Highlights • Children with a particular kidney immune disorder that is unresponsive to standard treatments do not benefit from the immune drug rituximab. • Additional studies are needed to fully understand the disease and to develop effective therapies for hard-to-treat cases.
Kidney disease a growing public health problem: ASN urges Congress to make a difference.
• A policy instituted in 2005 has reduced racial disparities in deceased-donor kidney transplantation among children. • Since the institution of the policy, called Share 35, fewer children receive kidneys from living donors. More than 800 children and adolescents in the U.S. are waiting for a kidney transplant.
• A technique that removes additional toxins during dialysis does not improve kidney failure patients’ survival or heart health, but intense treatments may provide a benefit. • The technique, called hemodiafiltration, deserves more study. Kidney failure is on the rise and currently afflicts 2 million people worldwide.
1) Information on a mandatory Medicare form regarding the care that older chronic kidney disease patients receive doesn’t match the actual care that is billed by physicians. 2) Better accuracy and consistency are needed when clinicians complete this form and submit it to Medicare.
• Minorities–especially African Americans, Hispanics, Pacific Islanders, and Native Americans–face a disproportionately increased risk for developing kidney disease. • The American Society of Nephrology, Dialysis Patient Citizens, and the National Urban League are hosting a Kidney Health Disparities Congressional Briefing this week.
Highlights: • In the largest observational study of its kind, 84% of all women and 55% of sexually active women on hemodialysis experienced sexual problems. • Sexual dysfunction was reported more often by women who were older, were less educated, had signs of depression, had reached menopause, had diabetes, and took diuretic therapy, or ‘water pills.’
Highlights:• Poor mental health may negatively affect dialysis patients’ heart health and survival. • Patients with poor mental health over time tend to die or be hospitalized for heart problems sooner than patients with good mental health. • Studies are needed to see if caring for kidney disease patients’ mental health may help prevent heart complications and even death.
The American Society of Nephrology (ASN), the world’s leading kidney organization, joins the American Board of Internal Medicine (ABIM) Foundation, eight other leading national medical specialty societies, and Consumer Reports in the new Choosing Wisely® campaign
• For most kidney failure patients, the age of a live donor—ranging from 18 to 64 years—has an insignificant effect on the long-term health of a transplanted kidney. • The finding should encourage more people to take part in living donor paired exchange programs, or kidney swaps.
• Patients with kidney failure have relatively poor physical health. • Frequent dialysis does not markedly improve kidney failure patients’ overall physical capacity compared with conventional dialysis.
• In 2007, 64% of Medicare beneficiaries with kidney failure participated in Medicare’s Part D prescription drug coverage program. • Of these Part D enrollees, 72% received financial assistance from the program. • Those who self-enrolled in Part D plans without financial assistance often chose more expensive coverage options. • 17% of Medicare beneficiaries with kidney failure lacked a known source of prescription drug coverage.
• Chronic kidney disease doesn’t always lead to kidney failure, and in some cases, kidney function can improve. • In this study, 10% of patients did not experience progressive kidney dysfunction, and 3% demonstrated clearly improved kidney function. • 60 million people globally have chronic kidney disease.
1) Many patients who undergo heart surgery experience kidney complications. 2) Blood and urine markers can indicate which surgery patients with injured kidneys will experience worsening kidney function. 3) Testing for these markers soon after heart surgery could help protect patients' kidneys.
• Kidney disease patients experience low complication rates after weight-loss surgery. • Maintaining weight loss is challenging for kidney disease patients, and obesity can limit their eligibility for kidney transplants. • Long-term studies are needed to determine whether the potential benefits of weight-loss surgery outweigh risks for kidney disease patients.
1) Frequent or extended dialysis treatments during the day or at night may improve patients’ survival compared with conventional dialysis. 2) Nighttime or daily dialysis may also improve patients’ health and reduce their need for medications. 3) Approximately 2 million patients in the world receive some sort of dialysis treatment.
Highlights: 1) Certain treatment reminders meant to improve primary care physicians’ prescribing habits for patients with chronic kidney disease (CKD) are ineffective. 2) Nearly 20% of people over the age of 65 years have CKD, and primary care physicians care for the vast majority of them. 3) Additional studies are needed to find ways to help improve physicians’ care of CKD patients.
Highlights: 1) Kidney transplantation is the preferred treatment for kidney failure patients, but blacks are less likely to receive kidney transplants than whites. 2) Kidney failure patients—particularly blacks and those living in poor neighborhoods—who take part in an education program are more likely to get evaluated for a kidney transplant. 3) Requiring a formal patient education class may help reduce disparities in kidney failure patients’ access to kidney transplantation.
