Annals Internal Medicine, Author Interviews, Clots - Coagulation, Heart Disease, Kidney Stones / 16.07.2019

MedicalResearch.com Interview with: [caption id="attachment_50193" align="alignleft" width="84"]Sunil Badve MBBS, MD, DNB, FRACP, PhD, FASN Senior Research Fellow, Renal & Metabolic Division Staff specialist nephrologist | St George Hospital University of New South Wales The George Institute for Global Health Australia Dr. Badve[/caption] Sunil Badve MBBS, MD, DNB, FRACP, PhD, FASN Senior Research Fellow, Renal & Metabolic Division Staff specialist nephrologist | St George Hospital University of New South Wales The George Institute for Global Health Australia MedicalResearch.com: What is the background for this study? Response: Despite the high prevalence of cardiovascular thrombotic events and venous thromboembolism (VTE) in chronic kidney disease (CKD), oral anticoagulant therapy is often underutilized in patients with advanced CKD and dialysis-dependent end-stage kidney disease (ESKD) due to uncertainty of benefit and potential bleeding complications. This comprehensive systematic review was performed to study the benefits and harms of oral anticoagulant therapy in patients with CKD.
Author Interviews, End of Life Care, JAMA, Kidney Disease / 08.07.2019

MedicalResearch.com Interview with: [caption id="attachment_43001" align="alignleft" width="133"]Dr. Ann M. O’Hare, MD Professor,Division of Nephrology University of Washington Investigator, VA HSR&D Center of Excellence Affiliate Investigator, Group Health Research Institute Seattle, WA  Prof. O'Hare[/caption] Dr. Ann M. O’Hare, MD Professor,Division of Nephrology University of Washington Investigator, VA HSR&D Center of Excellence Affiliate Investigator, Group Health Research Institute Seattle, WA  MedicalResearch.com: What is the background for this study? Response: We know that survival for people undergoing dialysis is generally quite limited.  Only a few studies have attempted to elicit how patients undergoing dialysis understand prognosis and how their prognostic awareness might be related to their interest in planning for the future, their preferences for resuscitation and the kind of care they would want if they were seriously ill or dying.
Author Interviews, Cost of Health Care, Kidney Disease / 03.07.2019

MedicalResearch.com Interview with: "Plugged into dialysis" by Dan is licensed under CC BY 2.0Andrew C. Qi,  Medical student Karen E. Joynt Maddox MD MPH Assistant professor of medicine Washington University School of Medicine Saint Louis, Missouri.  MedicalResearch.com: What is the background for this study?   Response: The End-Stage Renal Disease Quality Incentive Program (ESRD QIP) is a Medicare program that evaluates dialysis facilities in the U.S. based on a set of quality measures, and penalizes low-performing facilities. We’ve seen a growing understanding of how social risk factors like poverty and race/ethnicity impact patient outcomes in other settings, making it difficult for providers caring for disadvantaged populations to perform as well in these kinds of pay-for-performance programs. We were interested in seeing if this was the case for dialysis facilities as well, especially since patients receiving dialysis are already a vulnerable population.
Author Interviews, JAMA, Johns Hopkins, Kidney Disease, Surgical Research / 13.06.2019

MedicalResearch.com Interview with: [caption id="attachment_49763" align="alignleft" width="80"]Caitlin W. Hicks, M.D., M.S. Assistant Professor of Surgery Recipient of the Department of Surgery Rothman Early Career Development Award for Surgical Research Johns Hopkins Medicine Dr. Hicks[/caption] Caitlin W. Hicks, M.D., M.S. Assistant Professor of Surgery Recipient of the Department of Surgery Rothman Early Career Development Award for Surgical Research Johns Hopkins Medicine MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Arteriovenous fistula are associated with better long-term patency, lower rates of infection, and lower long-term costs compared to arteriovenous graft. As a result, the Fistula First Catheter Last Guidelines recommend placement of an arteriovenous fistula over an AVG whenever possible. We looked at individual physician utilization of AVF vs AVG for first-time AV access in Medicare beneficiaries. We found that the median physician utilization rate for AVG was only 18%, but that 21% of physicians use AVG in more than 34% of cases, which is above currently recommended  practice guidelines. 
Author Interviews, Cost of Health Care, Kidney Disease, UCLA / 14.05.2019

