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Nephrology faces challenges. Clinically, other internal medicine specialties increasingly are managing diseases traditionally considered in the domain of the nephrologist. Funding for kidney research is less per patient than every other major disease, such as cancer, cardiovascular disease, and diabetes. And the next generation is less interested in nephrology careers than any previous generation.
The American Society of Nephrology (ASN) is committed to working with every member of the kidney community—particularly the society’s more than 20,000 members—to overcome these challenges, assert the value of nephrology, and articulate a positive, bold vision for the specialty’s future. The question is no longer
Kidney transplantation is the renal replacement therapy (RRT) of choice for most patients with ESRD because it is associated with improved survival and improved quality of life, and it is less expensive than dialysis. The process leading to transplantation is complex, with multiple necessary steps that must be completed before transplantation. Despite improvement in outcomes, disparity across the board in the transplantation process continues to be a major problem.
Alexander and Sehgal (
Patients who’ve recovered from acute kidney injury (AKI) have a 3-fold higher risk of developing dementia than hospitalized patients who avoid AKI, according to a study presented at Kidney Week 2018.
Patients who experience AKI may face long-term health complications even if they completely recover. Previous studies have shown that experiencing AKI increases the risk of developing chronic kidney disease (CKD) and cardiovascular disease. But the long-term consequences of AKI for brain health weren’t clear.
“We used to think that almost all cases of AKI would have complete recovery, but now realize that many people have later development of CKD,”
It was a busy Wednesday afternoon in clinic in East Harlem, where the no-show rate can be as high as 50%, but this day it seemed like the show rate was more like 120%.
My patient panel for the day was diverse: from standard CKD management to managing the pitfalls of immunosuppression. Finally, my last patient of an exhausting day came in. One of my continuity patients with CKD stage 5, she came to partake in our monthly dance around the topic of dialysis access planning, which always starts well and ends with a fall.
“I know what that thing
Countries with high rates of missed hemodialysis (HD) treatments have elevated rates of death and other adverse outcomes, reports a study in
The researchers analyzed data on 8501 patients in 20 countries participating in the international Dialysis Outcomes and Practice Patterns Study (DOPPS). All patients had been on HD therapy for longer than 120 days. The 4-month missed treatment rate varied from less than 1% in Italy and Japan to 24% in the United States.
After exclusion of patients from six countries with 4-month missed treatment rates of less than 5%, longitudinal and
About 75% of patients on dialysis received a prescription for an opioid medication and nearly one-third of them also received prescriptions for benzodiazepines—prescribing patterns that were associated with a substantially increased risk of hospitalization for overdose, according to a study presented at Kidney Week.
More than half of patients on dialysis experience pain, according to a previous study (
On September 27 and 28, 2018, the Food and Drug Administration (FDA) convened and facilitated the workshop “Evidence Based Treatment Decisions: The Right Dose and Regimen—the Right Patient/Individualized Treatment.” The focus of the workshop was on the patient, specifically on utilizing biomarkers during the drug development process to determine the right treatment regimen to prevent long-term rejection of the patient’s transplanted organ. I participated in the meeting on behalf of the Kidney Health Initiative (KHI) as Vice-Chair of the Patient Family Partnership Council (PFPC).
The workshop was the byproduct of two factors. The first was the creation of the Transplant
In the “new future” of medicine, data from patients, such as genetics, integrative physiology, digital phenotyping, and the environment, will be collected and tracked, then made readily available to clinicians, according to Robert M. Califf, professor of cardiology at Duke University School of Medicine and founding director of the Duke Clinical Research Institute. By the time a patient enters an exam room, the clinician will already have a “total background” on the patient that can inform treatment with a data trove that goes beyond the patient’s self-description.
Dr. Califf, who describes himself as a data science politician, gave a state-of-the-art
Concerning national and regional patterns of prescribing opioids to patients with chronic kidney disease (CKD) were found in a pair of studies presented at Kidney Week.
A nationwide epidemic of opioid abuse and overdose has led to increased scrutiny of prescribing of this class of drugs. Patients with CKD are at increased risk of pain, and are more likely to be prescribed opioids than patients without kidney disease (7.5% vs. 5.4%), according to a study presented by Daniel Murphy, MD, Renal Diseases and Hypertension Fellow at the University of Minnesota.
Because opioids are cleared through the kidneys, their use among
Sertraline may be more effective than cognitive behavioral therapy (CBT) for treating depression in patients on dialysis, according to a study at Kidney Week 2018. Another study found elevated heart risks with selective serotonin reuptake inhibitors (SSRIs) with greater QT-prolonging effects.
Almost one-quarter of patients on dialysis have depression, but many don’t receive treatment, said Rajnish Mehrotra, MD, professor of medicine at the University of Washington in Seattle. One obstacle has been the dearth of data on depression treatment in patients on dialysis, who are typically excluded from clinical trials of antidepressants in the general population, noted Magdalene Assimon, PharmD,
