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Clinical Journal of the American Society of Nephrology
Journal Prestige (SJR): 3.099  Citation Impact (citeScore): 5 Number of Followers: 27  Subscription journalISSN (Print) 1555-9041 - ISSN (Online) 1555-905X Published by American Society of Nephrology  [2 journals]
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Authors: Dias; Maria Rita; Eusébio, Catarina Pereira; Jardim, João Augusto
Abstract:
No abstract available
PubDate: Thu, 01 Aug 2024 00:00:00 GMT-
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- Preterm Births Increases the Odds for Glomerular Diseases
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Authors: Critzer-Fox; Jessica
Abstract: No abstract available
PubDate: Mon, 22 Jul 2024 00:00:00 GMT-
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- Re-Examining Acute Peritoneal Dialysis: Back to the Future!
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Authors: Lee; Pei Shan; Cullis, Brett; Chan, Christopher T.
Abstract: No abstract available
PubDate: Tue, 16 Jul 2024 00:00:00 GMT-
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- Supporting Fellows during Pregnancy: Improvement Is Needed
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Authors: Freidin; Natalie; Campbell, Ruth C.
Abstract: No abstract available
PubDate: Tue, 09 Jul 2024 00:00:00 GMT-
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- Understanding the BP-Lowering Mechanism of Chlorthalidone in Advanced
Kidney Disease-
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Authors: Jafar; Tazeen H.; Feng, Liang
Abstract:
No abstract available
PubDate: Tue, 09 Jul 2024 00:00:00 GMT-
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- Sodium Bicarbonate Treatment and Clinical Outcomes in Chronic Kidney
Disease with Metabolic Acidosis: A Meta-Analysis-
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Authors: Yang; Ting-Ya; Lin, Hong-Min; Wang, Hsien-Yi; Chuang, Min-Hsiang; Hsieh, Chia-Chen; Tsai, Kang-Ting; Chen, Jui-Yi
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Key Points Sodium bicarbonate for patients with CKD and metabolic acidosis leads to a significant improvement in kidney function.Treatment with sodium bicarbonate increases in mid-arm muscle circumference, indicating a positive effect on enhancing muscle mass.Sodium bicarbonate supplementation is associated with a higher risk of elevated systolic BP, marking a potential side effect.Background In patients with CKD, impaired kidney acid excretion leads to the onset of metabolic acidosis (MA). However, the evidence is not yet conclusive regarding the effects of sodium bicarbonate in treating CKD with MA.Methods Databases with PubMed, Embase, and the Cochrane Library were used to search for randomized controlled trials (RCTs) from the inception until November 11, 2023, to identify RCTs investigating the effect of sodium bicarbonate in participants with CKD and MA. The primary outcome was the change in eGFR. Secondary outcomes included hospitalization rates, change in systolic BP, all-cause mortality, and mid-arm muscle circumference. A random-effects model was applied for analysis, and subgroup, sensitivity analyses were also performed.Results Fourteen RCTs comprising 2037 patients demonstrated that sodium bicarbonate supplementation significantly improved eGFR (standardized mean difference [SMD], 0.33; 95% confidence interval [CI], 0.03 to 0.63; P = 0.03). The group receiving sodium bicarbonate had a lower hospitalization rate (odds ratio, 0.37; 95% CI, 0.25 to 0.55; P < 0.001). Higher mid-arm muscle circumference was observed with sodium bicarbonate treatment compared with those without (SMD, 0.23; 95% CI, 0.08 to 0.38; P = 0.003, I2
PubDate: Tue, 09 Jul 2024 00:00:00 GMT-
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- Lessons Learned from HERA: the First Alport Syndrome Therapeutic Clinical
Trial-
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Authors: Weinstock; B. André
Abstract: No abstract available
PubDate: Fri, 21 Jun 2024 00:00:00 GMT-
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- Validation of Noninvasive Detection of Hyperkalemia by Artificial
Intelligence–Enhanced Electrocardiography in High Acuity Settings-
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Authors: Harmon; David M.; Liu, Kan; Dugan, Jennifer; Jentzer, Jacob C.; Attia, Zachi I.; Friedman, Paul A.; Dillon, John J.