MedicalResearch.com Interview with: [caption id="attachment_49111" align="alignleft" width="200"]Chris Childers, MD, PhDDivision of General SurgeryDavid Geffen School of Medicine at UCLA10833 Le Conte Ave., CHS 72-247Los Angeles, CA 90095 Dr. Childers[/caption] Chris Childers, MD, PhD Division of General Surgery David Geffen School of Medicine at UCLA Los Angeles, CA 90095 MedicalResearch.com: What is the background for this study? Response: Patients with end-stage renal disease – poorly functioning kidneys – often have to receive dialysis. This typically requires a patient to visit an outpatient clinic several times a week to have their blood filtered by a machine. Over the past few years, two for-profit companies have increased their control over the outpatient dialysis market – DaVita and Fresenius. Combined they control approximately ¾ of the market.  A number of concerns have been raised against these for-profit companies suggesting that the quality of care they deliver may be worse than the care delivered at not-for-profit companies. But, because they control so much of the market and because patients have to receive dialysis so frequently, patients may not have much choice in the clinic they visit. Medicare covers patients who are 65 years or older and also patients on dialysis regardless of age.  Medicare pays a fixed rate for dialysis which they believe is adequate to cover the clinics' costs. However, if a patient also has private insurance, the insurer is required to pay for dialysis instead of Medicare. Whereas Medicare rates are fixed by the federal government, private insurers have to negotiate the price they pay, and may pay much more as a result.
Author Interviews, Cost of Health Care, JAMA, Kidney Disease, UCSF / 27.12.2018

MedicalResearch.com Interview with: [caption id="attachment_46717" align="alignleft" width="155"]Oanh Kieu Nguyen, MD, MA Assistant Professor Division of Hospital Medicine Zuckerberg San Francisco General Hospital UCSF Dr. Nguyen[/caption] Oanh Kieu Nguyen, MD, MA Assistant Professor Division of Hospital Medicine Zuckerberg San Francisco General Hospital UCSF MedicalResearch.com: What is the background for this study? Response: In U.S. citizens and permanent residents with kidney failure or end-stage renal disease (ESRD), having health insurance, Medicare, or Medicaid guarantees access to regularly scheduled hemodialysis 2-3 times per week, the evidence-based standard of care for ESRD. This treatment helps people live relatively normal lives. In 40 of 50 U.S. states, undocumented immigrants with ESRD have limited access to hemodialysis because they are not eligible for any form of federal assistance including Medicare or Medicaid, and must wait until they are life-threateningly ill to receive dialysis through a hospital emergency department, a situation called “emergency-only hemodialysis.” There are an estimated 6,500 undocumented individuals in the U.S. suffering from ESRD. A unique opportunity made it feasible for uninsured undocumented immigrants with ESRD receiving emergency-only dialysis in Dallas, Texas, to enroll in private, commercial health insurance plans in 2015 and made it possible for researchers to compare scheduled vs. emergency-only dialysis among undocumented immigrants with ESRD. This natural experiment included 181 undocumented immigrants, 105 of whom received insurance coverage and enrolled in scheduled dialysis and 76 of whom remained uninsured. 
Author Interviews / 12.12.2018

MedicalResearch.comInterview with:

Tetsuo Shoji, MD, PhD.
Department of Vascular Medicine
Osaka City University Graduate School of Medicine
Osaka Japan
Dr. Shoji

Tetsuo Shoji, MD, PhD.
Department of Vascular Medicine
Osaka City University Graduate School of Medicine
Osaka Japan

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Response: Vitamin D is known to be associated with health and disease of various organs such as bone, heart, brain, and others. Vitamin D is activated by the liver and kidneys to a hormone called 1,25-dihydroxyvitamin D which binds to vitamin D receptor in cells to exert its functions.

Vitamin D activation is severely impaired in patients with kidney disease requiring hemodialysis therapy, leading to mineral and bone disorder(MBD). Therefore, active form of vitamin D is one of the standard choices of treatment for MBD caused by kidney function loss.

Previous observational cohort studies showed that the use of active vitamin D in hemodialysis patients was associated with lower likelihood of all-cause death, cardiovascular death, and incident cardiovascular disease.Potentially cardio-protective effects of active vitamin D were shown by basic studies using cultured cells and animal models. Then, many nephrologists began to believe that active vitamin D is a “longevity hormone” or a “panacea” for kidney patients requiring dialysis therapy, although there was no evidence by randomized clinical trials. 

