who do varies by modality, according to research presented at Kidney Week 2019.
Many patients who begin urgent, unplanned hemodialysis in a center may prefer to switch to home dialysis. To learn more about the patients who do make this switch and how it affects their survival, Sonny Nguyen, MD, a resident physician at Harbor University of California–Los Angeles (UCLA) Medical Center, and his colleagues analyzed data from the US Renal Data System on 190,642 patients who started urgent, in-center hemodialysis with