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Key Points Measuring blood potassium has always required access to blood. The surface electrocardiogram, analyzed using an artificial intelligence algorithm, can detect hyperkalemia bloodlessly.The artificial intelligence-analyzed electrocardiogram exhibited a high negative predictive value but substantially lower positive predictive value.Background Artificial intelligence (AI) electrocardiogram (ECG) analysis can enable detection of hyperkalemia. In this validation, we assessed the algorithm's performance in two high acuity settings.Methods An emergency department (ED) cohort (February to August 2021) and a mixed intensive care unit (ICU) cohort (August 2017 to February 2018) were identified and analyzed separately. For each group, pairs of laboratory-collected potassium and 12 lead ECGs obtained within 4 hours of each other were identified. The previously developed AI ECG algorithm was subsequently applied to leads 1 and 2 of the 12 lead ECGs to screen for hyperkalemia (potassium>6.0 mEq/L).Results The ED cohort (N=40,128) had a mean age of 60 years, 48% were male, and 1% (N=351) had hyperkalemia. The area under the curve (AUC) of the AI-enhanced ECG (AI-ECG) to detect hyperkalemia was 0.88, with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive likelihood ratio (LR+) of 80%, 80%, 3%, 99.8%, and 4.0, respectively, in the ED cohort. Low-eGFR (
PubDate: Fri, 21 Jun 2024 00:00:00 GMT-
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- A Six-Year Follow-Up of Bloodstream Infections in Hemodialysis Facilities
in the United States, National Healthcare Safety Network, 2020-
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Authors: Keenan; John; Barbre, Kira A.; Dollard, Philip; Hoxworth, Tamara; Qureshi, Iram; Dunham, Lindsay; O'Leary, Erin; Nuwoaty, Selom Agbobli; Bagchi, Suparna; Edwards, Jonathan; Meng, Lu; Benin, Andrea; Bell, Jeneita
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Key Points In 2020, 7183 hemodialysis facilities in the United States reported bloodstream infection data for over five million patient-months to the Centers for Disease Control and Prevention's National Healthcare Safety Network.Pooled mean bloodstream infection rates per 100 patient-months ranged from 0.12 among patients with arteriovenous fistulas to 0.80 among patients with central venous catheters.Rates of bloodstream infection were lower than predicted overall and in almost all states and territories.Background Approximately 500,000 people in the United States undergoing hemodialysis are at risk of bloodstream infections (BSIs). The Centers for Disease Control and Prevention's National Healthcare Safety Network conducts surveillance for BSIs among outpatient hemodialysis facilities in the United States. Quality improvement initiatives encourage these facilities to adopt evidence-based interventions to decrease the incidence of BSI in patients. We describe the incidence of BSI among patients at outpatient hemodialysis facilities in the United States during 2020, stratified by state or territory.Methods Outpatient hemodialysis facilities report BSI events to the National Healthcare Safety Network. Pooled mean rates with 95% confidence interval (CI) were calculated overall and for each type of vascular access (arteriovenous [AV] fistula, AV graft, or a central venous catheter). Standardized infection ratios (SIRs) were calculated as observed BSI events divided by the predicted number of events on the basis of national aggregate data. Median facility-level SIRs and 95% CIs were stratified by state and US territory.Results During 2020, 7183 outpatient hemodialysis facilities reported data for 5,235,234 patient-months with 15,181 BSI events. Pooled mean rates per 100 person-months were 0.29 (95% CI, 0.29 to 0.30) overall, 0.80 (95% CI, 0.78 to 0.82) for central venous catheter, 0.12 (95% CI, 0.12 to 0.12) for AV fistula, 0.21 (95% CI, 0.20 to 0.22) for AV graft, and 0.28 (95% CI, 0.19–0.40) for other access types. The national SIR was 0.40 (95% CI, 0.39 to 0.41). South Dakota had a SIR significantly higher than one (1.34; 95% CI, 1.11 to 1.62). Fifty-one of 54 states and territories had BSI SIR significantly lower than one.Conclusions In 2020, the median SIR for BSI in US outpatient hemodialysis facilities was lower than predicted overall and in almost all states and territories. An elevated SIR was identified in South Dakota.
