Feature Channels: Kidney Disease

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On behalf of the more than 720,000 Americans with kidney failure whose lives depend on either a kidney transplant or dialysis to survive and their families, the 40 million Americans with kidney diseases, and the more than 20,000 ASN members who are physicians, scientists, nurses, and health professionals, ASN applauds the leadership of HHS Secretary Alex M. Azar, II, in confronting the issue of a three-year statutory restriction on Medicare coverage of immunosuppressant drugs following a kidney transplant. STATEMENT OF AMERICAN SOCIETY OF NEPHROLOGY (ASN) PRESIDENT MARK E. ROSENBERG, MD, FASN, ON HEALTH AND HUMAN SERVICES (HHS) SECRETARY AZAR’S ANNOUNCEMENT ON IMMUNOSUPPRESSIVE COVERAGE FOR KIDNEY TRANSPLANTS Washington, DC (March 15, 2019) – On behalf of the more than 720,000 Americans with kidney failure whose lives depend on either a kidney transplant or dialysis to survive and their families, the 40 million Americans with kidney diseases, and the more than 20,000 ASN members

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In a study of adults in Sweden, poor kidney function was linked with a higher risk of certain cancers, especially skin and urogenital cancers.

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• After examining comprehensive pathology findings and clinical, immunological, and outcome data pertaining to patients with transplant glomerulopathy, investigators identified 5 groups of patients with distinct features, as well as different outcomes in terms of survival rates of transplanted kidneys.

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• Exposure to secondhand smoke was linked with a higher prevalence of kidney disease, as well as development of incident kidney disease. • This association was present even at low levels of exposure.

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• In a phase 3 clinical trial, tenapanor significantly lowered elevated blood phosphate in patients receiving maintenance hemodialysis, resulting in an average reduction of 1.0–1.2 mg/dL over 8 weeks. • Side effects were largely limited to softening of stool and more frequent bowel movements.

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On behalf of the 40 million Americans living with kidney diseases and their families and the more than 20,000 ASN members who are physicians, scientists, nurses, and health professionals, ASN applauds the bold vision and leadership of HHS Secretary Alex M. Azar II in establishing an HHS-wide comprehensive kidney strategy and wholeheartedly agree that “we’ve waited long enough. We just need renewed ambition and the right policies.

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Scientists from Utrecht University, University Medical Center Utrecht and Hubrecht Institute have successfully created kidney organoids from urine cells.

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Henry Ford Health System has appointed Craig Rogers, M.D. the new chair of its Department of Urology, effective April 1, 2019.

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• Payments by organ transplant recipients and Medicare decreased significantly following the introduction of generic immunosuppressive medications. • Large differences in out-of-pocket payments for immunosuppressive medications between Part D beneficiaries who did and did not qualify for the Medicare low-income subsidy suggest that recipients with resources just above the threshold to qualify for the subsidy may experience considerable financial strain.

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Nine patients at Penn Medicine have been cured of the Hepatitis C virus (HCV) following lifesaving heart transplants from deceased donors who were infected with the disease, according to a study published in the American Journal of Transplantation.

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• A set of interventions designed to improve care for patients with acute kidney injury (AKI) was associated with reductions in length of hospital stay, shorter duration of AKI episodes, and an increase in AKI incidence that likely reflected improved recognition. • The intervention also led to improvements in several metrics related to AKI care, including AKI recognition, medication optimization, and fluid assessment by clinicians.

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• People with kidney failure are nearly ten times as likely as other Medicare beneficiaries to undergo lower extremity amputation during their final year of life. • Despite having a poor prognosis, individuals with kidney failure who had a lower extremity amputation in their last year of life had a greater likelihood of admission to—and prolonged stays in—acute and subacute care settings during this time. They also were more likely to die in the hospital and discontinue dialysis, and to spend fewer days receiving hospice services.

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Mining a large database of adverse reactions to medications, UC San Diego researchers found that people who took proton pump inhibitors (e.g., Prilosec, Nexium) for heartburn and acid reflux were more likely to experience kidney disease than people who took other forms of antacid.

