In 2017, we established an annual celebration of articles that our editorial team designated as “Editors’ Choice” selections. The editors are delighted to recognize the five articles listed below that have been selected to receive the 2020 Editors’ Choice Award. These articles will be freely available at AJKD.org until January 15, 2021. Congratulations to all the authors!
Continuous Renal Replacement Therapy Dosing in Critically Ill Patients: A Quality Improvement Initiative by Benjamin R. Griffin, Amanda Thomson, Mark Yoder, Isaiah Francis, Sophia Ambruso, Adam Bregman, Michelle Feller, Shannon Johnson-Bortolotto, Christine King, Deborah Bonnes, Lisa Dufficy, Chaorong Wu, Anip Bansal, Darlene Tad-y, Sarah Faubel, and Diana Jalal (December 2019)
Control chart before and after intervention implementation. Figure 3 from Griffin et al, AJKD © National Kidney Foundation.
From the authors: Continuous renal replacement therapy (CRRT) is a form of continuous dialysis used in critically ill patients, often in the intensive care unit. National guidelines recommend that CRRT be prescribed at a dose of 20-25 mL/kg/hr; however, prescription practices are variable. Inconsistent prescribing patterns among providers may lead to errors in dosing of medications such as antibiotics, and increase rates of blood chemistry abnormalities. This study describes a quality improvement initiative to increase compliance with national guidelines for CRRT dosing. Over the course of one year, multiple interventions to improve compliance were implemented, including modifications to the electronic medical record, modifications to the procedure note and CRRT order templates, and education of providers regarding proper prescribing practices. Following these interventions, the rate of administration of CRRT using dosing consistent with national guidelines doubled from 33% to 66%.
Editorial A Quality Improvement Initiative Targeting CRRT Delivered Dose: The What, the How, and the Why by Javier A. Neyra and Ashita J. Tolwani [FREE]
Blog Post: Reaching Renal Replacement Therapy Targets Through Quality Improvement Initiatives: A Success Story by Diana Mahbod [FREE]
The Frequency of Routine Blood Sampling and Patient Outcomes Among Maintenance Hemodialysis Recipients by Alison Thomas, Samuel A. Silver, Jeffrey Perl, Megan Freeman, Justin J. Slater, Danielle M. Nash, Marlee Vinegar, Eric McArthur, Amit X. Garg, Ziv Harel, Rahul Chanchlani, Michael Zappitelli, Eduard Iliescu, Abhijat Kitchlu, Daniel Blum, William Beaubien-Souligny, and Ron Wald (April 2020)
From the authors: Though regularly-scheduled blood sampling is a routine part of the surveillance provided to maintenance hemodialysis recipients, there is little evidence to guide the frequency of such assessments. In this population-wide retrospective cohort study comparing patients who received more frequent (monthly) assessments versus less frequent assessments (every 6 weeks), more frequent testing did not show evidence of a survival advantage, a reduction in cardiovascular events, or hospitalizations. Our data demonstrate the potential safety of widening the interval between routine blood testing in hemodialysis recipients, a practice which could have a favorable impact on resource consumption and utilization.
Editorial Routine Monthly Blood Draws in Hemodialysis: Where Is the Evidence? by Eduardo Lacson Jr. and Klemens B. Meyer [FREE]
Cost-effectiveness of Using Kidneys From HCV-Viremic Donors for Transplantation Into HCV-Uninfected Recipients by Mark H. Eckman, E. Steve Woodle, Charuhas V. Thakar, Rita R. Alloway, and Kenneth E. Sherman (June 2020)
From the authors: Only a small proportion of patients with kidney failure receive kidney transplants. In large part, this is due to the imbalance between supply and demand for organs. A significant proportion of kidneys are discarded due to donors’ infection with the hepatitis C virus. Yet, aside from infection with hepatitis C, many of these donors are young and healthy and their organs could provide a recipient with many years of life. In addition, the wait to get a kidney transplant can be many years. There has been a marked increase in the number of hepatitis C infected organs available that could shorten the wait for a transplant. This study used a computer model to analyze the clinical and economic outcomes for end stage kidney disease patients considering accepting transplantation with such an organ. It demonstrates that transplanting kidneys from HCV-viremic donors into HCV-uninfected recipients increased quality-adjusted life expectancy and reduced costs compared with a strategy of transplanting kidneys from HCV-unexposed donors.
Editorial: HCV-Infected Deceased Donor Kidney Transplantation—Time to Take Up the Offer by Yuvaram N.V. Reddy et al [FREE]
Blog post: How Cost-Effective is Transplanting Hepatitis C Positive Kidneys? by Anju Yadav [FREE]
Effectiveness of Influenza Vaccination Among Older Adults Across Kidney Function: Pooled Analysis of 2005-2006 Through 2014-2015 Influenza Seasons by Junichi Ishigami, Yingying Sang, Morgan E. Grams, Josef Coresh, Alex Chang, and Kunihiro Matsushita (June 2020)
From the authors: Influenza vaccination is particularly important for older adults and those with high risk conditions including reduced kidney function. In this study, we assessed the effectiveness of influenza vaccination among older adults with and without reduced kidney function. We found that nearly 40% of older adults with and without reduced kidney function were not vaccinated, and receiving an influenza vaccination reduced the risk of hospitalization relevant to influenza by approximately 10% when kidney function was preserved or mild to moderately reduced, but the benefit was not evident when kidney function was severely reduced. Thus, the uptake of influenza vaccination should be improved, while further studies are needed to determine the optimal influenza vaccination strategies for individuals with severely reduced kidney function.
~INTRODUCING THE NKF MISSION AWARD~
“Recognizing research published in AJKD that has great promise to enhance the lives of those affected by kidney disease”
Use of a Decision Aid for Patients Considering Peritoneal Dialysis and In-Center Hemodialysis: A Randomized Controlled Trial by Lalita Subramanian, Junhui Zhao, Jarcy Zee, Megan Knaus, Angela Fagerlin, Erica Perry, June Swartz, Margie McCall, Nicole Bryant, and Francesca Tentori (September 2019)
From the authors: An online decision aid (DA) was tested to assess if it helped patients with chronic kidney disease (CKD) make decisions about the type of dialysis that would best fit their needs and lifestyle. The DA, developed collaboratively with patients, patient advocates, and clinicians, increased knowledge about CKD and treatment options and decreased uncertainty. The proportion of patients unsure of their treatment preference decreased from 47% to 16% after DA use. However, it did not change patients’ self-confidence in selecting a treatment option. Participation was limited to 140 English-speaking people with advanced CKD, internet access, and computer literacy, which may have limited the generalizability of the findings. Studying long-term effects on treatment choice in a wider population of CKD patients in the future may provide further insights into the benefits of the DA.