PubDate: Tue, 18 Jun 2024 00:00:00 GMT-
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- Mechanisms of Antihypertensive Effect of Chlorthalidone in Advanced
Chronic Kidney Disease: A Causal Mediation Analysis-
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Authors: Agarwal; Rajiv; Sinha, Arjun D.; Tu, Wanzhu
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Key Points Chlorthalidone reduces the amount of fluid and the BP, but fluid volume reduction is not the cause of lowering of BP.It is not volume loss but the response to volume loss such as the synthesis of substances that lower BP is important.Background Chlorthalidone (CTD) in a chronic kidney disease randomized trial demonstrated a robust reduction in systolic BP in stage 4 CKD. In this study, we explore the mechanisms underlying the antihypertensive effect of CTD.Methods In this prespecified analysis, we analyzed the contributions of baseline levels of 24-hour urinary sodium and aldosterone and the changes from baseline to 4 weeks in the multiple mediators reflecting volume status in a causal mediation analysis framework. Baseline levels of these mediators served as covariates. No power calculation for this analysis was performed.Results Of the 160 patients randomized, 140 (87.5%) were included in this analysis. Compared with placebo, CTD within 4 weeks reduced weight −1.5% (95% confidence interval [CI], −2.2 to −0.7) and volume −1.4% (95% CI, −2.2 to −0.6), stimulated plasma renin 40.5% (95% CI, 25.4% to 57.4%) and serum aldosterone 40.2% (95% CI, 11.7% to 76%), and reduced plasma N-terminal pro-B-type natriuretic peptide levels −19.4% (95% CI, −33.8% to −1.9%). Mediation analysis revealed the following results: for weight change, the total effect on systolic BP was −10.8 mm Hg (95% CI, −16 to −5.7), of which weight change (indirect effect) accounted for −0.9 mm Hg (95% CI, −4.2 to 2.5) and BP change independent of weight (direct effect) accounted for −10 mm Hg (−15.7 to −4.2). Thus, the percent mediation was 8.1% (95% CI, −22.4 to 38.5). Baseline excretion of 24-hour sodium or aldosterone or any of the changes in the above mediators examined accounted for
PubDate: Wed, 12 Jun 2024 00:00:00 GMT-
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- C3 Glomerulopathy Recurs Early after Kidney Transplantation in Serial
Biopsies Performed within the First 2 Years after Transplantation-
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Authors: Tarragón; Blanca; Peleg, Yonatan; Jagannathan, Geetha; Sekulic, Miroslav; Chang, Jae-Hyung; Cohen, David J.; Crew, Russell J.; Dube, Geoffrey K.; Fernandez, Hilda E.; Husain, Syed Ali; Mohan, Sumit; Morris, Heather K.; Appel, Gerald B.; Jadav, Paresh; Santoriello, Dominick; Kudose, Satoru; Stokes, M. Barry; Batal, Ibrahim; Bomback, Andrew S.