To show evidence for it, we conducted a randomized clinical trial namedJ-DAVID in which 976 hemodialysis patients were randomly assigned to treatment with oral alfacalcidol or treatment without active vitamin D, and they were followed-up for new cardiovascular events during the four-year period. The risk of cardiovascular events was not significantly different between the two groups. The risk of all-cause death was not significantly different either.

To our surprise, the risk of cardiovascular event tended to be higher in the patients who continued treatment with active vitamin D than those who continued non-use of active vitamin D, although the difference was not statistically significant.

Author Interviews, Cost of Health Care, JAMA, Kidney Disease / 31.10.2018

MedicalResearch.com Interview with: "Plugged into dialysis" by Dan is licensed under CC BY 2.0Amal Trivedi, MD, MPH Associate Professor of Health Services, Policy and Practice Associate Professor of Medicine Brown University MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Affordable Care Act Medicaid expansion gave states the option to expand coverage to low-income adults. Prior research has reported that these expansions have been associated with increased coverage, improved access to care, and in some studies better self-rated health. To date the impact of Medicaid expansion on mortality rates, particularly for persons with serious chronic illness, remains unknown. Our study found an association between Medicaid expansion and lower death rates for patients with end-stage renal disease in the first year after initiating dialysis.  Specifically, we found an absolute reduction in 1-year mortality in expansion states of -0.6 percentage points, which represents a 9% relative reduction in 1-year mortality.     
Author Interviews, JAMA, Kidney Disease / 07.10.2018

MedicalResearch.com Interview with: "Plugged into dialysis" by Dan is licensed under CC BY 2.0 Elani Streja MPH PhD Division of Nephrology and Hypertension University of California, Irvine | UCI · Elvira O. Gosmanova, MD, FASN Medicine/Nephrology Albany Stratton VA Medical Center Csaba P Kovesdy MD Fred Hatch Professor of Medicine Division of Nephrology, University of Tennessee Health Science Center Nephrology Section Chief, Memphis VA Medical Center Director, Clinical Outcomes and Clinical Trials Program Memphis TN, 38163  MedicalResearch.com: What is the background for this study? What are the main findings? Response:  Cardiovascular disease (CVD) is one of the leading causes of mortality and morbidity in patients with chronic kidney disease (CKD). Statins are lipid-lowering drugs that have a proven track record in reducing risk of CVD in patients with advanced CKD who did not yet reach its terminal stage or end-stage renal disease (ESRD). Paradoxically, new prescription of statins after ESRD onset failed to reduce CVD related outcomes in three large clinical trials. However, benefits of statin continuation at transition from advanced CKD to ESRD was never formally tested. Therefore, we identified a cohort of 14,298 US Veterans who used statins for at least half of the year during 1 year before ESRD transition and evaluated mortality outcomes based on whether statins were continued or stopped after ESRD onset. We found that ESRD patients who continue statins for at least 6 months after transition had 28% and 18% lower risk of death from any cause or cardiovascular causes, respectively, during 12-months of follow up, as compared with statin discontinuers.
Annals Internal Medicine, Author Interviews, Cost of Health Care, Kidney Disease / 22.05.2018

MedicalResearch.com Interview with: [caption id="attachment_41937" align="alignleft" width="133"]Lilia Cervantes, M.D. Internal Medicine, Hospitalist Denver Health and Hospital Authority Assistant Professor, Division of General Internal Medicine Founder, Healthcare Interest Program and Health Equity Lecture Series at Denver Health University of Colorado Health Sciences Center Dr. Cervantes[/caption] Lilia Cervantes, M.D. Internal Medicine, Hospitalist Denver Health and Hospital Authority Assistant Professor, Division of General Internal Medicine Founder, Healthcare Interest Program and Health Equity Lecture Series at Denver Health University of Colorado Health Sciences Center MedicalResearch.com: What is the background for this study? What are the main findings?  Response:  For most undocumented immigrants with kidney failure in the U.S., access to hemodialysis is limited and they can only receive it when they are critically ill and near-death.  This type of “emergency-only” hemodialysis is already known to be nearly 4-fold more costly, has 14-fold higher mortality rate, and leads to debilitating physical and psychosocial distress for these patients compared to those receiving regular hemodialysis. This study shows that clinicians who are forced to provide this substandard care are also harmed.  They experience moral distress, emotional exhaustion, and several other drives of professional burnout due to witnessing needless suffering and high mortality. 
Author Interviews, Baylor College of Medicine Houston, Kidney Disease, Occupational Health / 01.02.2018

