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Kidney Policy Increases Patient Referrals, Evaluations

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Following implementation of the kidney allocation system (KAS) in 2014, dialysis facilities referred more new dialysis patients and transplant centers evaluated more new patients even though fewer evaluated patients were placed onto the transplant waitlist, analysis of data from three southeastern states shows.

“Nationally, we have seen declines in waitlisting, which is an unintended consequence of this policy change. There is less urgency to waitlist patients earlier because they are not accruing time on the list based on the date they were placed on the list,” Rachel Patzer, PhD, MPH, Emory University School of Medicine, Atlanta, Georgia, told Medscape Medical News in an email. Read more.

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Risk Factors for Chronic Kidney Disease

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Chronic kidney disease is defined as damage of the renal parenchyma that results in chronic deterioration of kidney function and may result in progression to end-stage renal disease. It is a non-communicable disease that includes a range of physiological disorders which are attributed to abnormal renal function and its progressive decline infiltration rate (the glomerular filtration rate).

There are five stages of kidney damage in chronic kidney disease that range from mild kidney dysfunction to complete failure. The burden of chronic kidney disease is increasing worldwide and is becoming increasingly prevalent in developing countries. Overall, the prevalence is estimated to be between 8 and 16% worldwide. Patients who have stage three or four chronic kidney disease are at a higher risk of progressing to either end-stage renal disease or death. Read more.

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How Important are Our Kidneys to Our Overall Health?

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The kidneys play a dominant role in regulating both the volume and composition of the extracellular fluid. They function to ensure that the body maintains a homeostatic internal environment. They achieve this by excreting the appropriate amounts of several types of solutes. The substances that are ex greeted are both substances that are in excess, and therefore waste, alongside foreign compounds.

When kidneys fail, several problems result. The first-line treatment of kidney impairment, dysfunction, or failure, or dialysis and kidney transplantation, though the latter is common only for advanced (end-stage) kidney disease. Read more.

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Cost-Analysis Fuels Debate on Transplant Waitlists

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Policies that increase access to waiting lists for kidney transplant are likely to substantially increase administrative and medical costs without providing any benefit, said authors of a new study.

An examination of cost reports from all certified U.S. transplant hospitals from 2012 to 2017 indicated that Medicare reimbursements for transplant evaluation and waiting list management increased from $0.95 billion to $1.32 billion, according to researchers led by Xingxing Cheng, MD, of Stanford University School of Medicine in California. Read more.

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Models predict acute kidney injury after cardiac surgery

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Models based on perioperative basic metabolic panel laboratory values performed well in predicting acute kidney injury at 72 hours and 14 days after cardiac surgery, researchers reported in JAMA.

The researchers created four models. The first was based on preoperative serum creatinine, the second on perioperative absolute change in serum creatinine, the third on the first two models combined and the fourth on the third model plus blood urea nitrogen, potassium, bicarbonate, sodium and albumin adjusted from time of surgery to blood draw.
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Adherence promotion strategies cost-effective, improve graft rejection rates

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Adherence promotion strategies, such as the Medication Adherence Promotion System, proved to be cost-effective and improved rejection rates among adolescent kidney transplant recipients, according to a published study.

“To date, there are several randomized controlled trials that show systems to improve medication adherence can improve adherence in transplant patients, but they have not demonstrated a decrease in rejection rates — which is the primary purpose to improve medication adherence in transplant patients,” Charles D. Varnell Jr., MD, MS, assistant medical director of kidney transplantation from the division of nephrology and hypertension at Cincinnati Children’s Hospital Medical Center in Ohio, told Healio.
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