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Key Points C3 glomerulopathy recurs very early and frequently after kidney transplant.Protocol biopsies and the use of electron microscopy alongside immunofluorescence are key to diagnose recurrent C3 glomerulopathy in the allograft.Background C3 glomerulopathy (C3G), which encompasses C3GN and dense deposit disease (DDD), results from dysregulation of the alternative complement pathway. Data on disease recurrence after kidney transplantation are limited, and details on histologic features of recurrent C3G are scarce. We aimed to evaluate C3G recurrence in the allograft, with a focus on histologic presentation and progression.Methods We retrospectively analyzed 18 patients with native kidney failure attributed to C3G (12 C3GN and six DDD), who received a kidney transplant from January 2016 to January 2023. Demographic, genetic, clinical, and histologic data were studied. The NanoString 770 genes PanCancer Immune Profiling Panel was used for transcriptomic analysis. Disease recurrence was the primary outcome.Results During a median (interquartile range) follow-up period of 37 (18–56) months, C3G recurrence occurred in 16 (89%) patients (11 with C3GN and five with DDD) at a median (interquartile range) of 33 (13–141) days after transplantation. Over a third (38%) of recurrent cases were detected in protocol biopsies, and only 31% of patients presented with>300 mg/g of proteinuria. Recurrence in index biopsies was mainly established through a combination of immunofluorescence and electron microscopy findings, while it showed only subtle histologic alterations and no characteristic transcriptomic signals. Over time, histologic chronicity indices increased, but all the allografts were functioning at the end of follow-up. Patients with recurrence of C3GN and DDD showed overlapping immunofluorescence and electron microscopy findings and had similar recurrence rate and time to recurrence.Conclusions Most of the patients with native kidney failure attributed to C3G developed disease recurrence very early after kidney transplantation, usually with minimal proteinuria, mild histologic alterations, and favorable short-term allograft survival. Immunofluorescence and electron microscopy played a crucial role in detecting early, subclinical recurrence of C3GN and DDD, which showed significant overlapping features.
PubDate: Fri, 07 Jun 2024 00:00:00 GMT-
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- Assessment of GFR in Patients with Cancer: A Statement from the American
Society of Onco-Nephrology-
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Authors: Kitchlu; Abhijat; Silva, Verônica T. Costa E.; Anand, Shuchi; Kala, Jaya; Abudayyeh, Ala; Inker, Lesley A.; Rosner, Mitchell H.; Karam, Sabine; Gudsoorkar, Prakash; Gupta, Shruti; Chen, Sheldon; Klomjit, Nattawat; Leung, Nelson; Milanez, Tomaz; Motwani, Shveta S.; Khalid, Sheikh B.; Srinivasan, Vinay; Wanchoo, Rimda; Beumer, Jan H.; Liu, Geoffrey; Tannir, Nizar M.; Orchanian-Cheff, Ani; Geng, Yimin; Herrmann, Sandra M.
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Accurate assessment of GFR is crucial to guiding drug eligibility, dosing of systemic therapy, and minimizing the risks of both undertreatment and toxicity in patients with cancer. Up to 32% of patients with cancer have baseline CKD, and both malignancy and treatment may cause kidney injury and subsequent CKD. To date, there has been lack of guidance to standardize approaches to GFR estimation in the cancer population. In this two-part statement from the American Society of Onco-Nephrology, we present key messages for estimation of GFR in patients with cancer, including the choice of GFR estimating equation, use of race and body surface area adjustment, and anticancer drug dose-adjustment in the setting of CKD. These key messages are based on a systematic review of studies assessing GFR estimating equations using serum creatinine and cystatin C in patients with cancer, against a measured GFR comparator. The preponderance of current data involving validated GFR estimating equations involves the CKD Epidemiology Collaboration (CKD-EPI) equations, with 2508 patients in whom CKD-EPI using serum creatinine and cystatin C was assessed (eight studies) and 15,349 in whom CKD-EPI with serum creatinine was assessed (22 studies). The former may have improved performance metrics and be less susceptible to shortfalls of eGFR using serum creatinine alone. Since included studies were moderate quality or lower, the American Society of Onco-Nephrology Position Committee rated the certainty of evidence as low. Additional studies are needed to assess the accuracy of other validated eGFR equations in patients with cancer. Given the importance of accurate and timely eGFR assessment, we advocate for the use of validated GFR estimating equations incorporating both serum creatinine and cystatin C in patients with cancer. Measurement of GFR via exogenous filtration markers should be considered in patients with cancer for whom eGFR results in borderline eligibility for therapies or clinical trials.