MedicalResearch.com Interview with: [caption id="attachment_39787" align="alignleft" width="210"]Hemodialysis machine Wikipedia image Hemodialysis machine
Wikipedia image[/caption] Dr. Kevin F. Erickson MD, MS Section of Nephrology and Selzman Institute for Kidney Health Baylor College of Medicine Houston, TX MedicalResearch.com: What is the background for this study? Response: An amendment to the Social Security Act passed in 1972 made it so nearly every person who develops end-stage renal disease – or ESRD – in the U.S. becomes eligible for Medicare, regardless of their age. At the time the law was passed, the bill’s supporters argued that access to life-sustaining dialysis therapy would enable patients to continue being productive members of society through work and activities at home. While the law has succeeded in providing access to dialysis therapy for many patients who would have otherwise died from kidney failure, it has been less successful at helping patients to continue working. The rate of employment among patients with ESRD who are receiving dialysis in the U.S. is low and has continued to decrease over time, despite both financial benefits from employment and evidence suggesting that patients who are employed experience improved quality of life and sense of wellbeing. We used a national ESRD registry to examine trends in employment between 1996 and 2013 among patients starting dialysis in the U.S. and in the six months before ESRD. Our goal was to determine whether difficulties that patients face when trying to work begin even before they develop ESRD.
Author Interviews, CDC, Diabetes, Kidney Disease / 08.11.2017

MedicalResearch.com Interview with: Nilka Ríos Burrows, MPH, MT (ASCP) Lead, Chronic Kidney Disease Initiative CDC Division of Diabetes Translation.  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Kidney failure treated with dialysis or a kidney transplant is called end-stage renal disease (ESRD).  ESRD is a costly and disabling condition often resulting in premature death. During 2000–2014, kidney failure from diabetes among U.S. adults with diabetes decreased by 33%, and it declined significantly in most states, the District of Columbia, and Puerto Rico. No state experienced an increase in kidney failure from diabetes. Continued awareness and interventions to reduce risk factors for kidney failure, improve diabetes care, and prevent type 2 diabetes might sustain these positive trends.
Author Interviews, Fertility, Geriatrics, Kidney Disease / 06.11.2017

MedicalResearch.com Interview with: [caption id="attachment_37895" align="alignleft" width="116"]Silvi Shah, MD, FACP, FASN Assistant Professor, Division of Nephrology University of Cincinnati Cincinnati, OH Dr. Shah[/caption] Silvi Shah, MD, FACP, FASN| Assistant Professor Division of Nephrology University of Cincinnati Cincinnati, OH MedicalResearch.com: What is the background for this study? What are the main findings? Response: Elderly represent the fastest growing segment of incident dialysis patients in Unites States. The annual mortality in end stage renal disease (ESRD) patients is very high ~ 20%. Since most of the deaths occur in the first year of dialysis, it is possible that health conditions present prior to initiation of dialysis may impact long-term outcomes. In this study, we determined the impact of poor functional status at the time of dialysis initiation and pre-dialysis health status on type of dialysis modality, type of hemodialysis access and one-year mortality in elderly dialysis patients. We evaluated 49,645 adult incident dialysis patients (1/1/2008 to 12/31/2008) from the United Data Renal Data System (USRDS) with linked Medicare data for at least 2 years prior to dialysis initiation. Mean age of our study population was 72 years. At dialysis initiation, 18.7% reported poor functional status, 88.9% has pre-dialysis hospitalization, and 27.8% did not receive pre-dialysis nephrology care. Patients with poor functional status had higher odds of being initiated on hemodialysis than peritoneal dialysis, lower odds of using arteriovenous access as compared to central venous catheter for dialysis and higher risk of one-year mortality.
Author Interviews, Frailty, Kidney Disease / 04.11.2017

