Anemia is a well-known complication of chronic kidney disease (CKD), and treatment of anemia with erythropoietin (EPO)-stimulating agents (ESAs) is associated with improved quality of life and less need for transfusions (1−3). Since the introduction of ESAs three decades ago, gone are the days when large numbers of patients on dialysis were transfusion dependent—well, nearly (4). Up to 10% of people still do not respond adequately to ESAs, and hyporesponsiveness has been associated with increased mortality (5, 6). For years, ESAs have been the mainstay of treatment for anemia of CKD, but
For many years to come, just thinking of the year 2020 will put most of us into sympathetic overdrive. Coronavirus infectious disease 2019 (COVID-19) has dominated every part of our practice and continues to do so as we enter 2021. But if we track the arc of time, each tumultuous period has also spurred strides of innovation. Despite the odds, we have witnessed and continue to look forward to new landmark trials in nephrology that will have a lasting impact on our clinical practice. As our foray into the inaugural Fellows First column, we recap highlights of 2020 and anticipate
One thought that stood out during the first year of my fellowship was “healthcare transition from pediatric- to adult-focused care.” When the chart and age indicated readiness for patients’ transitions, I was not prepared. There were a lot of questions. Are they ready? Are they going to do well? Will they be able to fulfill their dreams and goals? Are these feelings similar to what one encounters when dropping their child off at college? I wondered. I wasn’t sure.
What does transition mean? To understand this better, I decided to make a note of the words that
Hurricane Michael made landfall as an unprecedented category 5 hurricane in the Florida panhandle, with maximum sustained wind speeds of 155 mph at 1 p.m. on October 10, 2018. Along the Florida panhandle, the cities of Mexico Beach and Panama City suffered the worst of Michael, with catastrophic damage reported (1).
According to US Renal Data System 2015 data, a total of 468,000 patients were receiving dialysis in the United States (2). Of those patients, 26,382 were in Florida, and about 350 patients were in Bay County. Dialysis patients are a
Nephrologists and renal fellows are often asked to evaluate patients with acute respiratory distress syndrome (ARDS) for acute kidney injury (AKI), electrolyte or acid–base disturbances, or volume overload. ARDS is associated with high mortality rates and is present in ≤10.4% of patients in critical care units (1). Evidence has shown that ARDS is an independent risk factor for AKI, which is prevalent in up to a third of ARDS patients (2).
Decisions about the initiation of renal replacement therapy (RRT) in patients with ARDS require special attention from nephrologists because there are considerations beyond
Love it or hate it, social media has become an ever-pervasive presence in nearly every aspect of our lives, and no sphere has been spared, especially nephrology. We may postulate that this is perhaps because nephrology, by its very nature, provides such a rich soil for academic discourse; that fluid physiology demands a blog post, electrolyte puzzles make great tweets, and regardless of all that we just cannot help posting salty jokes. That may be true, but certainly the world of nephrology on social media as we know it has also been laboriously designed through the
In mid-January 2020 I first heard about COVID-19. At first, it came across as yet another respiratory viral disease that had moderately higher infectivity compared with previous viruses. I never imagined that it was just the beginning of what would become a pandemic and that later case numbers would be staggering and overwhelming. COVID-19 has taken a toll not only on patients but also on healthcare systems, their workers, and the economy.
Sooner than I could comprehend the full extent of the damage, I found myself engulfed in the midst of this pandemic. It now feels like
International medical graduates (IMGs) play an important role in the US healthcare delivery system. About a quarter of the 800,000 practicing physicians are IMGs, and 41% of practicing IMGs are in primary care disciplines (1). These physicians play a vital role in the care of vulnerable populations in the underserved areas of both urban and rural settings. In a survey conducted in pediatrics, international IMGs are more likely to work in underserved areas than are American medical school graduates (2).
About 18% of graduating pediatric residents are IMGs, and about 25% of fellows
It comes as no surprise to anyone within the nephrology community that interest in a career in nephrology has declined drastically over the past decade, particularly among United States allopathic medical graduates. According to the American Society of Nephrology Data Brief regarding the 2020 nephrology fellowship match, 39% of nephrology fellowship positions went unfilled, with only 41% of available tracks filling (1). Only 69 United States allopathic medical graduates matched into nephrology, corresponding to a 14% decline from the previous year’s match. This trend is of particular concern, given the increasing prevalence of patients with kidney
Medicare began paying for eight telemedicine visits a year instead of 12 face-to-face visits as of January 2019. This allows patients to avoid missing work and reduces exposure to inclement weather, as in Anna’s family’s case. In addition, telemedicine visits save the family and the nephrologist travel expense.
This year I plan to use population health management with my kidney failure patients, both at home and in center, to decrease hospitalizations. For example, I will send push notifications to my kidney failure patients through their cell phones each weekend to encourage them to avoid excess fluid and potassium-enriched foods. This