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• An assessment of symptoms that was incorporated into routine care for patients undergoing hemodialysis successfully standardized symptom screening processes, improved patient and provider symptom awareness, and empowered patients to raise issues with providers. • There was little, if any, improvement in the metrics used to assess symptom management, communication between patients and providers, and communication among different types of clinicians.

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• Among US patients undergoing dialysis, those visiting dialysis facilities with higher proportions of minorities are less likely to be vaccinated against influenza, and the disparity seems to be increasing.

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• Studies conducted in mouse models, patients with cystic fibrosis, and different types of cells have helped to define how cystic fibrosis affects the kidneys. • A urine test may help to assess aspects of cystic fibrosis in patients, which may be useful for testing the effectiveness of new medications.

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Today, the U.S. Department of Health and Human Services (HHS) and the American Society of Nephrology (ASN) announced the six winners of the $3 million KidneyX: Redesign Dialysis Phase 2 competition during the virtual KidneyX Summit.

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• Exposure to higher amounts of fine particulate air pollution was associated with higher death rates among patients with kidney failure.

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• A recent study found that most kidney transplant recipients with COVID-19 do not need to be hospitalized. • Another study found that patients on dialysis who develop COVID-19 may have symptoms that are different from other patients with the infectious disease.

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• Kidney diseases affect more than 850 million people worldwide. • KidneyCure continues to propel positive change in public health, once again funding more than $3 million to support research that changes lives. • This year’s grant recipients, among the best and the brightest in the field, bring energy, innovation and expertise to areas undergoing rapid change: acute kidney injury and repair, home dialysis, and post-transplant care.

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• A new study has found that common terms used by physicians to describe kidney health may be distressing or too difficult to understand for patients with kidney disease.

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• Physicians who are training to become kidney specialists reported that the electronic medical record enhances their education, but the time demands of data and order entry can be a downside.

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People with kidney diseases are often excluded from clinical trials because of the complexity and high morbidity of kidney disease. COVID-19 puts people with kidney diseases at a two to sixteen-fold increased risk of severe symptoms. All investigators should include people with kidney diseases when developing vaccines, preventative therapies or treatments related to COVID-19.

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• In a study of adults with kidney failure treated with dialysis, 21% of patients reported regret that they decided to initiate dialysis. Certain factors were linked with a higher likelihood of experiencing regret

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• In a study of patients with newly diagnosed kidney failure at 71 kidney centers in the UK, older age, additional illnesses, obesity, and lower socioeconomic status were associated with a lower likelihood of being put on transplant waiting list.

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The COVID-19 pandemic highlights the vulnerability of people with kidney failure who rely on in-center hemodialysis. People with kidney failure are at high risk of severe COVID-19 complications and are exposed to infection due to a kidney replacement therapy process that requires traveling to a dialysis facility multiple times a week.

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• In an analysis of information on US adults initiating hemodialysis, 16% of patients were dispensed a short-acting benzodiazepine, and approximately one-quarter of these patients were also dispensed opioids. • Among patients with an opioid prescription, being dispensed a short-acting benzodiazepine had a 1.9-fold higher risk of dying over a median follow-up of 16 months compared with patients without a short-acting benzodiazepine.

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• In an analysis of blood and urine samples from 46,748 US adults, elevated levels of 7 environmental chemicals were associated with markers of kidney disease.

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• Among adults with kidney failure who were referred for transplantation, 60% of black and 66% of white patients were waitlisted within the first year. Differences in socioeconomic status and comorbidities between black and white patients could explain up to 58% of the disparity in listing. • Fewer black patients on transplant wait lists received transplants compared with white patients, but differences in socioeconomic status and comorbidities did not explain this disparity.

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• When considering treatments, patients with glomerular disease and their caregivers gave highest priority to the health outcomes of kidney function, mortality, and need for dialysis or transplant. • They also highly prioritized patient-reported outcomes such as life participation and fatigue that are not typically reported in clinical trials.

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• In a study of urban-dwelling individuals, housing insecurity was linked with a higher risk of developing albuminuria, a sign of kidney disease.

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• The American Society of Nephrology has launched several initiatives to provide guidance on COVID-19 as it relates to the care of patients with kidney disease.

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• Two studies examine potential benefits of blood pressure monitoring outside of doctors’ offices for patients with kidney disease.

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• In an analysis of information on adults who began treatment for kidney failure at any Georgia, North Carolina, or South Carolina dialysis facility, the distance from a patient’s residence to the nearest transplant center did not appear to affect the likelihood of transplant-related referrals and evaluations.

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Available evidence supports the use of marked changes in urine oxalate in CKD stages 1-3a and plasma oxalate in CKD stages 3b-5 as surrogate end points for clinical trials in primary hyperoxaluria. Worsening kidney function is considered an acceptable clinical trial end point; however in many patients with primary hyperoxaluria, kidney function is not lost at a rapid rate until very advanced stages of disease. Kidney stones are clinically meaningful, though lack sufficient standards for measurement and monitoring. Their role as a feasible clinical end point should be reconsidered as more data becomes available.

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• Study results call into question the utility of testing blood pressure load—the proportion of elevated blood pressure readings detected over 24 hours—for diagnosing hypertension in children.

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• In a study of kidney transplant recipients, the composition of certain immune cells in the blood 1 year after kidney transplantation was linked with a patient’s subsequent risk of kidney transplant failure.

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Tod Ibrahim, executive vice president of the American Society of Nephrology, was recently named president of the Council of Medical Specialty Societies (CMSS).

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• Exposure to higher amounts of fine particulate matter air pollution was associated with a higher degree of albuminuria—a marker of kidney dysfunction—as well as a higher risk of developing chronic kidney disease over time.