1) Home-based dialysis treatments for kidney failure are on the rise, particularly in developing countries. 2) Developed countries appear to be turning to home-based dialysis less. 3) Approximately 2 million kidney disease patients in the world receive some sort of dialysis treatment.
Highlights: 1) Patients who quickly stop taking the immunosuppressant prednisone after receiving a kidney transplant avoid experiencing serious prednisone-related side effects. 2) This rapid discontinuation of prednisone does not jeopardize the long-term survival of patients and their new organs. 3) Approximately 16,500 patients receive kidney transplants each year in the United States and must take prednisone and/or other immunosuppressive drugs.
Highlights • More than 20 million adults in the United States have chronic kidney disease. • Drugs that treat red blood cell deficiencies are critical for maintaining many chronic kidney disease patients’ health. • Experts comment on newly released federal recommendations for these drugs.
Highlights • High levels of TNF receptors in the blood increased diabetes patients’ risk of developing kidney problems by three- to five-fold a decade later. • Measuring blood levels of TNF receptors may help predict which patients’ kidneys are in jeopardy, and targeting TNF receptors may help protect them. • Half a million people in the U.S. have kidney failure and require dialysis or a kidney transplant, and 44% of these cases are due to diabetes.
Highlights • Bleeding in the upper gastrointestinal tract occurs more than 10 times as often in kidney failure patients than in individuals in the general population. • Upper gastrointestinal bleeding causes serious health problems—and even early deaths—for many patients with kidney failure. • More than 600,000 patients in the United States have kidney failure.
1) Hemodialysis uses up large amounts of water and power. 2) Solar power can help offset high utility costs and make dialysis treatments greener. 3) Approximately 2 million patients in the world receive some sort of dialysis treatment.
Highlights • Correcting anemia in kidney transplant recipients slows the progression of kidney failure and improves the function of transplanted kidneys. • Transplant patients with completely corrected anemia experience a significant improvement in quality of life. • Anemia is a common complication of kidney transplantation, with a prevalence of 25% to 40% after the first year.
1) Certain measures of kidney health can also predict who is likely to die prematurely. 2) Blood levels of the proteins creatinine, beta trace protein, and cystatin C may portray aspects of health that go beyond the kidneys. 3) Future studies should investigate whether a panel of markers of kidney function would provide a better prediction of an individual’s prognosis than any one marker alone.
Choosing WiselyTM campaign helps identify tests or procedures that may be reduced or eliminated to improve patient care.
Highlights: 1) Abrupt kidney injury can lead to numerous complications that affect individuals’ health and survival. 2) Soldiers’ kidneys are often at risk and can fail among those burned during combat in Iraq and Afghanistan. 3) Burned military patients with kidney injury are more likely to die than those without kidney injury.
Highlights: 1) Two similar blood pressure–lowering drugs could have different effects on dialysis patients’ heart health. 2) Angiotensin receptor blockers are more effective at fighting inflammation while angiotensin converting enzyme inhibitors are better at preventing blood vessel damage. Both properties could help prevent heart disease. 3) About 20% of kidney disease patients die within one year after they start dialysis and more than half die after five years—mostly from heart disease.
Highlights: 1) Few patients with injured kidneys that do not get better see a kidney specialist within a year of the injury. 2) Without treatment, kidney injuries can lead to kidney disease and other complications that affect individuals’ health and survival. 3) Physicians should strive to identify and treat kidney injury patients who need care.
1) Among patients on dialysis, African Americans tend to live longer than whites. 2) This survival difference only exists among patients with high levels of inflammation. 3) Determining inflammation’s role may improve survival for all patients treated with dialysis.
Dr. Ronald J. Falk leads the American Society of Nephrology.
Highlights: 1) People with type 1 diabetes are at high risk of developing kidney disease. 2) Intensive diabetes therapy can preserve kidney function in patients with type 1 diabetes. 3) Between one million and three million Americans may have type 1 diabetes. Each year, more than 15,000 children and 15,000 adults - approximately 80 people per day - are diagnosed with type 1 diabetes in the United States.
Highlights: 1) Medicare will soon reduce reimbursements to some dialysis facilities, which may lead to closures. Patients will have to drive further to get care at other facilities, which could compromise their health. 2) The Healthy People initiative provides 10-year national objectives for improving the health of all Americans. Healthy People 2020 presents new kidney-related objectives.
