Screening, education, care coordination and telehealth, and affordability are all important for improving equitable care for patients with chronic kidney disease to slow the progression to kidney failure.
Built on innovation, nephrology is a specialty of many firsts: from developing organ replacement therapies to advocating successfully for government support of lifesaving dialysis to removing race from a commonly used clinical algorithm. If asked in 2019, I would have declared nephrology the epitome of visionary leadership: determined to solve the most complex medical and social justice issues globally and inspired by a passion for patients.
Today, I view things somewhat differently. During the past 2 years, our specialty has demonstrated some of the most effective crisis leadership in medicine. When this column publishes, we may be past the worst
Renal cell and non-renal cell carcinomas associated with von Hippel−Lindau (VHL) disease show evidence of response to the hypoxia-inducible factor inhibitor belzutifan, reports a study in The New England Journal of Medicine.
The phase 2, open-label trial included 61 adults with VHL disease, with diagnosis based on the presence of germ- line VHL alterations and at least one renal cell carcinoma measuring at least 10 mm. All patients were treated with belzutifan, a novel oral hypoxia-inducible factor 2α (HIF-2α) inhibitor, at a dose of 120 mg/day. Complete or partial objective responses were assessed by an independent radiology review
A third dose of the COVID-19 vaccine achieves protective antibody levels in nearly 40% of kidney transplant recipients without a previous immune response, reports a study in JAMA Internal Medicine (1).
The single-center, single-blind randomized trial included 201 kidney transplant recipients who did not develop SARS-CoV-2 spike protein antibodies after two doses of the mRNA vaccine. Patients were assigned to either a heterologous vaccination strategy using an Ad26COVS1 viral vector vaccine or a homologous strategy with a third dose of an mRNA vaccine, either BNT162b2 or mRNA-1273. The main endpoint was seroconversion to detectable levels of SARS-CoV-2 spike
This article has been updated to include the following Correction:
The February Kidney News article “A Call to Action for Physicians: Become Informed and Empowered, and Begin to Heal Thyself” includes the statement, “The RUC [American Medical Association (AMA) Relative Value Update Committee] is a group of 32 physicians and other health care professionals who advise CMS [Centers for Medicare & Medicaid Services] on how to value various medical services. The advice of the RUC is nearly always accepted by CMS, yet nephrology is not currently represented on the committee.”
The nephrology community was abuzz at ASN Kidney Week 2021 as Rajiv Agarwal presented the results of the Chlorthalidone in Chronic Kidney Disease (CLICK) trial, with simultaneous publication in The New England Journal of Medicine(1).
In an attempt to refute the dogma that thiazide-like diuretics lose effectiveness at low estimated glomerular filtration rate (eGFR) (2), the CLICK trial enrolled 160 patients with stage 4 chronic kidney disease (CKD; eGFR 15 to >30 mL/min/1.73 m2) and uncontrolled hypertension—defined as a mean
For patients with advanced chronic kidney disease (CKD), early dialysis initiation—at an estimated glomerular filtration rate (eGFR) of 15–16 mL/min/1.73 m2—leads to modest reductions in mortality and cardiovascular events, reports a study in The BMJ(1).
“However, to reach the maximum survival benefit, patients would need to start dialysis up to 4 years earlier,” comments lead author Edouard Fu, PhD, a research fellow at the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
The conclusions are consistent with the sole previous randomized trial of dialysis initiation times—and support
Hippocrates. Engraving based on drawing by Peter Paul Rubens. National Library of Medicine, Bethesda, MD (CC by 4.0).
Portrait of Richard Bright from Thomas Joseph Pettigrew, Medical Portrait Gallery, vol. 2 (1838).
Nephrology is a relatively young specialty. It emerged in the second half of the 20th century, with the rise of kidney biopsy, dialysis, and transplantation. Although kidneys have been studied since antiquity, stones and obstruction were a dominant focus. Urology books from 1739 mention the only treatment of anuria as bladder catheterization (1). So, how did the study of glomerular diseases rise as a cornerstone of
As a specialty, nephrology is heavily dependent on international medical graduates (IMGs). According to the Association of American Medical Colleges (AAMC) (1), 65% of nephrology fellows in 2019 were IMGs, the highest of any major internal medicine specialty. This has now led to more than one-half of the active workforce being graduates of international medical schools (51%). Although the exact numbers of IMGs on a visa and the proportion of J-1s and H1-Bs are unknown, it is well recognized by local and national leaders that providing viable and satisfying solutions for entry into the workforce for a nephrology
Methotrexate (MTX) has been used for treatment of connective tissue disorders, including rheumatoid arthritis. In much higher doses, MTX is used for various hematologic and oncologic disorders (1). Renal elimination accounts for 70%−90% of the clearance of MTX (2). High-dose intravenous MTX has the potential for causing kidney injury by crystal precipitation within the renal tubules (3, 4). In addition, oral MTX can potentially accumulate in patients with reduced kidney function and lead to toxic effects, such as myelosuppression and hepatotoxicity (5). However, although MTX is contraindicated in patients with