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For patients whose estimated glomerular filtration rate (eGFR) declines to less than 30 mL/min/1.73 m2, continuing treatment with renin-angiotensin system blockers has continued cardiovascular benefits, suggests a study in JAMA Internal Medicine.

Using data from a large integrated healthcare system in Pennsylvania, the researchers identified approximately 163,000 patients who started angiotensin-converting enzyme inhibitor (ACE) or angiotensin receptor blocker (ARB) therapy between 2004 and 2018. Of these, nearly 11,000 patients subsequently had a drop in outpatient eGFR to less than 30 mL/min/1.73 m2. After elimination of patients who discontinued ACEI/ARB therapy before the drop in

Karen Blum

As the COVID-19 pandemic continues to take hold, kidney transplantation programs across the United States and elsewhere have been canceling or postponing many procedures, moving to telephone or video visits with patients, and emphasizing the importance of handwashing and social distancing in their quest to keep their patients safe.

“There’s a lot of unknowns about how SARS-CoV-2 will intersect with organ transplantation,” said Ajit Limaye, MD, professor of medicine and director of the transplant infectious disease program at the University of Washington in Seattle, during an international COVID-19 Town Hall webinar sponsored by the United Network for Organ Sharing, the

Ruth Jessen Hickman

Exposure to nephrotoxic medications is a major cause of acute kidney injury (AKI) in hospitalized children, increasing the costs and length of hospital stays. In one study of pediatric patients not in the intensive care unit, 86% were exposed to a potentially nephrotoxic medication at some point during hospitalization (1). When children receive three or more nephrotoxic medications in the same day, the rates of AKI double (1). In some patients, the damage is permanent, leading to chronic kidney disease.

Stuart L. Goldstein, MD, director of the Center for Acute Care Nephrology at the Cincinnati Children’s

Bridget M. Kuehn

Dialysis centers across the country are taking extraordinary measures to ensure the safety of patients and staff during the Coronavirus Disease-2019 (COVID-19) pandemic. The team at Seattle’s Northwest Kidney Centers found itself on the leading edge of that effort when they learned that one of their dialysis patients was the first US fatality.

“Our guiding principles were first and foremost to ensure that patients are coming to dialysis,” said Suzanne Watnick, MD, Chief Medical Officer, Northwest Kidney Centers.

Watnick and Elizabeth McNamara, Vice-President of Patient Care Services and Chief Nursing Officer, shared their experiences during a webcast hosted by ASN’s

For hospitalized patients with acute kidney injury (AKI), postdischarge measurement of albuminuria may improve the ability to identify patients at higher subsequent risk of progressive kidney disease, according to a prospective, multicenter cohort study reported in the March issue of JAMA Internal Medicine.

Patients with an episode of AKI are at high risk of rapidly declining kidney function. New approaches are needed to identify those patients at highest risk of kidney disease progression.

Doubling of the urine albumin-to-creatine ratio (UACR) after hospital discharge is associated with a 1.5-fold increase in the odds of kidney disease progression, according to

Eric Seaborg

An arteriovenous fistula (AVF) is the guideline-recommended vascular access for hemodialysis, yet a large majority of patients in the US and Canada begin dialysis using catheter access, despite its higher rates of complications. Because patients resist having the AVF surgical procedure, many nephrologists have looked to the results of observational studies that led to the hypothesis that AVF creation could affect kidney function—and even lead to benefits that could postpone the need for dialysis.

Definitive evidence for such a benefit remains elusive, however, with two new studies contributing to the discussion in conflicting ways, and providing no firm answers. A

Bridget M. Kuehn

Kidneys from donors with acute kidney injury (AKI) are often discarded, but a recent study suggests that transplant patients who receive donor kidneys with AKI do as well as those who receive comparable kidneys without AKI.

The findings are the latest in a growing body of evidence that suggests using more donor kidneys that are less than perfect may help increase access to transplantation. Transplantation is considered the best treatment option for most patients with kidney disease because it can improve their quality of life and help them live longer, according to the National Kidney Foundation. But with about 100,000

Karen Blum

A recent report in Health Affairs provides a sobering reminder of the importance of specialty medical care in improving health outcomes (1). The study of 11,581 rural and urban Medicare beneficiaries with one or more complex chronic conditions found that living in rural areas with fewer opportunities for seeing a specialist was associated with a 40% higher rate of preventable hospitalizations and a 23% higher rate of death compared to living in urban areas.

Preventable hospitalization rates per 100 beneficiaries ranged from 14.9 in rural areas to 10.6 in metropolitan areas in the study, while annual

Eric Seaborg

The initial pass rate for the nephrology certification exam dropped by 9% in 2019, setting off concerned discussions on Twitter and a search for explanations by many in the nephrology community.

The decline in the pass rate to 74% represents a precipitous drop from the 90% rate of 2016. The rates in both 2017 and 2018 were 83%. For the 15 subspecialties tested under the aegis of the American Board of Internal Medicine (ABIM) in 2019, the average pass rate was 90.5%.

Although the size of the decline raised questions about a problem with the test, ABIM is steadfast in

Tim O’Brien

The clot-promoting drug desmopressin is commonly used with the goal of reducing bleeding complications in patients undergoing percutaneous kidney biopsy. But the evidence supporting this practice is weak—particularly in patients with decreased kidney function.

Desmopressin’s impact on bleeding risk after kidney biopsy depends on the patient’s creatinine level, reports a paper in the open-access journal BMC Nephrology (1). In a retrospective analysis, Ambarish Athavale, MD, and colleagues of Cook County Health, Chicago, report that desmopressin is associated with fewer bleeding events in patients with elevated serum creatinine—but with a spuriously increased bleeding risk in those with