Highlights: 1) Sitagliptin is as effective as glipizide at lowering blood sugar levels in patients with type 2 diabetes and chronic kidney disease. 2) Sitagliptin is less likely than glipizide to cause dangerously low blood sugar levels. 3) Patients on sitagliptin tend to lose weight, while those on glipizide gain weight.
Highlights: 1) A test done mid-pregnancy accurately predicts which women will later develop preeclampsia, a late-pregnancy disorder characterized by high blood pressure and excess protein in the urine. Left untreated, preeclampsia can lead to serious—even fatal—complications for a pregnant woman and her baby. 2) Women with high blood pressure during pregnancy risk experiencing high blood pressure, kidney problems, and stroke in the future compared to women with normal blood pressure during pregnancy.
Highlights: 1) Pomegranate juice lowers kidney disease patients’ cholesterol, blood pressure, and the need for blood pressure medications. 2) More than 15% of kidney disease patients take herbs or dietary supplements that the National Kidney Foundation says may be harmful to their health.
Highlights: 1) Diabetic patients with kidney failure benefit the most when their hemoglobin A1C levels, which reflect blood glucose levels, are between 7% and 8%. 2) For diabetics who need dialysis, hemoglobin A1C levels of 8% or greater or less than 7% put them at increased risk of dying prematurely compared to patients with levels between 7.0% and 7.9%.
Highlights: 1) Pediatric racial minorities are much less likely than whites to get kidney transplants before they need dialysis, regardless of their families’ income. 2) Among children with kidney failure waiting for a transplant, blacks with no health insurance are more likely to die than whites, while Hispanics are less likely to die than other racial groups regardless of insurance status.
1) Healthy individuals over 70 years old can safely donate a kidney. 2) Kidneys from elderly donors do not last as long as those from younger living donors, but they last just as long as organs from younger deceased donors. 3) Nearly 90,000 people in the U.S. are waiting for a kidney transplant, and many will die before a suitable organ becomes available.
1) The current classification system for the kidney disorder called lupus nephritis is too detailed. 2) Physicians would benefit from a simpler classification system when they treat kidney problems in patients with lupus. 3) Lupus nephritis affects approximately 3 out of every 10,000 people, and it can be serious and lead to kidney failure.
1) Patients with an autoimmune disease called anti-neutrophil cytoplasmic antibody-associated vasculitis produce antibodies that damage blood vessels in the kidneys. 2) Patients with the disease harbor elevated blood levels of the protein Flt1, which hinders blood vessel repair. 3) Inhibiting Flt1 may help prevent kidney failure in the 1:50,000 patients around the world who have anti-neutrophil cytoplasmic antibody-associated vasculitis, plus those with other more frequent diseases involving blood vessels in the kidneys.
1) Pyridorin, a vitamin B6 derivative, may help slow or prevent the progression of mild kidney disease in some patients with diabetes. 2) The drug does not appear to help diabetics with more advanced kidney disease. 3) The prevalence of type 2 diabetes is expected to double by 2030. Kidney disease cases are sure to rise in parallel.
1) Suloxdexide is no better than placebo at preventing kidney failure or reducing urinary protein excretion in diabetes patients with kidney failure. 2) Kidney disease due to diabetes is the most common cause of kidney failure in developed countries. 3) The prevalence of type 2 diabetes is expected to double by 2030. Kidney disease cases are sure to rise in parallel.
1) Autosomal dominant polycystic kidney disease affects 12.5 million people worldwide; some patients develop severe disease during early childhood 2) Certain genetic mutations aggravate the disease and cause early symptoms 3) Genetic tests could identify who’s at risk for early disease.
1) Patient characteristics affect whether dialysis clinics achieve treatment success and receive Medicare reimbursement. 2) How well kidney disease patients follow their prescribed treatments has the greatest impact. 3) Dialysis clinics in low-income urban areas provide care to more patients who don’t follow their prescribed treatments; these clinics get unfairly penalized.
1) Patients who take at least one blood pressure-lowering medication at bedtime have better control of their blood pressure and are less likely to experience heart problems than patients who take medications in the morning. 2) Sleep-time blood pressure is a better measure of heart health than wake-time blood pressure. 3) About one out of three U.S. adults has high blood pressure.
1) One out of 20,000 newborns has autosomal recessive polycystic kidney disease, and 30% die shortly after birth. 2) The gene that’s implicated in the disease produces a protein that’s important for signaling in the kidneys 3) New urine tests might help diagnose the disease.
Gene testing could help identify patients who need early treatment.
1) Public reporting of the successes and failures of transplant centers has not diminished the gaps between the best and worst centers. 2) If each center’s performance matched that of the best center, about a third of deaths and organ failures could be averted.
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