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The House Appropriations Committee on Labor, Health and Human Services, Education, and Related Agencies released its draft funding bill for fiscal year (FY) 2023 on June 22. The report language in the bill bolsters the nation's public health infrastructure and strengthens biomedical research and innovation. The bill allocates funding for and directions to agencies and programs on policy priorities for which ASN and the broader kidney health community have advocated. Key policies are highlighted here.

Centers for Disease Control and Prevention (CDC)

The committee includes a total of $10.5 billion for the CDC, which is $2 billion more than the

A dual immune/solid organ transplant procedure has been successfully used to perform kidney transplantation without the need for long-term immunosuppressive therapy in three children with a rare genetic disorder, according to a brief report in The New England Journal of Medicine (1). The study was led by Alice Bertaina, MD, PhD, of the Division of Stem Cell Transplantation and Regenerative Medicine and associate professor of pediatrics at Stanford University.

The patients were three children (two siblings) with Schimke immuno-osseous dysplasia (SIOD), an autosomal recessive disease associated with short stature due to bone dysplasia, glucocorticoid-resistant nephrotic syndrome,

Jeffrey Kott, Jorge Chancay, and Fasika M. Tedla

Belatacept is a soluble recombinant fusion protein composed of the constant fragment of human immunoglobulin G1 and modified extracellular domain of cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). It inhibits T-lymphocyte activation by blocking costimulation, the requisite signal that T-lymphocytes must receive through interactions between proteins expressed on antigen-presenting cells and T-lymphocytes in addition to signal from engagement of the antigen receptor (Figure 1).

Belatacept mechanism of action

In 2011, the US Food and Drug Administration (FDA) approved belatacept for prophylaxis against acute rejection in de novo adult kidney transplant recipients based on randomized trials that showed better

Abhijit S. Naik

Optimal management of immunosuppression in patients returning to dialysis after kidney transplant failure is an area of active investigation. It is common practice to start weaning immunosuppression over the first year after graft failure. To date, most literature on the effects of immunosuppression on those with transplant failure comes from single-center studies and expert opinion based on these studies. Maintaining immunosuppression after transplant failure is driven by the desire to reduce sensitization and prevent acute rejection of the failed transplant while preserving residual kidney function (13). However, this has to be balanced by the higher risk

For dialysis patients with nonvalvular atrial fibrillation (AF), anti-coagulation with apixaban—at both standard and below-label doses—lowers the risk of bleeding events compared with warfarin, concludes a study in the American Journal of Kidney Diseases.

Using US Renal Data System data from 2013 to 2018, the researchers identified 17,156 Medicare beneficiaries with nonvalvular AF receiving maintenance hemodialysis. All patients (12,517) had a new prescription for warfarin, and 2382 patients had apixaban at a label-concordant dose of 5 mg twice daily, or 2257 patients had apixaban at a lower dose of 2.5 mg twice daily. Outcomes, including stroke or systemic

Barry I. Freedman, Lijun Ma, and Marva M. Moxey-Mims

Discovery of the genetic association between apolipoprotein L1 (APOL1) gene kidney-risk variants and chronic kidney disease in individuals with recent African ancestry dramatically altered the landscape in nephrology (1). This observation accounted for much of the threefold higher incidence rate of end stage kidney disease (ESKD) in African Americans (AAs) compared with other populations. APOL1 genotypes also underlie a portion of the disparity in outcomes after deceased donor kidney transplantation (DDKT). Kidneys transplanted from deceased donors with African ancestry fail more rapidly than those from non-African ancestry donors (2). A

The US health care workforce is facing a shortage impacting those seeking kidney care. In 2019, the Association of American Medical Colleges projected that demand for physicians will continue to outpace supply, and the United States will see a shortage of up to 122,000 physicians by 2032 (1). Although this threat facing the US health care workforce has been exacerbated by the COVID-19 pandemic, the kidney care workforce is already facing shortage challenges. Just one practicing nephrologist is available for every 3427 people living with kidney diseases in the United States. As a talented and diverse kidney care

Benjamin Lidgard and Nisha Bansal

In patients with advanced chronic kidney disease (CKD), the decision to pursue invasive strategies for treatment of coronary artery disease involves careful consideration. Data from the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA)-CKD trial may better inform these decisions. The National Heart, Lung, and Blood Institute (NHLBI)-funded ISCHEMIA-CKD trial was a randomized clinical trial that included 777 patients from 30 countries, predominantly in the United States, Russia, Poland, India, and China. Inclusion criteria included aged ≥21 years, kidney failure on maintenance dialysis or estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2, and at

Lori Hartwell

As the health care community looks to home hemodialysis to improve the quality of life and overall management of patients with kidney diseases, all work should start by centering patient experiences and realities. I was diagnosed with kidney failure at the age of 2 in 1968 and luckily fell into the care of pioneer pediatric nephrologist Richard Fine, MD, who saved my life more than once with his innovative spirit. I was the first child to experience peritoneal dialysis in California, and I successfully managed my own home dialysis for 10 years. I have since founded the Renal Support Network

Matthew Abramson and Priya Deshpande

Although allogeneic hematopoietic stem cell transplant (HSCT) is the curative treatment for many patients with hematologic conditions, these patients are at a higher risk of acute kidney injury (AKI) and chronic kidney disease (CKD) as a result of conditioning therapies, exposure to radiation therapy, and chronic treatment with calcineurin inhibitors (Figure 1). CKD and albuminuria increase the risk of hypertension and end stage kidney disease, which ultimately impact mortality (1, 2). Many studies have evaluated the incidence of CKD post-HSCT, and the incidence of CKD ranges from 4% to 66% (39