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“If you really want to do something, you’ll find a way. If you don’t, you’ll find an excuse.” —Jim Rohn, American entrepreneur, author, and motivational speaker
Arguably, the biggest problem facing end-of-life decision making in elderly patients with advanced and end stage renal disease is that conversations about the end of life simply don’t happen often enough. In one survey of dialysis patients, fewer than 10 percent reported having a conversation about end-of-life issues with their nephrologist in the past year. Moreover, fewer than 10 percent reported that any physician had ever discussed prognosis with them (
In the United States, chronic kidney disease (CKD)—defined by reduced GFR <60 mL/min per 1.73 m2, or presence of kidney damage—is very common in the elderly population. The prevalence of CKD is estimated to be 46.8 percent in those older than 70 years (
The United States ESRD population is aging. Patients over the age of 65 have the highest adjusted prevalence of ESRD (
Hypertension remains a growing problem in our aging population. Recent data from the National Health and Nutrition Examination Survey (NHANES) estimate that almost one-third of the adult population meets the criteria for hypertension (
The Framingham Heart Study helped to elucidate the expected trajectory of blood pressure in normotensive and
Although there has been an overall slowing of incident cases of ESRD in the United States during the past several years, the elderly population continues to have the highest incident rates of ESRD (
One of the major challenges for today’s society is the growth of the elderly population. By 2030, the age segment over 65 years will have nearly doubled, and the incidence of multiple age-associated disorders is predicted to increase in parallel. Age-associated changes of the kidney are important not only because normal aging alters renal function, but also because of the high frequency of ESRD in the elderly population (
Patients’ access to specialized care before kidney failure develops varies significantly across the United States and among different racial groups. And perceived racial discrimination may have negative effects on kidney function.
Pre-ESRD nephrology care is crucial for optimizing the health of patients with this condition. How the United States and global kidney community ensure such care for the millions of people with kidney disease is crucial to stemming the disease’s growing prevalence.
One approach is to look at the adequacy of care patients receive in different parts of the country and then examine the reasons for discrepancies in care.
Brendan
Nearly two years after the Centers for Medicare and Medicaid Innovation (CMMI) announced the first-ever disease-specific innovation model, the first performance period of the ESRD Seamless Care Organizations (ESCO) program is slated to begin in January 2015. Large Dialysis Organization (LDO)-based ESCOs will be the first to participate in the program, followed by ESCOs operated by Small Dialysis Organizations (SDOs) in July 2015. Speaking at a meeting of the Council of Medical Subspecialty Societies in late November 2014, CMMI Seamless Care Models Group Director Hoangmai Phan, MD, confirmed the early 2015 launch date.
But as 2014 wound to a close,
In an attempt to control Medicare spending on physicians’ fees, Congress enacted the SGR formula in 1997. Although it has called for dramatic reductions in payments over the past decade, each year Congress has temporarily overridden the cuts and kept the SGR in place. According to the formula, if no changes are
Suppose you’re seeing a new patient with kidney disease, high blood pressure, and high cholesterol. What if you could order a single lab test that would assess all known gene variants that might affect his response to common drugs—not just medications he’s currently taking, but also common drugs that may be prescribed in the future? That’s the approach being studied by The University of Chicago’s Center for Personalized Therapeutics and other centers nationwide.
The goal is to develop a “medical system model” to overcome barriers to personalized medicine, incorporating patient-specific pharmacogenomic results into everyday patient consultations. The model is being
