As a family physician and diabetes team lead in Juneau working for the Southeast Alaska Regional Health Consortium, Mary Owen, MD, could audit the care received by all of the diabetes patients served by her tribal clinic. The Special Diabetes Program for Indians (SDPI) funded this population-based approach through the Indian Health Service (IHS), which contracted with the clinic.
The audits allowed Owen, now director of the Center of American Indian and Minority Health at the University of Minnesota Medical School, to assess blood pressure and blood sugar control among patients and to gauge how many patients were receiving guideline-directed
When the pandemic hit more than 2 years ago, nephrologists and their patients had to pivot on a dime to adapt to telehealth technologies. Those technologies have proved popular with both nephrologists and patients. But now, clinicians face new challenges as they try to develop sustainable and equitable hybrid telehealth and in-person care models for the long term.
Provisions in the 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act enabled the Centers for Medicare & Medicaid Services to temporarily waive restrictions on where and how patients could receive telehealth (1). This policy change led to a rapid
The US Preventive Services Task Force (USPSTF) will consider adding screening for chronic kidney disease (CKD) as a potential recommendation in response to a nomination from the Coalition for Kidney Health. The coalition submitted its request in December 2021 and received a response in February 2022, stating that USPSTF has added “Screening for CKD” to its “list of preventive services topics under active consideration.”
The positive response kicks off a thorough, multi-year review, according to Miriam Godwin, health policy director at the National Kidney Foundation (NKF), whom the coalition designated as its contact person in its request to USPSTF. Godwin
In a procedure designed to closely mimic a human-to-human kidney transplant, Jayme Locke, MD, MPH, director of the Division of Transplantation at The University of Alabama, Birmingham, and her colleagues tested the safety and feasibility of transplanting a genetically engineered pig kidney into a human patient with a non-functioning brain.
The results were reported in January 2022 and showed that the genetically modified pig kidneys did not trigger a hyper-rejection reaction, could support human blood pressure, and could produce urine (1). The procedure was one of a string of recent attempts to test the potential of using pig
Although kidney transplantation is the optimal therapy after kidney failure for prolonging patient survival and improving quality of life, kidneys transplanted from deceased donors often do not function longer than 10 to 15 years. Therefore, many recipients must eventually receive a second transplant or undergo dialysis, with considerations such as the scarcity of donor organs and the immunological sensitization of transplant recipients factoring into decisions related to these options.
Because direct comparison of transplantation versus dialysis continuation through a randomized controlled trial is not feasible due to ethical, biological, and logistic reasons, investigators recently conducted a retrospective study that analyzed
Patient advocate Dawn Edwards has spent most of the last 30 years on home dialysis, including 10 years on peritoneal dialysis. She has also mentored hundreds of people with kidney disease. So, she is well aware of the burdens and barriers that can stand in the way of a patient starting and staying on home dialysis. The key, she says, is having a good team.
“It's really important for clinical teams and interdisciplinary teams to…work together to provide patients the support and resources they need to be successful at home,” Edwards said.
That is the question a group of nephrologists are asking directors of their laboratories about diagnosing metabolic acidosis. They are advocating that measuring a patient's urine ammonium level is more helpful than trying to estimate it from the urine anion gap (UAG).
More than 170 nephrologists signed a public letter making this request to “directors of clinical laboratories,” first published on Twitter as the introductory step in a campaign to make urine ammonium tests more available.
The letter notes that the test would be valuable “not only in the diagnosis
Laboratories across the country should quickly implement a “refitted” Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation that does not include a race coefficient for estimating glomerular filtration rate (GFR), but the future of estimated GFR (eGFR) could lie with equations that combine creatinine with cystatin C because they offer greater accuracy. Those are two key takeaways from the recently released report of the National Kidney Foundation (NKF)-American Society of Nephrology (ASN) Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases.
Because the task force is recommending an adaptation of a widely used equation, experts told
It's a week-to-week challenge for Eric Wallace, MD, and his colleagues to treat patients with end stage kidney disease (ESKD) who are undocumented immigrants. Many are young people in their 20s and 30s who are working or in school; one recently was pregnant. They are not eligible for coverage under Medicare and cannot buy coverage through the Affordable Care Act on state exchanges. If they cannot buy private insurance, their only option for care is emergency dialysis, which is covered by the Emergency Medical Treatment and Active Labor Act (EMTALA).
When Alfred Cheung, MD, co-chair of the Kidney Disease Improving Global Outcomes (KDIGO) 2021 Clinical Practice Guideline update on the Management of Blood Pressure (1), and his colleagues were preparing to release their new guideline on blood pressure management in patients with chronic kidney disease (CKD), they knew it might “ruffle some feathers.”
But after careful consideration, their workgroup came to a conclusion that they should make the right recommendation to shoot for a target systolic blood pressure of less than 120 for patients with CKD, a recommendation supported by the results of the Systolic Blood Pressure Intervention