MedicalResearch.com Interview with: [caption id="attachment_37895" align="alignleft" width="116"]Silvi Shah, MD, FACP, FASN Assistant Professor, Division of Nephrology University of Cincinnati Cincinnati, OH Dr. Shah[/caption] Silvi Shah, MD, FACP, FASN Assistant Professor, Division of Nephrology University of Cincinnati Cincinnati, OH MedicalResearch.com: What is the background for this study? What are the main findings? Response: Elderly represent the fastest growing segment of incident dialysis patients in Unites States. The annual mortality in end stage renal disease (ESRD) patients is very high ~ 20%. Since most of the deaths occur in the first year of dialysis, it is possible that health conditions present prior to initiation of dialysis may impact long-term outcomes. In this study, we determined the impact of poor functional status at the time of dialysis initiation and pre-dialysis health status on type of dialysis modality, type of hemodialysis access and one-year mortality in elderly dialysis patients. We evaluated 49,645 adult incident dialysis patients (1/1/2008 to 12/31/2008) from the United Data Renal Data System (USRDS) with linked Medicare data for at least 2 years prior to dialysis initiation. Mean age of our study population was 72 years. At dialysis initiation, 18.7% reported poor functional status, 88.9% has pre-dialysis hospitalization, and 27.8% did not receive pre-dialysis nephrology care. Patients with poor functional status had higher odds of being initiated on hemodialysis than peritoneal dialysis, lower odds of using arteriovenous access as compared to central venous catheter for dialysis and higher risk of one-year mortality.
Author Interviews, Geriatrics, Kidney Disease / 04.11.2017

MedicalResearch.com Interview with: Charuhas Thakar, MD Professor Director of the Division of Nephrology Kidney CARE program University of Cincinnati MedicalResearch.com: What is the background for this study? What are the main findings? Response: Based on the plausibility that pre-dialysis health status can impact outcomes after initiation of chronic dialysis, we examined large national USRDS dataset with linked Medicare claims prior to dialysis. We found that 88% of patients who initiate dialysis experience at least one acute care hospitalization in two years preceding their dialysis start. If they do, that is associated with a significant increase in the risk of mortality at one year. We also examined effect of different types of hospitalizations in the pre-dialysis period – Cardiovascular, Infections, both, and neither of the two. There were statistical differences in the effect of type of hospitalization and post dialysis mortality.
Author Interviews, Cost of Health Care, Emergency Care, JAMA, Kidney Disease / 22.08.2016

MedicalResearch.com Interview with: [caption id="attachment_27209" align="alignleft" width="122"]Rachel Patzer, PhD, MPH Director of Health Services Research, Emory Transplant Center Assistant Professor Emory University School of Medicine Department of Surgery Division of Transplantation Dr. Rachel Patzer[/caption] Rachel Patzer, PhD, MPH Director of Health Services Research, Emory Transplant Center Assistant Professor Emory University School of Medicine Department of Surgery Division of Transplantation MedicalResearch.com: What is the background for this study? Response: Patients with End Stage Renal Disease (ESRD) make up less than 1% of all Medicare patients, but account for more than 7% of all Medicare expenses. Patients with ESRD have the highest risk of hospitalization of any patient with a chronic disease, and while hospital admissions have decreased over the last several years, emergency department utilization for this patient population has increased by 3% in the last 3 years. The purpose of the study we conducted was to describe the clinical and demographic characteristics associated with emergency department utilization.
Anemia, Author Interviews, Infections, Kidney Disease, UCSF / 21.10.2015

Dr. Julie H. Ishida MD San Francisco Veterans Affairs Medical Center Nephrology Section San Francisco, CAMedicalResearch.com Interview with: Dr. Julie H. Ishida MD San Francisco Veterans Affairs Medical Center Nephrology Section San Francisco, CA Medical Research: What is the background for this study? What are the main findings? Dr. Ishida: Intravenous iron is important in the treatment of anemia of end-stage renal disease, but it is biologically plausible that iron may increase infection risk. While results from epidemiologic studies evaluating the association between intravenous iron and infection in hemodialysis patients have been conflicting, guidelines for the treatment of anemia of chronic kidney disease have recommended caution in prescribing, avoidance and withholding of intravenous iron in the setting of active infection. However, no data specifically support the recommendation to withhold intravenous iron during active infection. Our study observed that among hemodialysis patients hospitalized for bacterial infection who had been receiving intravenous iron as an outpatient, continued receipt of intravenous iron was not associated with higher all-cause mortality, readmission for infection, or longer hospital stay.
Author Interviews, Kidney Disease, Social Issues / 18.06.2015

