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Kidney News sat down with Steven G. Achinger, MD, Managing Partner & Chairman of the Board at Watson Clinic LLP in Lakeland, FL, to speak about his recent move into management after 11 years of clinical nephrology practice, including how he made the decision and any advice he has for those considering a similar move.

Watson Clinic was founded in 1941 and is a 100% physician-owned and physician-governed clinic with 169 equal partners. It has 17 locations in Polk, Hillsborough, and Pasco counties that encompass more than 40 medical and surgical specialties.

In 2018, the clinic logged 1,054,031 outpatient

Kidney News interviewed Christian Schafmeister, PhD, Department of Chemistry, College of Science and Technology, Temple University, about his KidneyX Prize, “Atomically Precise Membranes for High-Flux and Selective Removal of Blood Toxins” during hemodialysis. Schafmeister presented the work for the Phase I Redesign Dialysis Prize at the inaugural KidneyX Summit in Washington, DC, on April 29, 2019.

You learned about the KidneyX Prize through a nontraditional route. Please describe it.

I was looking for applications where small, atomically precise membranes—a few hundred square centimeters—with very high selectivity and flux could be valuable. I was talking with a group developing a

Kidney News interviewed Jeff Ross, PhD, CEO of Miromatrix Medical, about the company’s work to bioengineer new kidney grafts consisting of human cells grown in pig extracellular matrix scaffolds. Ross presented the work, “Building New Kidneys,” at the inaugural KidneyX Summit in Washington, DC, on April 29, 2019.

KN: Why build new kidneys, and why now?

Dr. Ross The numbers are truly eye-opening—more than 700,000 Americans are living with kidney failure that requires dialysis or transplantation. Unfortunately, less than half of the patients who start dialysis will survive five years, while those fortunate to receive a kidney transplant

Steven Fishbane

I recently gave a lecture in Chicago on anemia in chronic kidney disease. Afterward, an audience member told me he usually does not go to lectures on anemia any more, presumably because the subject can sometimes seem a bit “played out.” In a sense I understand the sentiment, but I realized that this article might be an opportunity to rekindle interest in a subject that remains vitally important.

I believe that some gloss has been lost for several reasons: 1) Multiple dishearteningly negative studies have demonstrated the dangers of overtreating with erythropoietin analogues (EPO) (1). 2) Nurse-operated EPO

Ahmed A. Awan, Wolfgang C. Winkelmayer, and Bhamidapati V. Murthy

Posttransplantation anemia (PTA) is an oft-neglected aspect of posttransplantation care that is associated with adverse outcomes for the kidney allograft and the recipient. The prevalence of anemia in kidney transplant recipients (KTRs) is very high, ranging from 25% to 40% depending on the definitions used, parameters measured, and average time since transplantation across study populations (13). The American Society of Transplantation (AST) and the World Health Organization have defined anemia as hemoglobin <13 g/dL in men or <12 g/dL in women. On the basis of these definitions, at the time of kidney

Daniel W. Coyne

In 2018, expert opinion that our present strategies for the use of intravenous (IV) iron were harming chronic kidney disease (CKD) patients took a severe thrashing. Despite clear evidence that iron is essential for treating the anemia of CKD, generous IV iron use has been discouraged by guidelines and by many experts. Despite this advice, physicians in the United States have given more IV iron to dialysis patients than those in other regions of the world. The results from the Proactive IV Iron Therapy in Haemodialysis Patients (PIVOTAL) trial, paired with the results from IV iron trials that include nondialysis

Rebecca J. Schmidt

The introduction of erythropoietin-stimulating agents (ESAs) in the late 1980s revolutionized the treatment of anemia for patients with chronic kidney disease (CKD), with the ensuing parade of clinical trials serving as the scientific basis for current management principles. Unlike other fields, CKD-related anemia management has been challenged by a windstorm of regulatory events and payment policies affecting the particulars of managing this important complication of CKD. The principles of management today reflect this regulatory influence on scientific discovery and collective clinical experience.

Current guidance

A comprehensive evidence-based guideline for managing CKD-related anemia, the Kidney Disease: Improving Global Outcomes (KDIGO) guideline,

Jay Wish

Hypoxia-inducible factor prolyl-hydroxylase inhibitors (commonly known as HIF stabilizers or PHIs) belong to a new class of orally administered drugs to treat anemia in patients with CKD.

Hypoxia-inducible factor (HIF) is present in nearly all tissues and constitutes the body’s natural mechanism to adapt to hypoxic conditions. HIF is a heterodimer consisting of an alpha and beta subunit. The alpha subunit is rapidly degraded by a proline hydroxylase (PH) enzyme in the presence of oxygen, thereby preventing the heterodimerization with the beta subunit and its transcriptional effects on over 4000 genes, depending on the tissue.

Activation of these genes leads

Exposure to high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) shows a modest but significant association with kidney disease in a military population, reports a study in the open-access journal JAMA Network Open.

The retrospective analysis included data on more than 764,000 US Army soldiers on active duty from 2011 through 2014. Eighty-six percent of participants were men; median age was 27 years. Dispensing and dose of prescription NSAIDs were evaluated for association with incident diagnoses of acute kidney injury (AKI) and chronic kidney disease (CKD).

The participants received a total of 1.6 million distinct NSAID prescriptions during the

Robert Provenzano

The editors hope that this issue of ASN Kidney News focusing on anemia and its management will allow readers to review lessons learned from our use of rEPO and to take pause as we thoughtfully embark on anemia treatment strategies utilizing newer agents that may soon be available.

CKD affects over 10% of the US population, with anemia being present as this disorder progresses, ultimately terminating in ESKD, preemptive kidney transplantation, or conservative management. Even with these clinical endpoints, anemia often remains a critical comorbidity. With increased focus on value-based payment and most important, patient-centered care, the management