Before the National Institutes of Health (NIH) Revitalization Act, women were largely underrep-resented in clinical trials, partly out of concerns for teratogenic effects. The act, passed in 1993, made it mandatory that clinical trials funded through NIH include data from women and minorities (1).
The percentage of women included in clinical trials has improved significantly since that time (2), although women are still underrepresented with respect to disease prevalence in some reports (3). However, data from men and women are often still aggregated together, and analyses based on sex are often not reported.
A recent article in The New England Journal of Medicine emphasizes the ethical importance of giving well-educated patients true choices when it comes to management of advanced chronic kidney disease, especially regarding potential dialysis cessation (1). Through coordination with palliative care specialists, nephrologists can offer patients a wide variety of options to help meet their specific personal needs and goals.
Although a vital, life-saving therapy, dialysis can come with side effects and significant psychological, social, and financial pressures on patients. Solomon Liao, MD, is director of palliative care at the University of California, Irvine, and one
A recent study in the New England Journal of Medicine may shift the balance for clinicians who are considering the use of drug-coated balloons (DCBs) for treating dysfunctional dialysis arteriovenous (AV) fistulas (1). The improved rates of fistula patency and reassuring data on safety underscore the potential of this technology to improve patients’ lives and reduce healthcare expenditures.
Percutaneous transluminal angioplasty with standard balloons is currently the recommended treatment for dysfunctional hemodialysis fistulas. A balloon is inserted into the dialysis shunt and inflated in a stenotic area to stretch the vessel and restore normal flow. Although
Dialysis patients pose a major challenge for limiting the spread of the SARS-CoV-2 virus, as they normally receive thrice weekly dialysis in often densely populated outpatient centers. They may have compromised immune systems, and many have additional health comorbidities that put them at risk of poor outcomes from COVID-19 (1).
Early in the pandemic, many symptomatic dialysis patients positive for COVID-19 were transferred to hospitals to reduce the risk of spread at outpatient dialysis units (1). It became clear, however, that triaging all such patients to hospitals might unnecessarily strain inpatient dialysis units, which might already
Exposure to nephrotoxic medications is a major cause of acute kidney injury (AKI) in hospitalized children, increasing the costs and length of hospital stays. In one study of pediatric patients not in the intensive care unit, 86% were exposed to a potentially nephrotoxic medication at some point during hospitalization (1). When children receive three or more nephrotoxic medications in the same day, the rates of AKI double (1). In some patients, the damage is permanent, leading to chronic kidney disease.
Stuart L. Goldstein, MD, director of the Center for Acute Care Nephrology at the Cincinnati Children’s
As dialysis centers prepare for the the need—either current or increasingly likely—for inpatient units to work at surge capacity to manage patients during the COVID-19 pandemic, it’s becoming clear that constraints on both personnel and resource supplies may make it impossible to successfully dialyze all patients using standard procedures. In such a scenario, institutions may aim to temporarily adjust their standard of care to provide sufficient treatments to as many patients as possible.
A paper in the Clinical Journal of the American Society of Nephrology provides guidance about different strategies and contingency plans that might be employed. Jamie
Bioengineering innovations to decrease failure rates of arteriovenous fistulas and grafts, improved infection control measures in catheter-based and peritoneal dialysis, and a new hemodialysis system designed for home use were the prize-winning “Redesign Dialysis Phase 2” innovations announced at the recent virtual KidneyX Summit.
KidneyX (the Kidney Innovation Accelerator) is a partnership between the American Society of Nephrology and the US Department of Health and Human Services (HHS) to promote innovations in kidney disease prevention, diagnostics, and treatment. Through a series of monetary prize competitions, KidneyX helps speed the development of new medical products by fostering collaboration among patients, health