The majority of individuals in the United States are not eligible to donate a kidney, even if they wanted to.
In addition to helping patients shed pounds, weight loss surgery may also improve kidney function.
Simple exercises can help improve the health of patients with kidney disease.
In a study of blacks with normal kidney function, those with severe periodontal disease developed chronic kidney disease at 4 times the rate of those without severe periodontal disease.
Acute kidney injury occurs frequently in Ebola virus disease; however, providing hemodialysis to these patients was previously thought to be too risky. Clinicians recently accomplished the first known successful delivery of renal replacement therapy with subsequent recovery of kidney function in a patient with Ebola virus disease.
Many young patients with chronic conditions don’t take their medications correctly, but 2 new studies point to ways to address such medication non-adherence.
Sleep apnea may accelerate kidney function decline in diabetic patients with kidney disease.
• A comparison of two different cholesterol management guidelines indicates that the vast majority of patients with chronic kidney disease are recommended to receive statins. • 50% of people with chronic kidney disease who are recommended to receive statins are not taking them.
Transplanted kidneys may not function long-term if they come from donors with variants in a particular gene.
Patients on dialysis are very vulnerable during emergencies or disasters, but many are unprepared for such situations.
The American Society of Nephrology (ASN) will award the President’s Medal to Congressional Kidney Caucus Co-Chairs Rep. Tom Marino (R-PA) and Rep. Jim McDermott, MD (D-WA) for their support of kidney care legislation and federal investment in kidney research.
Five leaders in the kidney health community are being acknowledged by the American Society of Nephrology (ASN), the world’s largest organization of kidney disease specialists. The award winners will be honored at ASN Kidney Week 2014, the world’s premier nephrology meeting, where more than 13,000 kidney health professionals from around the world will gather in Philadelphia, PA on November 11–16.
• A type of drug called an endothelin-A antagonist promotes the recovery of kidney function and improves responses following renal angioplasty in pigs with a disease frequently observed in patients in which the kidneys’ arteries are blocked. • Endothelin-A antagonists are currently available for treating a certain type of hypertension.
Obesity in a pregnant woman may increase the risk that her children will be born with congenital abnormalities of the kidney and urinary tract.
The American Society of Nephrology (ASN) has published a new report analyzing trends and factors influencing the current US nephrology workforce. Authored by leading health workforce researchers from George Washington University (GWU), the report outlines several challenges for the specialty, notably a declining interest in nephrology careers among medical students and residents and an uncertain job market for recent graduates. The study—The US Nephrology Workforce: Developments and Trends—is available online at ASN’s website http://www.asn-online.org/workforce.
• Every one-point increase in a Mediterranean diet score was associated with a 17% decreased likelihood of developing chronic kidney disease. • Dietary patterns that closely resembled the Mediterranean diet were linked with a 50% reduced risk of developing chronic kidney disease and a 42% reduced risk of experiencing rapid kidney function decline.
• Among kidney failure patients on dialysis, beta blockers that are easily removed from the circulation through dialysis were linked with a higher risk of premature death than beta blockers that are not easily removed through dialysis.
Home blood pressure monitors may be inaccurate in up to 15% of patients.
• People who developed kidney or urinary tract stones were more likely to later experience bone fractures. • The median time between diagnosis and bone fracture was 10 years
Binge drinking in early adulthood is associated with an increased likelihood of high blood pressure in males.
• Among patients with an autoimmune disease called ANCA-associated vasculitis, autoantibody increases were linked with an 11-fold increased risk of relapse in patients whose kidneys were affected. • Among patients without kidney involvement, such increases were associated only weakly with relapses.
• After the implementation of a new payment system for kidney failure care and changes to dosing guidelines for anemia drugs, there were no meaningful differences by race regarding changes in management practices or laboratory measures among dialysis patients.
• Among dialysis patients, aerobic activity was linked positively with health-related quality of life and inversely with depressive symptoms and premature death. • In general, patients had higher aerobic activity levels if they were treated in dialysis clinics offering exercise programs.
• Kidney disease patients with detectable levels of a blood protein called high-sensitivity troponin T had up to a 5-fold increased risk of developing heart failure. • Those with high levels of a protein called N-terminal pro-B-type natriuretic peptide had a nearly 10-fold increased risk of developing heart failure.
• Among kidney transplant recipients, persistent infection with BK virus does not have a negative immediate-term impact on patient or kidney survival, but infected patients are more likely to develop antibodies against their kidney transplants. • Such donor-specific antibodies are known to be detrimental to the survival of transplanted organs.
• Dialysis drives progressive white matter brain injury due to blood pressure instability; however, patients who dialyzed at 0.5◦C below body temperature were completely protected against such white matter changes.
• Among new dialysis patients, the most frequently cited concerns were that patients felt they were doing fine on dialysis and felt uncomfortable asking someone to donate a kidney. • Older age was linked with having high health-related or psychosocial concerns, as was being a woman, being less educated, and having more comorbid illnesses. • Patients having such concerns had less than half the chance of getting listed for a transplant than those without them.
Jane Schell, MD, an Assistant Professor at the University of Pittsburgh School of Medicine, is the inaugural recipient of the William and Sandra Bennett Clinical Scholars program, established to further nephrology education and teaching.
