Highlights from the August 2018 Issue

Editor’s Note: We asked authors of Original Investigations 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 valuable in helping them keep up with the latest research in the field of nephrology. From the August 2018 issue:

Impact of a Primary Care CKD Registry in a US Public Safety-Net Health Care Delivery System: A Pragmatic Randomized Trial by Delphine S. Tuot et al [FREE]

From the authors: Many patients with chronic kidney disease (CKD) do not receive optimal therapies in the course of receiving primary medical care. This occurs because of inefficient health care delivery systems and, in part, because providers are neither sufficiently aware of CKD nor have sufficient confidence about delivering care to individuals with CKD. We examined whether a primary care CKD registry that provides data to the entire healthcare team (i.e., medical assistants, nurses, nurse practitioners, and physicians) could improve kidney care in two primary care clinics. This type of intervention has been shown to be helpful for other chronic diseases. The CKD registry led to increases in appropriate medication prescriptions and evaluations for loss of albumin in the urine, but did not lead to improvements in blood pressure control or kidney function as assessed by the eGFR. Adoption of team-based CKD registries may represent one important step in translating evidence into practice for patients with kidney disease.

Editorial Improving Primary Care for Patients With CKD in the Digital Era by L. Ebony Boulware [FREE]

Association of Medicare’s Bundled Payment Reform With Changes in Use of Vitamin D Among Patients Receiving Maintenance Hemodialysis: An Interrupted Time-Series Analysis by Julia Spoendlin et al

From the authors: We assessed if the introduction of Medicare’s 2011 bundled payment system led to a reduction of the use of costly and previously separately billable injectable vitamin D products in patients with end stage renal disease (ESRD) requiring hemodialysis. Applying longitudinal analyses using data from the United States Renal Data System (USRDS), we assessed changes in vitamin D use over time between 2008 and 2013. Introduction of the bundled payment system was associated with an immediate decrease in the average dose and the starting dose of costly injectable vitamin D analogs, but not with the frequency of vitamin D applications. Use of cheaper alternative products did not increase until the end of 2013. It remains to be assessed whether these changes reflect the desired reduction in overutilization of expensive drugs or, potentially, compromised patient care.

Editorial Making Policy in the Dark: The Use of Activated Vitamin D Under Bundled Payments for Dialysis Care by Ahmed A. Awan et al [FREE]


Risk Predictors and Causes of Technique Failure Within the First Year of Peritoneal Dialysis: An Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) Study by Emily J. See et al

From the authors: Technique failure is a serious complication of peritoneal dialysis (PD) treatments, and the first year of therapy is a time of particularly high risk. This study aimed to identify the reasons for technique failure within the first year, and to identify the patient, dialysis, and center factors associated with increased risk. We studied all patients who commenced PD in Australia or New Zealand over the last 15 years and found that mechanical and “other” causes of technique failure (e.g. inadequate dialysis, psychosocial issues, patient preference) were most common in the first nine months, while the risk of technique failure due to death or peritonitis was greatest after this time. The elderly and patients with other health conditions, as well as those who were referred late to nephrology services, had received prior renal replacement therapy, or were managed in smaller dialysis centers were at greatest risk. This study provides important insights for the development of strategies to reduce early technique failure in PD patients.


One-Year Linear Trajectories of Symptoms, Physical Functioning, Cognitive Functioning, Emotional Well-being, and Spiritual Well-being Among Patients Receiving Dialysis by Mi-Kyung Song et al

From the authors: Little is known about how multiple dimensions of quality of life change over time in people on dialysis. We conducted a longitudinal observational study among 227 patients on dialysis to describe patient-reported dimensions of quality of life and how they changed over the period of one year. With commonly used questionnaires, we measured overall symptoms, physical functioning, cognitive functioning, emotional well-being, and spiritual well-being. We observed that, while these dimensions of quality of life often varied widely from month to month, physical functioning gradually worsened over time, while overall symptoms, cognitive functioning, emotional well-being, and spiritual well-being improved overtime. We found that older participants had better function across these dimensions and non-white study participants were more likely to report better spiritual well-being. Higher levels of comorbidity were associated with worse scores in most dimensions. Understanding longitudinal patterns of quality of life can help determine how healthcare needs of patients on dialysis change over time.