Holly Kramer, MD, MPH Department of Public Health Sciences Loyola University Chicago Health Sciences Campus Maywood, ILMedicalResearch.com Interview with: Holly Kramer, MD, MPH Department of Public Health Sciences Loyola University Chicago Health Sciences Campus Maywood, IL MedicalResearch: What is the background for this study? What are the main findings? Dr. Kramer: The U.S. dialysis dependent population continues to grow with  636,905 prevalent cases of end-stage renal disease (ESRD) in the U.S. as of December 31, 2012, , an increase of 3.7% since 2011.  Poverty is a well described risk factor for ESRD because poverty impacts access to care and nutritious foods.  The definitions for poverty in the U.S. have not changed over the past several decades despite marked changes in social structure.  For example, social integration in the U.S. society currently requires a cell phone, computer and internet access and access to transportation.  Healthy foods also cost more now relative to unhealthy foods compared to past decades.  Thus, the link between poverty and any chronic disease or health outcome is likely dynamic due to the evolving financial burden for living in a rapidly changing industrialized society.  Our study defined poverty as living in a zip code defined area with > 20% of the residents living below the federal poverty line.  We show that the prevalence of adults receiving dialysis who are living in poverty has increased over time.  We also show that the association between poverty and ESRD may be getting stronger over time.  
Author Interviews, Kidney Disease, OBGYNE, Pharmacology / 01.04.2015

Dr. Mala Sachdeva MD North Shore University Hospital, Long Island Jewish Medical Center Assistant Professor, Nephrology, Internal Medicine Hofstra North Shore-LIJ School of MedicineMedicalResearch.com Interview with: Dr. Mala Sachdeva MD North Shore University Hospital, Long Island Jewish Medical Center Assistant Professor, Nephrology, Internal Medicine Hofstra North Shore-LIJ School of Medicine Medical Research: What is the background for this study? Dr. Sachdeva: The last study examining pregnancy and dialysis outcomes in the United States was performed more than 15 years ago. Our study was conducted to evaluate practice patterns and to trend maternal and fetal outcomes in the pregnant dialysis female over the past five years. We did a surveymonkey-based survey of American nephrologists on their knowledge of managing pregnancy patients on dialysis. Medical Research: What are the main findings? Dr. Sachdeva: Over the past five years, more than 59 pregnancies have been reported. During this time period, almost half of the American nephrologist respondents (43%) have cared for pregnant females on hemodialysis. Hence, we can see that more nephrologists are now faced with taking care of the pregnant dialysis patient. Although a good number of patients initiated dialysis during pregnancy (32%), the majority (58%) of pregnancies occurred within the first five years of being on maintenance dialysis. Pregnancy outcomes can improve. Of the reported pregnancies 23% did not result in live births. 50% of the pregnancies were complicated by preeclampsia. There were no maternal deaths. Most nephrologists prescribe 4 to 4.5 hours of hemodialysis. 64% of respondents provide dialysis for six days per week. Only 21% aimed for a target predialysis BUN of less than 20 mg/dL while 66% of nephrologists targeted a BUN less than 50mg/dL.  75% of respondents do not have access to fetal monitoring during dialysis for their pregnant patient. There are approximately 32% of American nephrologists who are somewhat to very uncomfortable caring for a pregnant woman on hemodialysis. 51% of American nephrologists or a member of their staff counsel their female dialysis patients about contraception. So in summary, while majority of the US based nephrologists are trying to dialyze pregnant ESRD patients with more intense prescriptions, there are still some gaps with comfort and knowledge.
Author Interviews, Heart Disease, Kidney Disease / 30.03.2015

[caption id="attachment_13101" align="alignleft" width="125"]Hemodialysis Hemodialysis[/caption] MedicalResearch.com Interview with: Tanush Gupta, MD Department of Medicine, Division of Cardiology New York Medical College, NY Medical Research: What is the background for this study? What are the main findings? Dr. Gupta: There are approximately 600,000 prevalent cases of end stage renal disease (ESRD) in the United States. Cardiovascular disease is the leading cause of death in ESRD patients. Moreover, approximately 20% of these deaths due to cardiovascular disease are attributable to acute myocardial infarction (AMI). Multiple studies have shown that ESRD patients have poor short- and long-term survival after AMI relative to the general population. We analyzed the publicly available Nationwide Inpatient Sample (NIS) databases from 2003 to 2011 to examine the temporal trends in ST-elevation myocardial infarction (STEMI), use of mechanical revascularization for STEMI, and in-hospital outcomes in adult ESRD patients in the United States. We found that from 2003 to 2011, whereas the number of acute myocardial infarction hospitalizations in ESRD patients increased from 13,322 to 20,552, there was a decline in the number of STEMI hospitalizations from 3,169 to 2,558. The use of percutaneous coronary intervention (PCI) for STEMI increased from 18.6% to 37.8%, whereas there was no significant change in the use of coronary artery bypass grafting. During the study period, in-hospital mortality in ESRD patients with STEMI increased from 22.3% to 25.3%. We also observed an increase in average hospital charges and a decrease in mean length of stay during the study period.
Author Interviews, Cleveland Clinic, Kidney Disease, Social Issues / 21.01.2015