Highlight • Among patients with chronic kidney disease, the risks of developing kidney failure or dying prematurely increased markedly in a step-wise fashion after each successive hospitalization for heart failure.
• When dialysis patients reported discussions about transplantation with clinicians, they had a nearly 3-fold increased likelihood of being listed for transplantation, but clinician-reported discussions did not increase a patient’s likelihood of being listed. • In almost one-third of cases, clinicians reported that they had discussed transplantation with a particular dialysis patient, but the patient said that nobody had discussed it with them.
• Calcium build-up in the coronary artery walls was more useful for correctly predicting kidney disease patients’ risk of heart disease than other measures of atherosclerosis such as thickness of the carotid artery walls and narrowing of the arteries in the legs.
The American Society of Nephrology (ASN) congratulates The New York Times for calling attention to transplant tourism and organ trafficking. Yet ASN is disappointed with the article’s characterization of dialysis and failure to address opportunities to improve this lifesaving therapy. ASN urges Congress to pass legislation to help transplant recipients and living donors.
• In 2 predominantly black dialysis clinics, women were less likely to want to undergo living donor kidney transplantation compared with men, despite being more likely than men to receive unsolicited offers for kidney transplants from family and friends. • Women were also less likely to have been evaluated for a kidney transplant.
A new tool uses 11 questions to accurately calculate the probability that a patient will have another symptomatic kidney stone at 2, 5, or 10 years after the first stone.
Among patients on chronic hemodialysis, those with depressive symptoms and pain were more likely to abbreviate or miss dialysis sessions, visit the emergency department, and be hospitalized. Depressive symptoms were also linked with an increased risk of premature death.
• Among children with sporadic nephrotic syndrome, genetic mutations in the kidney’s filtration barrier were frequently linked with a lack of response to immunosuppressive treatments. • The genetic test was even more predictive than a kidney biopsy for identifying children who would not benefit from immunosuppressive therapies.
• Ferric citrate effectively reduced blood phosphorus levels while increasing iron stores and decreasing the need for intravenous iron and anemia medications in dialysis patients. • The medication may help reduce complications and costs associated with kidney disease care.
• Between 1999 and 2010, lower income regions in the US consistently had lower rates of living donation compared with higher income populations. • The difference in living donation rates between lower and higher income regions was much larger in recent years than it was in the past.
• The increased cost of an expensive drug that can prevent clots in dialysis catheters may be offset by lower costs for managing complications. • Additional studies are needed to determine the medication’s long-term cost and effectiveness.
The American Society of Nephrology (ASN) and the ASN Foundation for Kidney Research will fund $2.8 million in original, meritorious research in 2014 to improve care for the more than 20 million Americans with kidney disease, and for kidney patients worldwide.
• Obesity, high blood pressure, high triglycerides, and diabetes increase a person’s risk of developing chronic kidney disease decades later. • Early identification of such risk factors may help improve efforts to prevent kidney disease.
• In Tennessee and Florida, waiting times and other measures of geographic disparity in kidney transplantation became almost equal after the states adopted a Statewide Sharing variance to the national kidney allocation policy in the early 1990s. • Meanwhile, the geographic disparity in kidney transplantation became worse in other comparable states.
• During the first year of dialysis, white patients overall had higher hospitalization rates than blacks and Hispanics, but younger black patients, older black patients, and older Hispanic patients had increased hospitalization rates compared with whites of similar ages. • Both blacks and Hispanics were at greater risk of hospitalization due to dialysis-related infections than whites.
• Young black adults on dialysis living in poor neighborhoods had a higher risk of dying while still young compared with all other young black and white adults. • Among young adult dialysis patients living in poor neighborhoods, blacks had approximately a 1.5 times greater risk of dying compared with whites.
• Individuals’ risk of kidney cancer increased with decreasing kidney function. • Individuals with poor kidney function also had an increased risk of urothelial cancer • Kidney function was not linked with risk for other cancers, including prostate, breast, lung, and colorectal cancers.
• Kidney transplant patients had a reduced risk of treatment failure or premature death compared with patients on long and frequent home hemodialysis. • Kidney transplant patients had a higher risk of being hospitalized within the first several months to a year, but they had a reduced risk over the long term.
• After adjusting for demographic differences between kidney transplant recipients with polycystic kidney disease (PKD) and other kidney transplant recipients, PKD patients were 16% less likely to develop cancer than others who received a kidney transplant.
• Among patients with chronic kidney disease who were followed for an average of 1.3 years, those who walked for exercise were 33% less likely to die and 21% less likely to need dialysis or a kidney transplant. • The more patients walked, the less likely they were to die or to need dialysis or a transplant.
• Simulation models predict that a newly approved kidney allocation policy will lead to an average 7.0% increase in median patient life-years per transplant and an average 2.8% increase in median allograft years of life. • The policy may also improve access to transplantation for highly sensitized candidates but reduce access for older patients.
• Among kidney failure patients on dialysis who were treated in the hospital, one additional doctor visit in the month following hospital discharge was estimated to reduce the probability of 30-day hospital readmission by 3.5%. • Seeing kidney failure patients one additional time in the month following discharge could save $240 million in health care costs each year.
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