Leaving ASN Kidney Week 2016, I was excited to integrate new knowledge and thoughts into processes to improve the care and outcomes of patients with advanced CKD. Realizing that outcomes for these patients depend on early identification and appropriate management throughout their disease trajectory with attention to transitions across settings of care, and during disease progression or additions of co-morbidities, begs the question: Whose responsibility is it to bring up-to-date knowledge to the community primary care practitioners, home health agencies, other subspecialists, and anyone else who participates in the care of those with CKD 4+?
After several years of declining interest, the future of nephrology as a career choice continues to be uncertain. Preliminary results from the Nephrology Match AY 2017 revealed a continuing trend toward unfilled nephrology tracks, with almost no change from AY 2016 (95 vs. 93 filled tracks). Programs may face the difficult choice of trying to recruit post-match or perhaps reducing program size and recruiting either more attending nephrologists or physician extenders including physician assistants or nurse practitioners.
Last year’s match rate for nephrology was the lowest for all medicine fellowships. A particularly noteworthy trend has been the progressive decline in
Lifestyle factors, particularly higher body mass index (BMI), appear to explain the lower risk of end stage renal disease (ERSD) in women compared with men, according to data from the Chronic Renal Insufficiency Cohort (CRIC) Study presented at Kidney Week 2016.
The incidence of ERSD is 1.5 times higher in US men than women even though women live longer and are more likely to have chronic kidney disease (CKD), said Ana C. Ricardo, MD, MPH, MS, assistant professor of medicine at the University of Illinois at Chicago. Some studies have shown that men with CKD progress more quickly (Neugarten J,
Chicago—Stem cells from patients with polycystic kidney disease have been coaxed into growing into kidney-like structures, which may aid researchers studying the disease, according to a study presented at Kidney Week 2016.
Ryuji Morizane, MD, PhD, an instructor and scientist in the Brigham and Women’s Hospital Renal Division in Boston, and his colleagues presented data on how they grew the kidney-like structures, called kidney organoids. They also described the features of the kidney organoids and the disease features they recreate.
Improvements in cell culturing technology have allowed scientists to coax stem cells into growing into organoids that recapitulate many of
Chicago—Too little and poor quality sleep are associated with a greater risk of kidney failure, according to results from the Chronic Renal Insufficiency Cohort Study (CRIC) presented at Kidney Week 2016.
While sleep disorders are common in patients with chronic kidney disease (CKD), how poor sleep may affect disease progression is not clear, according to the study’s lead author Ana C. Ricardo, MD, MPH, an assistant professor in the division of nephrology at the University of Illinois College of Medicine at Chicago.
So Ricardo and her colleagues conducted a prospective study of 432 adults enrolled in the CRIC study at
Smoking may partly counteract the benefits of treatment with angiotensin converting enzyme inhibitors (ACE inhibitors) for patients with chronic kidney disease (CKD), according to a study presented at Kidney Week 2016.
Smoking has been linked to worsening kidney decline, but the exact mechanisms are unclear, according to lead author Bethany Roehm, MD, of Tufts Medical Center in Boston.
“The importance of smoking as a renal risk factor is highlighted by the fact that its negative effects have been shown in subjects of the general population and in patients with primary or secondary renal disease,” said Stephan R. Orth, MD, PhD,
Use of palliative care among patients with end stage renal disease (ESRD) has increased steadily since 2004, but use among minority patients lags behind whites, according to a study presented at Kidney Week 2016.
Palliative care, which focuses on comfort measures and may include discontinuing dialysis, may ease the burden for patients with ESRD who are nearing the end of life. To help ensure that patients are advised about the option of palliative care, the Centers for Medicare & Medicaid Services included voluntary end-of-life counseling in the 2016 physician fee schedule, wrote lead author Haytham Alkhaimy, MD, of Augusta (Georgia)
Patients who need dialysis for the treatment of ESRD have a high burden of disease because they have numerous coexisting illnesses (such as diabetes and congestive heart failure), high health care utilization with frequent hospitalizations and high rates of readmission, and a very high daily pill burden. The dialysis regimen adds further to this burden, because patients have to make significant changes in their day-to-day lives, including in their diets, to accommodate the treatment schedules and minimize risks to their health. Patients have further challenges in coping with the numerous demands imposed by a diagnosis of ESRD if they also
What do you mean my kidneys are failing?” “What is dialysis?” “Am I going to die?” “This can’t be happening to me.” “What about my family?” “I am afraid….” The diagnosis of kidney disease is a life-changing event for individuals and their families. Their entire world has just changed. They have lost their safe and secure view of their own sense of good health and well-being. Their sense of the future is not as certain. They are in crisis and grief. Crisis can be viewed as a critical event that requires people to develop new ways and acquire new skills
Having recently experienced an excellent meeting on mental health, chronic kidney disease (CKD), and ESRD, I wanted to offer some thoughts about the extraordinary role that psychology and people play in the course of this illness and its treatment. I commend the Rogosin Institute for convening a marvelous group of leaders from various parts of the country to deliberate on these issues.
What does one learn from such a roundtable? First and foremost, that kidney disease has a potential for dramatically disturbing a person’s sense of well-being. Many people with serious kidney disease are not aware that they have it.