The U.S. Department of Health and Human Services Office of the Chief Technology Officer and the American Society of Nephrology have selected 15 winning teams for Phase 1 of the KidneyX Redesign Dialysis prize competition. Through a series of prize competitions offering cash awards and other incentives, KidneyX aims to accelerate the development of innovative medical products and approaches that can significantly improve the way we prevent, diagnose, and treat kidney diseases.
• In middle-aged adults, following a healthy plant-based diet was linked with a lower risk of developing chronic kidney disease.
• Following an overall plant-based diet or a healthy plant-based diet was linked with experiencing a slower decline in kidney function.
• The Time to Reduce Mortality in ESRD (TiME) trial was a large pragmatic trial demonstration project designed to determine the benefits of hemodialysis sessions that are longer than many patients currently receive.
• The trial was conducted through a partnership between academic investigators and 2 large dialysis provider organizations using a highly centralized implementation approach.
• Although the trial accomplished most of its demonstration project objectives, uptake of the intervention was insufficient to determine whether longer sessions improve outcomes.
• A large genome-wide association study has identified 14 variants—including 9 new variants—at different locations in the genome that are linked to the development of kidney stones.
• Four of the variants were related to obesity, high triglycerides, or high blood uric acid levels. The remaining 10 variants were associated with kidney- or electrolyte-related traits that might affect crystallization pathways that lead to kidney stone formation.
• The prevalence of moderate-to-extreme pruritus in patients with non-dialysis chronic kidney disease was 24% and was more likely in older patients, women, and in those with advanced kidney disease, among other health conditions.
• More severe pruritus was associated with progressively poorer measures of quality of life and a higher likelihood of self-reported depression and restless sleep.
• Two new studies provide insights on how physicians can effectively and efficiently evaluate patient-reported outcomes and health-related quality of life in individuals with kidney disease.
• Very few apps related to chronic kidney disease are highly rated by patients or physicians
• Patient ratings of smartphone apps related to managing kidney disease correlated poorly with both physician ratings and consumer ratings.
Advocates from the American Society of Nephrology (ASN) and the American Association of Kidney Patients (AAKP) are meeting with representatives, senators, and their respective staffs today to urge Congress to support KidneyX, a public-private partnership to accelerate innovation in the prevention, diagnosis, and treatment of kidney diseases.
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
• 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.
• 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.
• 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.
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.
• 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.
• 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.
• 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.
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.
• 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.
• Certain practices in dialysis facilities related to managing fluid volume and low blood pressure during dialysis are important to patients’ health and survival.
• 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.
• 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.
• 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.
• 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.
• In a study of African-American men and women with normal kidney function, a pattern of higher collective consumption of soda, sweetened fruit drinks, and water was associated with a higher risk of developing kidney disease.
• Patients on peritoneal dialysis and their caregivers give high priority to clinical outcomes (such as infection and mortality) and many patient-reported outcomes (particularly fatigue and flexibility with time), which are absent in most trials in peritoneal dialysis.
• Dialysis reimbursement policies in most countries are focused on conventional in-center hemodialysis, although home hemodialysis and peritoneal dialysis might contribute to quality of life and cost savings.
• The reimbursement for dialysis in low- and middle-income countries is insufficient to treat all patients with kidney failure and has a disproportionately high impact on public health expenditure in those countries.
• Concerning adherence to certain recommended measures of kidney disease care for veterans with diabetes within the Veterans Affairs Health Care System, there is modest facility-level variation for some measures and larger facility-level variation for others.
• A pilot program delivered by community health representatives in the homes of patients with chronic kidney disease in Zuni Pueblo in rural New Mexico promoted patients’ active involvement in their own care.
• The program also led to modest improvements in several clinical measures, including decreases in body mass index, blood glucose levels, and inflammation, and improved mental health quality of life.
• In a study that compared uninsured patients starting hemodialysis with similar patients already covered by Medicare or Medicaid, patients with Medicare or Medicaid were more likely to receive dialysis through an arteriovenous fistula or graft by their fourth dialysis month.
• Patients with Medicare at the start of dialysis also had fewer hospitalizations involving vascular access infection in dialysis months 4-12.
The American Society of Nephrology (ASN) today announced former ASN President Raymond C. Harris, Jr., MD, FASN, will serve as co-chair for its Kidney Health Initiative (KHI). Harris, a professor of medicine, molecular physiology, and biophysics, is Director of the Vanderbilt Center for Kidney Disease and former chief of the nephrology division of Vanderbilt University’s Medical Center in Nashville, Tenn.
