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Sharon Itkoff

Creative arts therapy is a form of psychotherapy that draws on the creative process along with traditional talk therapy to facilitate personal growth, insight, and resilience. Because chronic illnesses, such as ESRD and chronic kidney disease, can have psychosocial and spiritual effects on one’s mind, body, and relationships, art therapy as a treatment modality can be used to supplement traditional medical approaches to help one seek balance, wholeness, and self-actualization instead of just focusing on the cure. When one’s energy is shifted from finding a cure to improving his or her quality of life in the here and now, the

Bridget M. Kuehn

Search engines are one of the first places many Americans turn when looking for health information, according to a 2013 survey by the Pew Research Center. But what they may not know is that the data from these searches is collected by the search engine and is increasingly being used for health research and public health surveillance.

The data has enormous potential to help researchers better understand pressing public health issues and perhaps even to identify individuals at risk of developing serious disease. But this emerging venue for health research also poses new questions about what constitutes consent for research

Bridget M. Kuehn

Electronic health records (EHRs) have made it much easier for physicians treating patients with chronic kidney disease (CKD) to collect data, including glomerular filtration rate (GFR), creatinine, blood pressure, cholesterol, anemia, and bone health, said Joseph Nally, MD, Director of the Center for Chronic Kidney Disease at the Cleveland Clinic. But they don’t always make it easy for physicians to use the data to improve patient care.

“The EHR has simplified the process in terms of information gathering, but it is still up to the physicians and caregiver team to do all the right things to optimize patient care,” Nally

Bridget M. Kuehn

Patients with chronic kidney disease who also have chronic obstructive pulmonary disease (COPD) have a 41% increased risk of death, according to a recently published study that relied on electronic health records (EHRs) (Navaneethan SD, et al. Am J Nephrol 2016; 43:39–46).

The finding is part of a growing body of evidence demonstrating the power of EHR-based studies to help elucidate the many factors that contribute to poor outcomes for patients with CKD. The technology is also being used to help test ways to improve their care.

Joseph Nally, MD, a coauthor of the COPD study and Director

Bridget M. Kuehn

A new rule from the Centers for Medicare & Medicaid Services (CMS) would extend access to CMS claims data to support quality improvement efforts. But the increased access to personally identifiable claims—including to for-profit companies—may pose privacy risks for patients.

The rule, released July 1, 2016, will allow organizations that the CMS has certified as “qualified entities” to share or resell CMS claims data analyses to clinicians, health care organizations, or other organizations, including for-profit ones, to be used for quality improvement efforts. The new rule also outlines privacy and security requirements for the organizations receiving patient-identifiable or de-identified data.

Eric Wallace

Almost 25 years after the Texas Telemedicine Project, one of the first major telemedicine initiatives, we are still trying to determine where and how telemedicine fits into modern nephrology.

Increased access to care is just one of many potential advantages of telemedicine. However, at a time of increasing healthcare costs, policymakers and payers ask, “What is the added value?” Furthermore, debates about acceptable means of providing telemedicine care rage on. Legal battles waged between providers of telemedicine and state medical boards have provided further hesitancy on the part of physicians to incorporate telemedicine into their daily practice. Many of the

S.A. Balogun and E. Abdel-Rahman

We are aging and living longer. This fact could be attributed to improved technology, medical advances, and the increased number and aging of the baby boomers. It is estimated that the number of elderly will be up to 2 billion by the year 2050 (1). This increase in the number of elderly is mirrored by an increase in medical problems such as acute and chronic kidney disease. This requires coordinated care by multiple specialties, with geriatricians and nephrologists playing a key role in the treatment of these patients.

At least 50 percent of the nephrology patient population are

Adnan Naseer and Csaba P. Kovesdy

In the United States we are currently experiencing the phenomenon of the “graying of America,” whereby the population is growing older and the proportion of those 65 years and older is rapidly increasing. Data from the U.S. Census Bureau predict that the number of individuals 65 years and older will double in the next 20 years. Most of this growth is happening in the “oldest old”—that is, 85 years and older. Among other challenges, the aging of the population brings the increasing burden of chronic disease conditions such as diabetes, hypertension, and heart disease (1), all of which

Mark E. Molitch

Diabetes mellitus is the most common cause of chronic kidney disease (CKD) and kidney failure (1). More than one quarter of the United States population over age 65 has diabetes (2), and 37 percent of them have an eGFR <60 mL/min/1.73 m2 (3).

Whether the decreased GFR is due to age-related decline or to diabetic kidney disease (see other articles in this issue), it affects the clearance of insulin and many diabetes medications and raises the risk of hypoglycemia (4). Hypoglycemia is the major barrier to achieving near-normal glycemia, which

Rachel W. Flurie and Gary R. Matzke

Chronic kidney disease (CKD) is a prevalent disease in the United States that disproportionately affects the elderly. The national prevalence is approximately 15 percent and reaches nearly 50 percent in adults aged 70 years and older (1). CKD stages 1 and 2 are characterized by a GFR >60 mL/min/1.73 m2, and dose adjustments are usually indicated only for drugs that have a narrow therapeutic index, such as aminoglycosides and vancomycin. CKD stages 3, 4, and 5 are characterized by progressively lower GFR—30 to 59, 15 to 29, and <15 mL/min/1.73m2, respectively—and drug dose adjustment