Ensuring that Nephrology fellowship programs provide quality training in all aspects of kidney care
These topics are of primary interest to kidney professionals concerned about the future of nephrology. The interest of students and residents in pursuing careers in nephrology has waned over the past decade. With the increasing population of patients with kidney diseases, now approaching 40 million in the United States, these issues must be addressed immediately, in order to sustain a sufficient workforce to care for patients with kidney diseases. Furthermore, the success of exciting programs such as KidneyX and Advancing American Kidney Health, which are designed to catalyze innovation and transform patient care, depends upon establishing a robust pipeline of talented young physicians and scientists in nephrology. Key among the groups of leaders who regularly address issues concerning the field of nephrology are nephrology division chiefs and training program directors (TPDs). Whereas TPDs have successfully addressed many training program issues, there was a need to engage division chiefs to address other issues that extend beyond the purview of TPDs. Therefore, in 2018, the American Society of Nephrology convened a small group of division chiefs to discuss these issues in depth and design a blueprint on how ASN might work with division chiefs to promote positive advances.
The U.S. Department of Health and Human Services (HHS) took bold steps today, December 17, in two proposed rules to increase the availability of organs for the 113,000 Americans waiting for a lifesaving organ transplant – 20 of whom die each day – and to strengthen support for Americans who choose to be living donors. Both proposed rules advance policy changes the American Society of Nephrology has long been advocating for and is strongly supportive of.
An investigation from Kaiser Health News and Reveal from the Center for Investigative Reportingfound that “between 2014 and 2019, nearly 170 organs could not be transplanted and almost 370 endured ‘near misses,’ with delays of two hours or more,” due to transportation problems. Nearly 113,000 people in the United States waiting for transplants, yet many organs, especially kidneys, are needlessly wasted because they do not reach their destination on time due to transportation issues.
Per the July 2nd, 2018 press release from The Declaration of Istanbul:
"The first new edition of the Declaration of Istanbul on Organ Trafficking and Transplant Tourism, a seminal document that has helped to guide ethical practice in organ donation and transplantation around the world, was presented today at an international workshop in Madrid, Spain.
The Declaration was originally published in 2008, following a summit convened by The Transplantation Society (TTS) and the International Society of Nephrology (ISN) in response to growing concerns about international trafficking in human organs. It established definitions of practices such as transplant tourism and organ trafficking, and principles to guide policy makers and health professionals working in organ donation and transplantation. Since 2008, more than 135 professional societies have formally endorsed the Declaration.
In an opinion piece published this week in USAToday.com, contributors Andy Slavitt and Adam Brandon argue that many patients waiting for organ transplants pass away waiting, not due to lack of donors, but because of a “government-run monopoly”. They are referring to organ procurement organizations (OPOs), which are regional organizations in the US “charged with showing up at the hospital and working with the surviving family to coordinate a potential donation”. Research has found that OPOs are inefficient causing “28,000 organs to go uncovered from potential donors each year” in the US.
The ISN Global Kidney Health Atlas gathers “data to determine the world status of existing resources, structures and organizations available to patients with CKD and AKI”. The Atlas “is designed to document the degree to which the six principles of Universal Health Coverage (Health Finance, Health Policy, Service Delivery and Safety, Essential Medications and Health Products, Health Information and Statistics, and Health Workforce) are available in each county or region”.
In a joint press release in June 2018, the American Society of Nephrology (ASN), the European Renal Association – European Dialysis and Transplant Association (ERA-EDTA), and the International Society of Nephrology (ISN), publicized that the current number of people who suffer from kidney diseases worldwide has reached over 850 million and it's time to raise awareness for action to help alleviate the epidemic.
Outlined in a recent report from CNBC by Lori Ioannous (@Loriloannou1), chronic kidney disease is a “modern-day plague in the United States, driven in large part by the nation’s obesity epidemic”. 30 million Americans, or 1 in 9 adults, have chronic kidney disease, with diabetes and hypertension being major causes. “More than 510,000 kidney patients are now on dialysis, and over 100,000 are on the kidney transplant list”.
Announced this week, the NKF Patient Network “will create an interactive community of chronic kidney disease (CKD) patients that link patient-entered data on their health history, outcomes and preferences with clinical and laboratory data obtained from electronic health records. This unique combination of data collected will enable individualized educational resources, research, clinical care and health policy decisions to be centered on the patient.”
The U.S. FDA has now approved INVOKANA® (canagliflozin) as the only type 2 diabetes (T2D) medicine indicated to treat diabetic kidney disease (DKD) and reduce the risk of hospitalization for heart failure in patients with T2D and DKD. Approximately 1 in 3 patients with T2D also has DKD, which can ultimately lead to kidney failure. Once patients reach kidney failure, the average 5-year survival is less than 40%, largely due to cardiovascular-associated morbidity and mortality. This is the first new treatment option in nearly 20 years indicated to slow the progression of DKD in these patients.