PubDate: Fri, 07 Jun 2024 00:00:00 GMT-
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- Assessment of GFR in Patients with Cancer Part 2: Anticancer
Therapies—Perspectives from the American Society of Onco-Nephrology
(ASON)-
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Authors: Kitchlu; Abhijat; Silva, Verônica T. Costa E.; Anand, Shuchi; Kala, Jaya; Abudayyeh, Ala; Inker, Lesley A.; Rosner, Mitchell H.; Karam, Sabine; Gudsoorkar, Prakash; Gupta, Shruti; Chen, Sheldon; Klomjit, Nattawat; Leung, Nelson; Milanez, Tomaz; Motwani, Shveta S.; Khalid, Sheikh B.; Srinivasan, Vinay; Wanchoo, Rimda; Beumer, Jan H.; Liu, Geoffrey; Tannir, Nizar M.; Orchanian-Cheff, Ani; Geng, Yimin; Herrmann, Sandra M.
Abstract:
No abstract available
PubDate: Fri, 07 Jun 2024 00:00:00 GMT-
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- A Randomized Controlled Clinical Trial Testing Effects of Lademirsen on
Kidney Function Decline in Adults with Alport Syndrome-
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Authors: Gale; Daniel P.; Gross, Oliver; Wang, Fang; Esteban de la Rosa, Rafael José; Hall, Matthew; Sayer, John A.; Appel, Gerald; Hariri, Ali; Liu, Shiguang; Maski, Manish; Shen, Yuqian; Zhang, Qi; Iqbal, Sajida; Kowthalam, Madhurima Uppara; Lin, Julie; Ding, Jie; on behalf of the HERA Clinical Trial Group
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Key Points Lademirsen, an anti–microRNA-21 therapy, was generally well-tolerated in adults with Alport syndrome at risk of rapid disease progression.There were no significant differences between lademirsen-treated and placebo-treated participants in eGFR at any timepoint.The proportions of participants with prespecified reductions in eGFR at weeks 24 and 48 were not significantly different for lademirsen versus placebo.Background Preclinical models of disease have suggested that targeting microRNA-21 (miRNA-21) may slow the decline in kidney function in individuals with Alport syndrome (AS). The objective of this study was to investigate the effects of the anti–miRNA-21 oligonucleotide, lademirsen, on rate of eGFR decline in adults with AS at risk of rapid disease progression.Methods This study was a phase 2 trial of lademirsen, with a randomized, double-blind, placebo-controlled period followed by an open-label period. Adults with AS, eGFR>35 to
PubDate: Mon, 03 Jun 2024 00:00:00 GMT-
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- Lower-Dosage Acute Peritoneal Dialysis versus Acute Intermittent
Hemodialysis in Acute Kidney Injury: A Randomized Controlled Trial-
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Authors: Parapiboon; Watanyu; Tatiyanupanwong, Sajja; Khositrangsikun, Kamol; Phulkerd, Thanawat; Kaewdoungtien, Piyanut; Pichitporn, Watthikorn; Lumlertgul, Nuttha; Peerapornratana, Sadudee; Chen, Fangyue; Srisawat, Nattachai
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Key Points The efficacy of acute peritoneal dialysis is still controversial.There was no significant difference in 28-day mortality between acute peritoneal dialysis and intermittent hemodialysis.Background Lower delivered dose of acute peritoneal dialysis (PD) in AKI requires less resources but raises concerns regarding adequate solute and water clearance. The relative merits of lower-dose PD versus intermittent hemodialysis remain uncertain.Methods A multicenter randomized controlled trial compared the outcomes between acute lower-dosage PD (18–24 L per day) and intermittent hemodialysis (three times per week) from May 2018 to January 2021 in patients with AKI. The primary outcome was 28-day mortality rate. Secondary outcomes included 28-day dialysis-free survival and kidney recovery, metabolic profile, and procedure-related complications. Noninferiority of PD to hemodialysis would be demonstrated if the upper bound of the 95% confidence interval ( CI) on risk difference (PD-hemodialysis) in 28-day mortality rates between the two groups was
PubDate: Wed, 29 May 2024 00:00:00 GMT-
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- Vascular Access Considerations in Home Hemodialysis
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Authors: Chan; Ryan J.; Chan, Christopher T.
