For nephrologists working in Hawaii, like David Na’ai, MD, it's not uncommon to have caseloads of nearly 200 patients—double the 75 to 100 recommended. Na’ai, associate professor at the John A. Burns School of Medicine at the University of Hawai’i in Honolulu, described the situation as “near crisis levels.”
The island is home to approximately one-quarter of the Native Hawaiians and Pacific Islanders (NHPIs) living in the United States (1), according to the US Department of Health and Human Services Office of Minority Health. Asian Americans are the largest racial or ethnic group on the island (2
Recognizing the ongoing challenges affecting health care workers nationwide, leading to burnout and moral distress, the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience has devised the National Plan for health workforce well-being.
“It is critical for us to have a coordinated plan at the national level to help shift US health care from the current reality of a workforce shortage and burnout crisis to a future where every health worker is able to experience joy in their workplace and knows that they are valued,” said NAM President Victor Dzau, MD, in a prepared statement. The
Two recent studies published in CJASN address different aspects of the COVID-19 pandemic in adults with advanced kidney diseases: one examines whether prior COVID-19 vaccination affected the outcomes of individuals on dialysis who became infected with SARS-CoV-2 (1), and the other assesses the pandemic's impact on treatment decision-making for older patients with chronic kidney disease (CKD) (2).
People with CKD or other severe chronic medical conditions are at higher risk for more serious COVID-19 illness, and patients with kidney failure who rely on in-center hemodialysis face an elevated risk of becoming exposed to the
As a family physician and diabetes team lead in Juneau working for the Southeast Alaska Regional Health Consortium, Mary Owen, MD, could audit the care received by all of the diabetes patients served by her tribal clinic. The Special Diabetes Program for Indians (SDPI) funded this population-based approach through the Indian Health Service (IHS), which contracted with the clinic.
The audits allowed Owen, now director of the Center of American Indian and Minority Health at the University of Minnesota Medical School, to assess blood pressure and blood sugar control among patients and to gauge how many patients were receiving guideline-directed
When the pandemic hit more than 2 years ago, nephrologists and their patients had to pivot on a dime to adapt to telehealth technologies. Those technologies have proved popular with both nephrologists and patients. But now, clinicians face new challenges as they try to develop sustainable and equitable hybrid telehealth and in-person care models for the long term.
Provisions in the 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act enabled the Centers for Medicare & Medicaid Services to temporarily waive restrictions on where and how patients could receive telehealth (1). This policy change led to a rapid
The US Preventive Services Task Force (USPSTF) will consider adding screening for chronic kidney disease (CKD) as a potential recommendation in response to a nomination from the Coalition for Kidney Health. The coalition submitted its request in December 2021 and received a response in February 2022, stating that USPSTF has added “Screening for CKD” to its “list of preventive services topics under active consideration.”
The positive response kicks off a thorough, multi-year review, according to Miriam Godwin, health policy director at the National Kidney Foundation (NKF), whom the coalition designated as its contact person in its request to USPSTF. Godwin
In a procedure designed to closely mimic a human-to-human kidney transplant, Jayme Locke, MD, MPH, director of the Division of Transplantation at The University of Alabama, Birmingham, and her colleagues tested the safety and feasibility of transplanting a genetically engineered pig kidney into a human patient with a non-functioning brain.
The results were reported in January 2022 and showed that the genetically modified pig kidneys did not trigger a hyper-rejection reaction, could support human blood pressure, and could produce urine (1). The procedure was one of a string of recent attempts to test the potential of using pig
Although kidney transplantation is the optimal therapy after kidney failure for prolonging patient survival and improving quality of life, kidneys transplanted from deceased donors often do not function longer than 10 to 15 years. Therefore, many recipients must eventually receive a second transplant or undergo dialysis, with considerations such as the scarcity of donor organs and the immunological sensitization of transplant recipients factoring into decisions related to these options.
Because direct comparison of transplantation versus dialysis continuation through a randomized controlled trial is not feasible due to ethical, biological, and logistic reasons, investigators recently conducted a retrospective study that analyzed
Patient advocate Dawn Edwards has spent most of the last 30 years on home dialysis, including 10 years on peritoneal dialysis. She has also mentored hundreds of people with kidney disease. So, she is well aware of the burdens and barriers that can stand in the way of a patient starting and staying on home dialysis. The key, she says, is having a good team.
“It's really important for clinical teams and interdisciplinary teams to…work together to provide patients the support and resources they need to be successful at home,” Edwards said.
That is the question a group of nephrologists are asking directors of their laboratories about diagnosing metabolic acidosis. They are advocating that measuring a patient's urine ammonium level is more helpful than trying to estimate it from the urine anion gap (UAG).
More than 170 nephrologists signed a public letter making this request to “directors of clinical laboratories,” first published on Twitter as the introductory step in a campaign to make urine ammonium tests more available.
The letter notes that the test would be valuable “not only in the diagnosis