MedicalResearch.com Interview with: Suma Prakash MD, MSc, FRCPC Department of Medicine, Division of Nephrology Case Western Reserve University MetroHealth Medical Center Cleveland, Ohio Medical Research: What is the background for this study? What are the main findings? Dr. Prakash: Patients with advanced chronic kidney disease are often faced with difficult decisions of having to choose between options to replace their kidney function. Many patients may not be ready to make treatment decisions since most people don’t want to need a chronic medical treatment. The behavioural stage of change model originally used to help people with smoking cessation has been used to help patients make decisions about self-care with diabetes and undergo cancer screening. It has not been studied in patients with chronic kidney disease. As patients progress through the stages, they are more ready to make decisions. Focusing on better understanding the decision making process from patients’ perspectives allows us as medical professionals to help patients make timely decision about their options.
Author Interviews, Kidney Disease, Vanderbilt / 09.12.2014

Dr. Julia Lewis, MD, Lead Investigator Nephrologist and Professor of Medicine Vanderbilt University Medical CenterMedicalResearch.com Interview with: Dr. Julia Lewis, MD, Lead Investigator Nephrologist and Professor of Medicine Vanderbilt University Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Lewis: The 48-week Open Label Extension (OLE) study for Auryxia™ (ferric citrate) was conducted to determine long term safety following the Phase 3 52-week active-control period. The study also evaluated changes in serum phosphorus, transferrin saturation (TSAT), serum ferritin, hemoglobin, hematocrit and additional parameters, as well as intravenous (IV) iron and erythropoiesis-stimulating agent (ESA) usage. In the OLE study, Auryxia demonstrated long-term safety in dialysis-dependent chronic kidney disease (CKD) patients. The results were consistent with those seen in the published pivotal Phase 3 trial. The study demonstrated that the adverse events (AE’s) profile of Auryxia was similar to that seen in the Phase 3 52-week active-control period. AEs occurred in 142 patients treated with Auryxia. They were primarily non-serious gastrointestinal (GI) - related AE’s, including diarrhea, nausea, vomiting and constipation. Serious adverse events occurred in 75 patients, though none were related to Auryxia. In addition, there were no clinically or statistically significant differences in liver enzymes or aluminum levels observed from baseline to the end of the 48 weeks. Similar to the original trial, we witnessed excellent phosphorus control with the drug, along with an increase and then a plateau in serum ferritin and TSAT levels with Auryxia. The plateauing of serum ferritin and TSAT further supports iron absorption is highly regulated by the gastrointestinal track as seen in the 52-week active control period. This suggests that the body absorbs iron as needed for effective erythropoiesis. Additionally, iron store increases from ferric citrate resulted in, by the end of the extension study, 85% of subjects not using any IV iron. We presented this data at the 2014 American Society of Nephrology Meeting. The abstract can be found online at www.asn-online.org.
Author Interviews, Kidney Disease, Lipids / 01.12.2014

Thomas Weichhart, PhD Associate Professor, Medical University of Vienna Institute of Medical Genetics Vienna AustriaMedicalResearch.com Interview with: Thomas Weichhart, PhD Associate Professor, Medical University of Vienna Institute of Medical Genetics Vienna Austria Medical Research: What is the background for this study? Dr.  Weichhart: Impairment of high-density lipoprotein (HDL) function has been associated with cardiovascular events in patients with kidney failure on hemodialysis. The protein composition of HDLs is altered in these patients presumably compromising the cardioprotective effects of HDLs. In an earlier study we found that two proteins in particular, namely Serum Amyloid A (SAA) and Surfactant Protein B (SP-B), are significantly raised in the HDL of dialysis patients, and these also contribute towards HDL losing its protective effect. In the current study we have now developed an novel test that can quickly and directly measure the SAA and SP-B bound to HDL.
Exercise - Fitness, Kidney Disease / 20.11.2014