The American Society of Nephrology (ASN), the world’s largest organization of kidney health professionals, has elected Mark E. Rosenberg, MD, FASN, as the next ASN President.
Dr. Rosenberg officially assumes his role as ASN President during the society’s annual meeting, ASN Kidney Week 2018, the largest gathering of kidney care specialists in the world, and he will begin his term on January 1, 2019.
• Frailty is associated with decreased access at multiple stages in the pathway to kidney transplantation. Improvement in physical frailty may increase access to transplantation.
• Results from the study will be presented at ASN Kidney Week 2018 October 23–October 28 at the San Diego Convention Center.
• An analysis reveals that many transplanted kidneys in France would have likely been discarded in the United States.
• Results from the study will be presented at ASN Kidney Week 2018 October 23–October 28 at the San Diego Convention Center.
• Nephrologists often lack confidence in managing women’s health issues that may be related to kidney disease.
• Results from the study will be presented at ASN Kidney Week 2018 October 23–October 28 at the San Diego Convention Center.
• Among patients with chronic kidney disease, individuals with pro-inflammatory diets had a higher risk of developing kidney failure.
• Results from the study will be presented at ASN Kidney Week 2018 October 23–October 28 at the San Diego Convention Center.
• Individuals with kidney disease have a higher likelihood of using prescription opioids, and the prevalence of prescription opioid use in the chronic kidney disease population has increased in recent years.
• Certain factors are associated with opioid drug use in patients with chronic kidney disease.
• Results from the study will be presented at ASN Kidney Week 2018 October 23–October 28 at the San Diego Convention Center.
• Within one year after initiating dialysis, patients on more frequent home hemodialysis were 23% less likely to die compared with patients receiving traditional in-center hemodialysis.
• Results from the study will be presented at ASN Kidney Week 2018 October 23–October 28 at the San Diego Convention Center.
The results of numerous high-impact clinical trials that could affect kidney-related medical care will be presented at ASN Kidney Week 2018 October 23–October 28 at the San Diego Convention Center.
• Compared with kidney transplant recipients who did not report a disability, recipients with a visual disability were at higher risk of organ failure and recipients with a walking disability were at higher risk of early death.
• Results from the study will be presented at ASN Kidney Week 2018 October 23–October 28 at the San Diego Convention Center.
• From 1995 to 2014, patient survival after kidney transplantation improved overall for pediatric recipients in the United States; however, racial/ethnic disparities in long-term survival worsened over time.
• Results from the study will be presented at ASN Kidney Week 2018 October 23–October 28 at the San Diego Convention Center.
• Patients with acute kidney injury had more than a 3-fold higher risk of developing dementia compared with those without acute kidney injury during a median follow-up time of 5.8 years.
• Results from the study will be presented at ASN Kidney Week 2018 October 23–October 28 at the San Diego Convention Center.
• In a study of kidney transplant recipients, those with ideal BMI (18–25) had the best organ survival. There was no difference when comparing BMI 30–35 with >35.
• There were no significant differences in patient survival across different BMI groups.
• Results from the study will be presented at ASN Kidney Week 2018 October 23–October 28 at the San Diego Convention Center.
• In patients with type 2 diabetes at high risk for cardiovascular disease, targeting blood sugar to normal levels (HbA1c<6.0%) reduced the risk for macroalbuminuria (a high amount of protein excreted in the urine) over an average follow-up of 7.7 years, but it had no impact on more significant kidney outcomes such as serum creatinine doubling (a marker of worsening kidney function) or the need for dialysis or transplantation.
• Targeting low blood pressures (<120mmHg) or the use of fenofibrate to lower cholesterol increased the risk for doubling of serum creatinine, although it had no impact on the need for dialysis or transplantation.
• Results from biopsies taken when kidneys were procured from donors were not reliable for determining whether the organs were suitable for transplantation.
The American Society of Nephrology’s Kidney Health Initiative is releasing its Technology Roadmap for Innovative Approaches to Renal Replacement Therapy.
• Receiving high-dose vs. standard dose influenza vaccine in 2016-17 was associated with lower rates of hospitalization in dialysis patients, although this association was not seen in 2015-16 (when few dialysis patients received the high-dose vaccine).
• There were no differences in rates of death between patients receiving the high-dose vs. standard dose influenza vaccine during either time period.