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Kim Zuber and Dale Gomez

Physician assistants (PAs) are licensed clinicians, trained in the medical model, who practice medicine in every specialty, setting, and state. They are dedicated to expanding access to care and transforming health through patient-centered, team-based medical practice, and as such, nephrology is a perfect home. In 1997, a cohort of nephrology PAs, under the auspices of the American Academy of Physician Associates, created a specialty organization—American Academy of Nephrology PAs (AANPA)—for all facets of nephrology PAs (e.g., office, dialysis, transplant, and intensive care unit). In 2020, of <148,000 PAs in the United States working in 70 medical and surgical subspecialties, only

Sara Krome

Physician assistants (PAs) have been colleague providers in health care since the late 1960s (1). PAs are trained at accredited PA programs across the country in the “medical” model of instruction, in contrast to nurse practitioners trained by the nursing instruction model (2). Most PA programs offer graduate-level education, with a degree such as Master of Health Science or Master of Physician Assistant Studies. A few programs remain that offer PA degrees or certificates at the baccalaureate level. Most graduate programs are 27 months (3). PAs are not required to and do not routinely

Summer Dyer and Linda Awdishu

Patients with chronic kidney disease (CKD) and end stage kidney disease have complex medication regimens and multiple comorbidities and can take in excess of 12 medications daily (1). High pill burden and multiple care providers place CKD and dialysis patients at risk for medication-related problems (MRPs). It has been shown that for every $1 spent on detecting and addressing MRPs in the dialysis population, $4 may be saved by the health care system (2). The Centers for Medicare & Medicaid Services (CMS) now requires monthly medication reconciliation in the End-Stage Renal Disease Quality Incentive Program (ESRD

Summer Dyer and Linda Awdishu

Patients with chronic kidney disease (CKD) and end stage kidney disease have complex medication regimens and multiple comorbidities and can take in excess of 12 medications daily (1). High pill burden and multiple care providers place CKD and dialysis patients at risk for medication-related problems (MRPs). It has been shown that for every $1 spent on detecting and addressing MRPs in the dialysis population, $4 may be saved by the health care system (2). The Centers for Medicare & Medicaid Services (CMS) now requires monthly medication reconciliation in the End-Stage Renal Disease Quality Incentive Program (ESRD

Christin Giordano McAuliffe

The number of patients requiring nephrology subspecialty care has grown tremendously. Unfortunately, while fellowship applicants have increased nearly 10% since 2019, nephrology has only had an increase of about 3% (1). This gap between workload and workforce has led to an increase in the use of non-physician practitioners (NPPs), the Centers for Medicare & Medicaid Services’ term that includes nurse practitioners (NPs) and physician assistants (PAs). Within our specialty, however, there has not been adequate discussion regarding proper utilization of NPPs.

While physicians understand their own personal background, they may not understand the wide range of experiences of

Christin Giordano McAuliffe

The number of patients requiring nephrology subspecialty care has grown tremendously. Unfortunately, while fellowship applicants have increased nearly 10% since 2019, nephrology has only had an increase of about 3% (1). This gap between workload and workforce has led to an increase in the use of non-physician practitioners (NPPs), the Centers for Medicare & Medicaid Services’ term that includes nurse practitioners (NPs) and physician assistants (PAs). Within our specialty, however, there has not been adequate discussion regarding proper utilization of NPPs.

While physicians understand their own personal background, they may not understand the wide range of experiences of

Yumeng Wen and Chirag R. Parikh

In the United States, approximately 40,000 new patients are added to the waitlist for kidney transplantation each year, yet in 2021, only 19,000 on the waitlist received deceased donor kidney transplants (1). Because of the burdens of dialysis and the kidney shortage, nearly 8000 waitlisted patients died or became too sick to receive a transplant in 2021 (1). From 2010 through 2020, 18%–21% of procured kidneys were not transplanted, and kidney discards are on the rise (2). In 2021 alone, a total of 5080 kidneys were procured and then discarded. A minority of donor

Frank Hullekes, Rucháma Verhoeff, Paolo Cravedi, and Leonardo V. Riella

Focal segmental glomerulosclerosis (FSGS) recurrence post-transplantation represents one of the most challenging conditions causing kidney allograft failure. Despite intensive research over the past decades, many gaps remain in understanding its pathophysiology. Herein, we review several questions highlighting recent advancements and their potential use in clinical practice.

Are there any reliable predictors of FSGS recurrence?

FSGS is not a specific disease entity but a histopathological “pattern of injury” seen on light microscopy that primarily targets podocytes. Multiple underlying etiologies that lead to podocyte loss have been identified, including systemic, genetic, and medication induced and those mediated by adaptive kidney responses (

Elhussein A. E. Elhassan, Kane Collins, Edmund Gilbert, and Peter J. Conlon

The importance of genomic mismatch between donor and recipient in organ transplantation has been appreciated since Dr. Joseph E. Murray undertook the first successful kidney transplantation in 1954 (1). This seminal event confirmed the critical role that genetics plays in transplant outcome. Subsequent studies demonstrated the importance of genetically inherited human leukocyte antigen (HLA) mismatch between donor and recipient. To guide decision-making in living donors, genomics functions as an additional toolkit to determine susceptibility of a specific inherited disease aggregating among families or specific ancestries, such as apolipoprotein L1 (APOL1) nephropathy.

In the 1990s and early 2000s, several

Sam Kant, Daniel C. Brennan, and Samira Farouk

As featured in the July edition of Kidney News, this issue again highlights advances in kidney transplantation. The July issue included articles on the new kidney transplant allocation system, updates from the apolipoprotein L1 (APOL1) Long-term Kidney Transplantation Outcomes (APOLLO) study, recent groundbreaking advances in xenotransplantation, racial inequities and measures to address them, and a review of the increasingly encountered challenge of oxalosis in kidney transplantation. We now turn our attention to genomics, biomarkers, new insights into thrombotic microangiopathy (TMA), focal segmental glomerulosclerosis recurrence in transplantation, and finally, updates on the use of belatacept.