Urinary Biomarkers of Kidney Tubular Damage and Risk of Cardiovascular Disease and Mortality in Elders by Vasantha Jotwani et al

From the authors: Kidney disease has been linked with the development of heart disease in older adults, but the mechanisms are not fully understood. We hypothesized that kidney tubular damage, measured by urine biomarker levels, would be associated with higher risks of heart disease and death in a cohort of older adults. We found that urine α1-microglobulin and neutrophil gelatinase-associated lipocalin were each associated with higher risks of cardiovascular disease and death over ten years, even after controlling for traditional measures of kidney health. Our findings suggest that kidney tubular damage may be an important risk factor for heart disease and death in older adults.


Coffee Consumption and Incident Kidney Disease: Results From the Atherosclerosis Risk in Communities (ARIC) Study by Emily A. Hu et al

Photo by rawpixel.com on Pexels.com

From the authors: The Dietary Guidelines for Americans 2015 suggest that 3-5 cups of coffee per day can be incorporated into a healthy lifestyle. Coffee consumption has been suggested to decrease risk of chronic diseases and all-cause mortality. However, the literature for coffee and chronic kidney disease (CKD) is sparse. Therefore, we have conducted an analysis on coffee consumption and CKD among black and white middle-aged adults from 4 different communities in the US. We found that participants who consumed higher amounts of coffee per day (at least 3 cups/day) had a lower risk of CKD compared to participants who never drank coffee. However, we did not find the same association for coffee and more advanced stages of kidney disease such as end-stage renal disease and kidney failure.


From the authors: Buttonhole (BH) cannulation is a popular way to access the bloodstream using the same fibrous tract (“buttonhole”) at each dialysis session. However, the technique has been linked to an increased rate of access-related infection. Our study investigated the frequency of bacterial growth in the BH tract and subsequent infectious complications. Cultures were systematically collected from the BH and cannula tip during a 3-months period. Thirty-eight percent of the patients had transient bacterial growth and 11% sustained growth in their BH (often with staphylococci species). Asymptomatic growth of bacteria from the blood was found in 30% of those with BH bacterial colonization. Except for slightly more redness, BHs with bacterial growth showed no signs of infection. During follow-up patients with previously positive BH cultures had considerably more clinically apparent access-related infections. Colonization of the BH tract and even blood stream infections are very common and associated with a high risk of access-related infections.

Changes in Blood Pressure During Young Adulthood and Subsequent Kidney Function Decline: Findings From the Coronary Artery Risk Development in Young Adulthood (CARDIA) Study by Elaine Ku et al 

From the authors: There has been sparse data on how a single blood pressure measurement or repeated blood pressure measurements during young adulthood relate to future loss of kidney function. The goal of this study was to compare how single and repeated measurements of blood pressure taken during young adulthood over a ten-year period relate to kidney function changes over the next ten years. We found that in young adults between ages 18-30 years participating in an observational study, increasing blood pressures during repeated measurements correlate with subsequent loss of kidney function more so than single blood pressure measurements. Young adults who have continued rises in their BP levels over time, even in the absence of a diagnosis of high blood pressure, may need screening for kidney disease.

Photo by rawpixel.com on Pexels.com

Blog Post BP Monitoring in Young Adults: Is It More Than Just One Number? by Kelli King-Morris & Zhabiz Solhjou [FREE]

On the Cover: In A Few Words (IAFW) is a recurring AJKD feature through which we give voice to the diverse stories that characterize kidney disease. Physicians, health professionals, patients, and family members are encouraged to submit nonfiction essays, poems, or original art that convey how kidney disease has impacted their lives. This month’s cover features a painting, Chaotic Beauty,” by Jason E. Jones, a visual artist who received a kidney transplant in 2015. He shares his personal experience with kidney disease by painting images of volcanoes, calm when dormant but chaotic when they erupt.

“Chaotic Beauty” painted by Jason E. Jones. Photograph © Jason E. Jones.

 

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