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• Among patients with kidney failure and atrial fibrillation, Black, Hispanic White, and Asian patients filled prescriptions of stroke-preventive medications less often than non-Hispanic White patients, and they were more likely to experience stroke. • Equalizing the distribution of these medications would prevent 7%–12% of the stroke disparity among racial/ethnic minorities.

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• Researchers observed incremental increases in the incidence of 2 types of kidney disease—lupus nephritis and ANCA-related glomerulonephritis—with increasingly lower income.

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• This study examined the validity of national quality measures used to assess the quality of kidney-related care in the United States. • Of 60 existing quality metrics related to kidney care, only half were rated as highly valid.

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• Survival after kidney transplantation during childhood has improved over the last 40 years in Australia. • Survival rates improved primality due to decreases in deaths from cardiovascular disease and infection.

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American Society of Nephrology briefing on kidneyx: accelerating the future of kidney care

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• Between 15 and 22 out of every 100 patients in India with mild-to-moderate chronic kidney disease had significant impairment in at least 1 of the 5 domains of quality of life. • Quality of life scores were associated with sociodemographic factors (lower income, poor education, and female gender), with almost no major impact of medical- or disease-related variables.

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• An analysis compared transplant recipients who received kidneys through national kidney paired donation and those who received kidneys from other living donors (such as relatives, friends or other paired exchange mechanisms). • Despite a higher number of risk factors for poor outcomes in the kidney paired donation group, recipients in the two groups had similar rates of organ failure and mortality over a median follow-up of 3.7 years.

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• In analyses of biopsies of deceased donor kidneys, a repeat biopsy often showed very different findings than the initial biopsy, calling into question decisions to decline an organ based on the initial biopsy findings. • Although the first biopsy findings were not associated with post-transplant outcomes, findings from the second biopsies—which were performed in a relatively standardized manner at one organ procurement organization and read by the same group of pathologists—provided useful information about how well the organ functioned after transplantation.

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• Subtle structural features of donated kidneys—which were observed through biopsies taken at the time of donation—were associated with the longevity of organs after they were transplanted.

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The American Society of Nephrology (ASN) has developed a Kidney Care First (KCF) Model Calculator, a tool that will help nephrologists anticipate how their practices might perform if they choose to participate in the new payment program.

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• In adults followed for a median of 17.5 years, cardiovascular diseases—including heart failure, atrial fibrillation, coronary heart disease, and stroke—were each linked with a higher risk of developing kidney failure. • Heart failure was associated with the highest risk: adults hospitalized with heart failure had an 11.4-times higher risk of developing kidney failure than individuals without cardiovascular disease.

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Washington, DC (January 8, 2020) — The House Energy and Commerce Committee is scheduled to hold a hearing on Wednesday, January 8, on the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2019, advancing a long-standing legislative priority of the American Society of Nephrology.

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• Among patients who experience cardiac arrest while in the hospital, those on dialysis were less likely to have a shockable rhythm and more likely to be outside of the intensive care unit at the time of arrest compared with patients not on dialysis. • Patients on dialysis had lower scores for resuscitation quality, and they were less likely to have defibrillation within 2 minutes. • Patients on dialysis had a similar likelihood of surviving to hospital discharge, and they had better neurological function at the time of discharge.

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• In a study of kidney transplant recipients, those with higher adherence to the Mediterranean diet were less likely to experience kidney function loss.

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Today, seven new members were named to the Kidney Health Initiative (KHI) Board of Directors. KHI is a public-private partnership between the American Society of Nephrology (ASN) and the US Food and Drug Administration (FDA).

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This study identified the types of dialysis facilities in the United States that care for “safety-net reliant” dialysis patients—those who are uninsured or have only Medicaid coverage and do not qualify for Medicare.

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• In an analysis of patients treated with dialysis in the 5 U.S. territories and the 50 U.S. states between 1995 and 2012, the mortality rates were similar for Whites or Blacks, and higher for Hispanics and Asians in the territories.

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The US Department of Health and Human Services (HHS) today took bold steps 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.

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KidneyX received $5,000,000 in the government spending package announced late Monday, December 16. Included as part of two “omnibus” spending packages, the Labor, Health and Human Services, Education, and Related Agencies (LHHS) bill includes first-time funding for KidneyX for Fiscal Year 2020.

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• Among 1,018 children with newly diagnosed chronic kidney disease and 4,072 children with normal kidney function who were seen at primary care practices, 71% and 50%, respectively, received at least one medication that might be toxic to the kidneys over an average follow-up of 3.3 years. • The rate of such prescriptions was 4-times higher in patients with kidney disease than in those without.

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• After a Medicare payment policy related to dialysis was implemented in 2011, use of home-based peritoneal dialysis increased significantly. • Increases were seen for both “early” and “late” peritoneal dialysis: more patients initiated dialysis with peritoneal dialysis and more patients switched from hemodialysis to peritoneal dialysis.

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• Deletion of the gene that codes for an enzyme called GSTM1 increased kidney injury in mice with hypertension and kidney disease, but supplementing the diet with broccoli powder lessened kidney injury in the genetically altered mice. • In humans, high consumption of broccoli and other cruciferous vegetables was linked with a lower risk of kidney failure, primarily in individuals lacking GSTM1.

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• Wearable and implantable devices may allow for intensive self-care for patients with kidney failure outside of the clinic. • Additional research must focus on technological improvements to bring such ambulatory devices to patients as envisioned by the recent Executive Order on the “Advancing American Kidney Health Initiative”.

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The American Society of Nephrology (ASN) is pleased to announce the winners of the new Midcareer Awards, which recognize nephrologists who have distinguished themselves in five key areas of accomplishment early in their careers.