In the United States, as in many other developed countries, the incidence of treated end stage renal disease (ESRD) increases with advancing age; the highest rates are observed in individuals between the ages of 75 and 79 (Figure 1) (1). There is concern, however, that the functional rehabilitation of elderly dialysis patients is often unsatisfactory and the gain in life expectancy with renal replacement therapy is rather modest. This should not be surprising, because elderly patients with ESRD have a significantly greater burden of coexisting illnesses and are more likely to be frail.
A new calendar year, like a blank page, brings the promise of things to come. ASN Kidney News asked the ASN Board of Advisors and attendees at Renal Week 2010 what things the nephrology community should watch in the coming year. We got answers.
Changes to healthcare administration, especially dialysis services, dominated the responses. The Affordable Healthcare Act, bundling of dialysis payments, and the resurrection of CROWNWeb all raise more questions than answers for our community.
The past year brought a prototype implantable kidney and the first bioengineering session at Renal Week. Technological advances clearly form another “thing
A blog, short for web log, is a user-generated web site. It may serve as a personal diary, an educational tool, a social outlet, or the web presence for a business. Blogs can be text and pictures, but may also include audio or video files. Blogs generally link to other websites such as source materials, and most include a mechanism for comments to generate online discussion. For an excellent example of useful blogs, see Renal Fellow Network (http://renalfellow.blogspot.com/).
What is a wiki?
A wiki is a group-edited document. One person may write an entry,
We would gladly take the bet if the chance of winning were 96 percent. We certainly would not change our minds if the odds dropped to 94 percent. However, many scientists make different decisions on the basis of the p values inherent in this example—whether p = 0.04 or p = 0.06.
Most scientists utilize Frequentists statistics to prevent abuse of data. Frequentists require that you specify your hypothesis, statistical test, and the criteria of success in advance. Often this criterion is a “significant” p value, especially in medical studies. While p ≤
Nephrologists do a lot to improve and prolong the lives of their patients, but we all wish we could do more. No magic fairy will grant our wishes. They will only be fulfilled through painstaking research.
In this section, Speth and Wood speak as scientist and patient about the importance of animal models in the development of therapies for chronic kidney disease. Animal research is still a key component of procedure and drug development that benefits people and animals. Barker, Story, and Wathen present their thoughts on statistical evaluations and the conflict between Frequentists versus Bayesian analyses. Take heed: there
As the new academic year begins, nephrology fellows beginning their adult nephrology training can look back at the application process with a unique perspective compared with previous years’ fellows. They are the first class to enter the fellowship through the National Resident Match Program. The match has been considered a success in the fellowship community (Kohan and Rosenberg, 2009).
As one applicant cycle has closed, however, fellowship directors begin thinking about the recruitment process for future years. Given the projected shortage of nephrologists (Rosenberg, 2007), fellowship directors wonder if the pool of high-quality applicants will continue to grow. Pediatric nephrology
The work lives of most pediatric nephrologists differ significantly from those of our internal medicine colleagues in all aspects of the career pathway. Changing patient and trainee demographics and expectations have spurred a renewed interest in evaluation of our current training processes with an eye toward the future.
Pediatric nephrology patient volumes are increasing. Improved survival of children with a wide variety of congenital or acquired diseases that were routinely fatal in the past is contributing to a higher number of patients with CKD associated with other complex medical needs. At the other end of the spectrum, the nation’s obesity
The United States will face a shortage of nephrologists during the next decade. This shortfall will occur despite the fact that the number of nephrology fellows nearly doubled during the past 20 years, from 460 in 1987 to 863 in 2008 (1,2). The current disparities—by ethnicity, socioeconomic status, and geographical location—among patients with kidney disease will worsen as a result of this shortage.
At least three simultaneous trends are conspiring to fuel this crisis: Nephrology is not an appealing career option for the majority of U.S. medical school graduates (USMGs), the graduates of international medical schools
For years, international medical graduates (IMGs) have comprised a significant percentage of the fellows in nephrology training programs who prepare to provide treatment to the rapidly growing population of patients suffering from kidney disease. In the 2006–2007 school year, physicians trained in foreign institutions constituted 47 percent of the fellowship class, an increase over the historic low of 38 percent in 2002–2003, and a return to the high percentages posted in the late 1990s. IMGS comprised 59 percent of all nephrology fellows in 1997–1998 (Table 1.).
While IMG interest is vital to the success of nephrology training programs
U.S. nephrology training program directors (TPDs) are increasingly joining forces to meet many of today’s current challenges. These efforts are spearheaded by the American Society of Nephrology’s (ASN) TPD executive committee. The committee consists of members elected by the TPD community to serve three-year terms, and is led by the ASN Education Director for Nephrology Fellowships.
TPDs and the TPD executive committee have been involved in several important issues of late, including participation in the national residency matching program and establishment of the in-training examination and geriatric nephrology curriculum.