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The disease systemic lupus erythematosus (SLE) — marked by the attack on joints, skin, and kidneys by the body’s immune system — is linked to an abnormal mix of bacteria in the gut. This is according to a new study led by scientists at NYU School of Medicine.

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Cholesterol-lowering statin drugs reduce the risk of cardiovascular disease in kidney disease patients who are not on dialysis. But a new study finds that statins are used by only 21.8 percent such patients who do not already have cardiovascular disease or diabetes or have not been diagnosed with high cholesterol.

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A combination of two drugs – one of them an immunotherapy agent – could become a new standard, first-line treatment for patients with metastatic kidney cancer, says an investigator from Dana-Farber Cancer Institute, reporting results from a phase 3 clinical trial.

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In a population-based study, both patients on dialysis and those who received kidney transplants experienced over 2.5-times higher risks of cancer death than age- and sex-matched individuals without kidney failure.

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NYU Langone Transplant Institute launches a new pancreas transplantation program, expanding regional access to care for people with complications from diabetes and other illnesses.

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肾结石是一种常见且痛苦的疾病，许多患者都会经历反复发作。大多数患者在初次排石后想知道未来再次发作的可能性，但这并不容易预测。现在，Mayo Clinic的研究人员通过一个在线预测工具来跟踪肾结石形成者的常见特征，以帮助患者预测未来是否会再次发作。该研究成果发表在 Mayo Clinic Proceedings上。

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Numares and Mayo Clinic Laboratories have announced a collaboration to develop clinical diagnostic tests that will measure clusters of risk factors as opposed to individual biomarkers. The unique testing will use nuclear magnetic resonance (NMR) technology, focusing on cardiovascular disease, kidney disease and liver cancer — among a few other specific diseases.

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Os cálculos renais são uma condição comum e dolorosa, com muitos pacientes experimentando episódios recorrentes. A maioria das pessoas que passam pelo primeiro cálculo renal quer saber quais são as probabilidades de episódios futuros, mas isso não é sempre fácil de prever.

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An individualized diet based on a person's genetics, microbiome and lifestyle is more effective in controlling blood glucose (sugar) levels than one that considers only nutritional composition of food, Mayo Clinic researchers have confirmed. The research published in the Feb. 8 edition of JAMA Network Open demonstrates that each person's body responds differently to similar foods, due to the unique composition of each person's gut microbiome — the complex community of trillions of bacteria within the digestive track.

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• When kidney failure patients experienced cardiac arrest at outpatient dialysis facilities, CPR initiated by dialysis staff was associated with a better chance of survival but was only performed in 81% of cardiac arrest events. • Dialysis staff were more likely to initiate CPR within larger dialysis clinics, for male patients, and when cardiac arrests were witnessed.

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Treatment with the NSAID carprofen triggers subtle low-grade inflammation in the heart and kidneys. The combination of carprofen pretreatment and heart attack magnifies this impact by dysregulating the acute inflammatory response, amplifying inflammation and intensifying the cardiorenal syndrome.

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Los cálculos renales no solo son frecuentes y dolorosos, sino que muchos sufren eventos recurrentes. La mayoría de las personas que pasan el primer cálculo renal desean saber cuál es la probabilidad de tener otro en el futuro, pero eso no siempre es fácil de predecir.

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• Certain practices in dialysis facilities related to managing fluid volume and low blood pressure during dialysis are important to patients’ health and survival.

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Kidney stones are a common and painful condition, with many sufferers experiencing recurrent episodes. Most people who pass an initial stone want to know their chances of future episodes, but this has not always been easy to predict. Now Mayo Clinic researchers are tracking the familiar characteristics of kidney stone formers in an online prediction tool that could help sufferers anticipate if they'll experience future episodes. The study was published in Mayo Clinic Proceedings.

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• Among kidney failure patients on hemodialysis, those who consumed higher amounts of fruits and vegetables had lower risks for dying prematurely—both from cardiovascular and non-cardiovascular causes.

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For a patient awaiting a new organ – namely a liver or kidney – living donation provides a viable alternative and can often shorten a recipient’s wait time.

