Highlights from the April 2018 Issue

Editor’s Note: In an effort to improve the understanding of Original Investigation articles published in AJKD, we asked authors to provide short nontechnical summaries that would briefly summarize what inspired their study, the basic approach taken, what was learned, and why it matters. We hope our readers will find this service valuable in helping them to keep up with the latest research in the field of nephrology.

Psychometric Properties of the Kidney Disease Quality of Life 36-Item Short-Form Survey (KDQOL-36) in the United States by John D. Peipert et al

From the authors: Despite its broad usage among dialysis patients throughout the United States, there has been little assessment of the Kidney Disease Quality of Life 36-item Short-form Survey’s (KDQOLTM-36) measurement properties. This study evaluated the reliability, validity, and factor structure of the KDQOL-36 scales, which includes the SF-12 as its generic core and 3 kidney disease-targeted scales: Burdens of Kidney Disease, Symptoms and Problems of Kidney Disease, and Effects of Kidney Disease. Data from 70,786 dialysis patients in 1,381 United States dialysis facilities collected between 06/01/2015 and 05/31/2016 as part of routine clinical assessment were used. Each of the KDQOL-36’s kidney disease-targeted scales had acceptable reliability. Validity was supported by large correlations between the SF-12 and the KDQOL scales, as well as significant differences on the scales between patients on different types of dialysis, diabetic and non-diabetic patients, and patients who were employed full-time versus not.

Editorial A Timely Evaluation of the Psychometric Properties of the KDQOL-36 by Kelly Chong et al [FREE]

International Differences in the Location and Use of Arteriovenous Accesses Created for Hemodialysis: Results From the Dialysis Outcomes and Practice Patterns Study (DOPPS) by Ronald L. Pisoni et al [OPEN ACCESS]

From the authors: Vascular access (VA) practice varies greatly internationally, with better outcomes typically seen when using an arteriovenous fistula (AVF). Although an AVF is the preferred access for hemodialysis (HD) patients, VA should be individualized for a patient’s health status and other considerations. The prospective international DOPPS has collected detailed VA information from randomly-selected HD patients across hundreds of HD facilities since 1996. Having previously described large international differences in key aspects of VA practice, we were curious if these data could help inform to what extent international differences exist for successful use of a newly-created AVF, time-to-first-use of newly-created upper-versus-lower-arm AVFs and arteriovenous grafts (AVGs), percentage of AVFs placed in the lower-versus-upper-arm, predictors of lower-versus-upper-arm AVFs, and predictors of successful use of newly-created AVFs. We found large international differences in lower-versus-upper-arm AVF placement, predictors of AVF location, successful use of AVFs, and time-to-first-AVF/AVG-use. These international differences raise questions regarding what constitutes best practice. A large shift in lower-to-upper-arm AVF creation in the US prompts concerns of whether this practice change may place some patients at-risk of exhausting available sites for future AVF creation and associated long-term health implications.

Trend in arteriovenous fistula (AVF) location in the upper versus lower arm from the Dialysis Outcomes and Practice Patterns Study (DOPPS) 1 (1996-2001) to DOPPS 5 (2012-2015), by region. Figure 3 from Pisoni et al, AJKD © National Kidney Foundation.

Editorial Lessons From International Differences in Vascular Access Practices and Outcomes by Michael Allon [FREE]

Health Insurance and the Use of Peritoneal Dialysis in the United States by Jose J. Perez et al

From the authors: Patients with end-stage renal disease (ESRD) in the U.S. use peritoneal dialysis (PD) infrequently. Because patients with ESRD become eligible for Medicare in the month when they start PD without having to wait until the fourth month of ESRD, it is unknown whether having limited health insurance at the start of dialysis prevents patients from receiving PD. In a cohort of U.S. patients starting dialysis we examined the association between “Limited Insurance” (defined as having Medicaid-only or being uninsured) and PD use. We found that patients with Limited Insurance at the start of dialysis were less likely to use PD by their fourth dialysis month compared to patients with Medicare, but that those with Limited Insurance were more likely to switch to PD after they became eligible for Medicare based on having ESRD for three months. This suggests that, despite Medicare’s policy of covering patients as soon as they start PD, insurance limitations are an important barrier to use of PD.

Editorial  Rising Peritoneal Dialysis Tide May Still Leave Some Patients Behind by Marc Turenne [FREE]

Blog Post  Health Insurance and PD Utilization at ESRD Onset in the US by Hitesh H. Shah [FREE]


Policy Forum Caring for Undocumented Immigrants With Kidney Disease by Rajeev Raghavan [FREE]

This article provides an update, considers looming US policy changes, examines how noncitizens receive kidney care globally, and proposes an approach to document and advocate for cost-effective and humane solutions that can improve the care of undocumented immigrants with kidney failure.

Undocumented Immigrants and Global Renal Replacement Therapy. Table 1 from Raghavan et al, AJKD © National Kidney Foundation.

On the Cover: Colorful footwear from Austin, Texas, site of the National Kidney Foundation’s Spring Clinical Meetings held April 10-14 this year. At this conference, health care professionals involved in every aspect of caring for patients with kidney disease will gather to learn about the latest developments in clinical nephrology. For a selection of the abstracts to be presented at #NKFClinicals, see p. 502.

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