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There is a global interest in expanding home dialysis utilization among patients with ESKD. Home hemodialysis (HHD) is an appealing KRT option for this population because of its multiple clinical and quality of life benefits. Central to successful HHD is the establishment and maintenance of a functioning vascular access that serves as a patient's lifeline while on therapy. While the selection of a vascular access type is influenced by individual patient circumstances, the arteriovenous fistula is generally the preferred access method. Training patients to use their dialysis access requires attention to safety, risk management, and monitoring for complications to minimize adverse events and technique failure. Policies incorporating systematic frameworks for quality improvement and assurance, in conjunction with the measurement of metrics relating to vascular access, are tools that should be used by HHD programs to enhance the value of care delivered. In this perspective, we aim to describe what is currently known about the various vascular access options in HHD and to elucidate what needs to be taken into consideration in the selection and care of this access.
PubDate: Tue, 21 May 2024 00:00:00 GMT-
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- A National Survey of Pregnancy and Parenthood among Nephrology Trainees: A
Focus on Nephrology Fellowship-
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Authors: Dixon; Angelina; Bansal, Nisha; Nicholas, Susanne B.; Ostrow, Anna; Kendrick, Jessica
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Key Points Parental leave policies for physician trainees are inconsistent.Nephrology fellows are largely unaware of parental leave policies and pregnancy accommodations in their programs.Individual nephrology programs should improve awareness about national and local program policies among trainees.Background National and international policies on parental leave for physician trainees are inconsistent. Physician trainees, including nephrology fellows, may be at higher risk of pregnancy complications. Physician trainees face barriers in meeting their breastfeeding goals and in finding childcare because of nontraditional work hours with extended or unpredictable shifts. We examine awareness of current policies in US nephrology fellowship programs regarding parental leave, pregnancy/breastfeeding accommodations, and fellows' perspectives on family planning.Methods An anonymous, online survey of US nephrology fellows was undertaken from June 9 to August 24, 2023.Results One hundred twenty nephrology fellows submitted the survey. Most of the fellow respondents were unaware of parental leave policies of their training programs (63%), the Accreditation Council for Graduate Medical Education (75%), and/or the American Board of Medical Specialties (75%). Forty-two percent were unaware of the duration of parental leave at their program. Nearly 45% of all respondents were unsure if their program limited night shifts or shifts>24 hours for pregnant trainees. Forty-three percent reported they were unsure of lactation accommodations, and 40% were unsure of access to subsidized childcare. When fellows received work accommodations for pregnancy or parenthood, their work obligations were largely covered by co-fellows (60%) or attendings (38%). Over 60% of fellows agreed or strongly agreed that they would avoid a pregnancy in fellowship because of concern that they would have to extend their training. Of the 40 fellows who chose to pursue pregnancy or parenthood during medical training, 75% did not change their career plans as a result.Conclusions Most nephrology fellows were unaware of parental leave policies and pregnancy/lactation accommodations. While the topic itself has a broad effect to all physician trainees, there is a need for improved awareness about national and local program policies among trainees across individual nephrology programs.
PubDate: Fri, 10 May 2024 00:00:00 GMT-
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- Association of Preterm Birth with Adverse Glomerular Disease Outcomes in
Children and Adults-
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Authors: Isaac; Jaya S.; Troost, Jonathan P.; Wang, Yujie; Garrity, Kelly; Kaskel, Frederick; Gbadegesin, Rasheed; Reidy, Kimberly J.
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Key Points Preterm birth was a risk factor for adverse outcomes in this heterogeneous cohort of children and adults with glomerular disease.In analyses adjusted for diagnosis and apolipoprotein L1 risk status, there was less remission and faster progression of kidney disease in those born preterm.A novel finding from this study is that adults born preterm were more likely to have an apolipoprotein L1 high-risk genotype.Background While some studies of children with nephrotic syndrome have demonstrated worse outcomes in those born preterm compared with term, little data exist on associations of preterm birth with outcomes in adult-onset glomerular disease. Cardiovascular outcomes in those born preterm with glomerular disease are unknown.Methods We performed a cross-sectional and longitudinal analysis of participants in the Cure Glomerulonephropathy cohort. Preterm (
PubDate: Fri, 10 May 2024 00:00:00 GMT-
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- Clinical Outcomes after a Kidney Stone Event in Kidney Transplant
Recipients-
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Authors: Ganesan; Calyani; Liu, Sai; Montez-Rath, Maria; Leppert, John T.; Pao, Alan C.