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Three ultrasound measurements moderately, but significantly, predict successful arteriovenous fistula maturation. Mature fistulas are vital for hemodialysis, but half fail to mature. This information can facilitate decisions by the clinician, like new surgery or abandonment of the fistula.

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Kidney transplant recipients are now benefiting from donor organs that do not match their blood type but are compatible and just as safe, according to a Vanderbilt University Medical Center study in the Journal of the American College of Surgeons.

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Extremely high blood pressure that leads to strokes, heart attacks and acute kidney damage, classified as hypertensive emergency, is five times higher in inner-city African-American patients than the national average, according to a recent study co-lead by a Rutgers researcher.

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• Patients undergoing dialysis experience various barriers to exercise—predominately fatigue, shortness of breath, and weakness. • Patients were primarily interested in exercise as a mechanism to improve quality of life as opposed to reduce heart disease and hospitalization.

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Intermountain Healthcare has announced a new collaboration with Israeli healthcare IT company MDClone to increase caregivers’ ability to transform data into information they can use to help people lead the healthiest lives possible.

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• Among kidney transplant recipients, cognitive performance improved significantly for both frail and nonfrail recipients by 3 months post-transplant. • Between 1 and 4 years post-transplant, improvements plateaued among nonfrail recipients, whereas cognitive function declined among frail recipients.

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• Influenza-like illness was linked with seasonal variation in the death rates of US patients with kidney failure.

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Researchers have found that, during acute kidney injury in a mouse model, the kidney-resident macrophages are reprogrammed to a developmental state, resembling these same cells when they are found in newborn mice. This reprogramming may be important to promote healing and tissue regeneration.

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Lower-than-normal zinc levels may contribute to high blood pressure (hypertension) by altering the way the kidneys handle sodium. The study is published ahead of print in the American Journal of Physiology—Renal Physiology.

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The American Society of Transplant Surgeons (ASTS) has accredited Loyola Medicine to offer a prestigious two-year fellowship in liver and kidney transplant surgery.

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• Whole-exome sequencing of blood or saliva revealed a genetic diagnosis of kidney disease in 32.7% of pediatric kidney transplant recipients. • The findings indicate that such a sequencing strategy may help individualize pre- and post-transplant care for many young kidney transplant recipients.

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The American Society of Transplant Surgeons (ASTS) has accredited Loyola Medicine to offer a prestigious two-year fellowship in liver and kidney transplant surgery. The first fellow will begin in July, 2020.

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New research suggests that drinking sugary, caffeinated soft drinks while exercising in hot weather may increase the risk of kidney disease. The study is published ahead of print in the American Journal of Physiology—Regulatory, Integrative and Comparative Physiology.

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New AI developed at the University of Surrey could identify and help reduce one of the top causes of hospitalisation for people living with dementia: urinary tract infections (UTI).

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Manish Kohli, M.D., has joined Moffitt Cancer Center as the vice chair of the Department of Genitourinary Oncology. He also has an extensive research background, focusing on creating new ways to bring individualized care to patients.

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Vanderbilt University Medical Center (VUMC) set a new record for total transplants among its five organ specialties in 2018 with more than 500 transplants.

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The replication of a bacterial virus is not necessary to cause lethal disease in a mouse model of a food-borne pathogen called Enterohemorrhagic Escherichia coli (EHEC), according to a study published January 10 in the open-access journal PLOS Pathogens by Sowmya Balasubramanian, John Leong and Marcia Osburne of Tufts University School of Medicine, and colleagues. The surprising findings could lead to the development of novel strategies for the treatment of EHEC and life-threatening kidney-related complications in children.

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• Scientists reveal activated structure of a receptor critical for blood pressure, salt homeostasis • Receptor is a target for drugs widely used to treat hypertension

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Research suggests that a gene that governs the body’s biological (circadian) clock acts differently in males versus females and may protect females from heart disease. The study is the first to analyze circadian blood pressure rhythms in female mice. The research, published ahead of print in the American Journal of Physiology—Regulatory, Integrative and Comparative Physiology, was chosen as an APSselect article for January.