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Krzysztof Kiryluk, MD
The American Society of Nephrology-American Heart Association Donald W. Seldin Young Investigator Award will be presented to Krzysztof Kiryluk, MD, MS, who will speak on “Genetic Discovery in IgA Nephropathy” on Friday, November 5.
Dr. Kiryluk is associate professor of medicine in the Division of Nephrology at Columbia University in New York City.
His research aims to define genetic factors that contribute to the risk of kidney disease. He leads several large collaborative national and international genetic studies of glomerular disorders, including IgA nephropathy and membranous nephropathy. He is investigating genetic regulators of IgA production and O-glycosylation
Nephrology care requires a long-term collaboration among the patient, his or her nephrologist, and the many other essential members of the healthcare team. However, in some situations, circumstances evolve to where it is in the best interest of all parties (including the patient) for a change in provider and/or facility. If an individual has a history of disruptive or maladaptive behaviors, the potential new provider or medical director is confronted with the dilemma of whether to accept the patient (
The use of home dialysis has increased substantially by ~93% over the 10-year period from 2007 to 2017, based on a 2019 report published by the United States Renal Data System (USRDS). Home dialysis and transplants currently account for ~39% of all treatments (~30% transplants, ~7% peritoneal dialysis [PD], and ~2% home hemodialysis [HHD]) (
Although nephrologists complete the “End Stage Renal Disease (ESRD) Medical Evidence Report Medicare Entitlement and/or Patient Registration” form (form 2728) 138,000 times per year, the form is underappreciated and surprisingly important (
Electronic health records (EHRs) have untapped potential for population health management. Population health focuses on the health outcomes of a group of individuals, rather than considering the health of one person at a time (
At the start of my second year of fellowship, I started considering what career opportunities were available to me within the vicinity of my fellowship training. I had been in the central Jersey area for many years and had established a strong referral network from colleagues, which I wished to maintain. Once I determined that I did not want to pursue further subspecialty training (i.e., transplant, interventional, etc.), the next decision was academic versus private practice.
My original desire was to join the faculty of my fellowship. Unfortunately, due to budget cuts at the time, there was not enough funding
According to the United States Renal Data System (USRDS)'s Annual Report for 2020, the number of incident patients with end stage kidney disease (ESKD) in 2018 was 131,636, which was an increase of 2.3% from the year prior (
Much has been written in the past few years about the nephrology workforce crisis. Fellowship positions go unfilled; some recent graduates choose to work as hospitalists instead. However, there are many bright spots on the horizon. Exciting new therapies, such as the sodium-glucose cotransporter-2 (SGLT2) inhibitors, offer the chance to help keep more people from reaching kidney failure. Meanwhile, recent policy advances, especially the Advancing American Kidney Health Executive Order in the United States, will help shift the practice of nephrology toward more comprehensive care of patients living with kidney diseases.
Nephrologists in private practice tend to value their independence
Over the past 30 years, kidney transplantation has grown greatly, and there are now >200 Centers for Medicare & Medicaid Services (CMS)-approved kidney transplant centers. As a result, many transplant nephrologists are not faculty members at a medical school and do not attend at large teaching centers but instead work in private practice. Almost all private practice nephrologists see some kidney transplant recipients, typically patients who are at least several months posttransplant and relatively stable. Private practice transplant nephrologists, however, also care for transplant recipients during the immediate peri- and posttransplant periods and are on staff at kidney transplant centers.
Value-based care (VBC) is the buzzword in healthcare today, and nephrology is not behind in this venture. The word evokes anxiety and fear in most, as it is usually equated with a push to reduce costs by deploying expensive infrastructure, which comes with significant regulatory burden. What really happens is that the payor (insurance entity) delegates a subset of the population to a risk-bearing entity (RE) that has the skill set and resources to improve the quality of care provided at a lower than historical cost by use of innovative care models and technology. The financial savings (or losses) are