Abstract:
No abstract available
PubDate: Thu, 14 Mar 2024 00:00:00 GMT-
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- Should Transplant Nephrology Pursue Recognition from the Accreditation
Council for Graduate Medical Education (ACGME)'-
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Authors: Singh; Neeraj; Anand, Prince M.; Gupta, Gaurav; Sawinski, Deirdre; Fix, Oren; Adey, Deborah; Akalin, Enver; Zayas, Carlos; Dadhania, Darshana; Doshi, Mona; Cibrik, Diane; Gupta, Mallika; Parsons, Ronald; Leca, Nicolae; Santos, Rowena Delos; Concepcion, Beatrice P.; Nishio Lucar, Angie G.; Ong, Song; Sridhar, Vikas Srinivasan; Parajuli, Sandesh; Zachariah, Mareena; Mehta, Shikha; Soliman, Karim; Shawar, Saed; Husain, Syed Ali; Preczewski, Luke; Friedewald, John; Mohan, Sumit; Wiseman, Alexander; Samaniego, Millie; Kumar, Vineeta; Tanriover, Bekir; Bloom, Roy
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Kidney transplant is not only the best treatment for patients with advanced kidney disease but it also reduces health care expenditure. The management of transplant patients is complex as they require special care by transplant nephrologists who have expertise in assessing transplant candidates, understand immunology and organ rejection, have familiarity with perioperative complications, and have the ability to manage the long-term effects of chronic immunosuppression. This skill set at the intersection of multiple disciplines necessitates additional training in Transplant Nephrology. Currently, there are more than 250,000 patients with a functioning kidney allograft and over 100,000 waitlisted patients awaiting kidney transplant, with a burgeoning number added to the kidney transplant wait list every year. In 2022, more than 40,000 patients were added to the kidney wait list and more than 25,000 received a kidney transplant. The Advancing American Kidney Health Initiative, passed in 2019, is aiming to double the number of kidney transplants by 2030 creating a need for additional transplant nephrologists to help care for them. Over the past decade, there has been a decline in the Nephrology—as well Transplant Nephrology—workforce due to a multitude of reasons. The American Society of Transplantation Kidney Pancreas Community of Practice created a workgroup to discuss the Transplant Nephrology workforce shortage. In this article, we discuss the scope of the problem and how the Accreditation Council for Graduate Medical Education recognition of Transplant Nephrology Fellowship could at least partly mitigate the Transplant Nephrology work force crisis.
PubDate: Tue, 06 Feb 2024 00:00:00 GMT-
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- Patient Training and Patient Safety in Home Hemodialysis
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Authors: Platnich; Jaye M.; Pauly, Robert P.
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The success of a home hemodialysis program depends largely on a patient safety framework and the risk tolerance of a home dialysis program. Dialysis treatments require operators to perform dozens of steps repeatedly and reliably in a complex procedure. For home hemodialysis, those operators are patients themselves or their care partners, so attention to safety and risk mitigation is front of mind. While newer, smaller, and more user-friendly dialysis machines designed explicitly for home use are slowly entering the marketplace, teaching patients to perform their own treatments in an unsupervised setting hundreds of times remains a foundational programmatic obligation regardless of machine. Just how safe is home hemodialysis' How does patient training affect this safety' There is a surprising lack of literature surrounding these questions. No consensus exists among home hemodialysis programs regarding optimized training schedules or methods, with each program adopting its own approach on the basis of local experience. Furthermore, there are little available data on the safety of home hemodialysis as compared with conventional in-center hemodialysis. This review will outline considerations for training patients on home hemodialysis, discuss the safety of home hemodialysis with an emphasis on the risk of serious and life-threatening adverse effects, and address the methods by which adverse events are monitored and prevented.
PubDate: Mon, 08 Jan 2024 00:00:00 GMT-
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