Prof. Francesca Mallamaci Professor of Nephrology Head of the Hypertension Unit at the Department of Nephro-Urology, CNR-IBIM Research on Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, ItalyMedicalResearch.com Interview with: Prof. Francesca Mallamaci Professor of Nephrology Head of the Hypertension Unit at the Department of Nephro-Urology, CNR-IBIM Research on Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy Medical Research: What is the background for this study? What are the main findings? Dr. Mallamaci: It is well known that physical activity is beneficial both in normal individuals and in patients with heart failure which represent a high risk category of patients. We have scanty information about physical activity in dialysis patients. So the aim of our study was to test the effectiveness of a low-intensity, easy to implement, home exercise program on physical performance in about 300 dialysis patients in a multicenter, randomized, controlled clinical trial (EXCITE, ClinicalTrials.gov NCT01255969). What we found in our study was that dialysis patients who performed exercise improved their physical performance and this was documented by 2 well known and validated performance tests such as the Six Minute Walking Test and the Sit-to-stand-to sit test. We found also that after 2 year follow-up dialysis patients who were in the active exercise arm had a lower rate of hospitalization and a trend to a better survival, compared to dialysis patients in the control arm of the study.
Kidney Disease / 16.11.2014

Anu Wadhwa, M.D. Assistant Professor of Medicine Division of Nephrology and Hypertension Loyola University Medical Center/ Hines VA Hospital Maywood, IL-60153MedicalResearch.com Interview with: Anu Wadhwa, M.D. Assistant Professor of Medicine Division of Nephrology and Hypertension Loyola University Medical Center/ Hines VA Hospital Maywood, IL-60153 Medical Research: What is the background for this study? Dr. Wadhwa: Patients with end stage renal disease rely on dialysis treatments to survive. Hence this population is very vulnerable during emergencies or disaster situations. We believe that patient education on an individual level is the cornerstone of a successful disaster plan. In this quality improvement study, we assessed disaster preparedness in our dialysis patients and evaluated multidisciplinary approach to disseminate this information. Multidisciplinary team of physicians, nurses, dieticians and social workers reviewed preparedness-relevant topics with the patients. Patients were provided purple cards (created by KCER) with emergency information to carry with them at all times. A simple yes/no questionnaire asking disaster preparedness relevant questions was given to the patients before and after this education was provided. Disaster preparedness was defined as perceived preparedness (survey question) and a positive response to at least three key questions-having a plan they have had discussed with a family member or dialysis unit, knowledge of backup dialysis facility and familiarity with emergency diet plan.
Author Interviews, Kidney Disease / 11.07.2014

MedicalResearch.com Interview with: Victoria A. Kumar, M.D. Internal Medicine/Nephrology Division of Nephrology Department of Internal Medicine Southern California Permanente Medical Group Los Angeles, California, USA Medical Research: What are the main findings of the study? Dr. Kumar: There was over a 2 fold increase in patient survival in incident peritoneal dialysis patients in the first year on dialysis compared to propensity matched incident hemodialysis patients.  We excluded any patients who utilized a central dialysis catheter at any point during the first 90 days on hemodialysis in an effort to reduce the mortality bias associated with hemodialysis patients who start with a catheter.  All hemodialysis patients had pre-dialysis care by a nephrologist prior to starting dialysis. The 2+ fold increase in survival among peritoneal dialysis patients resulted in a 2-3 year cumulative survival advantage for peritoneal dialysis patients, using both intent to treat and as-treated analyses.
Author Interviews, Heart Disease, Kidney Disease, McGill / 27.03.2014

Louise Pilote, MD, MPH, PhD Department of Medicine, McGill University Department of Epidemiology and Biostatistics, McGill UniversityMedicalResearch.com Interview with: Louise Pilote, MD, MPH, PhD Department of Medicine, McGill University Department of Epidemiology and Biostatistics, McGill University MedicalResearch.com: What are the main findings of the study? Dr. Pilote: Our study found that in patients with atrial fibrillation (AF) undergoing dialysis, warfarin use, compared to no-warfarin use, did not reduce the risk for stroke (adjusted hazard ratio (HR): 1.14, 95% confidence interval (CI): 0.78 to 1.67) but it was associated with a 44% higher risk for bleeding event (adjusted HR: 1.44, 95% CI: 1.13 to 1.85). However, warfarin use in non-dialysis patients with AF was associated with a 13% lower risk for stroke (adjusted HR: 0.87, 95% CI: 0.85 to 0.90) and only a 19% higher risk for bleeding event (adjusted HR: 1.19, 95% CI: 1.16 to 1.22).
Author Interviews, HIV, Kidney Disease / 11.09.2013

MedicalResearch.com Interview with: Magnus G. Rasch MD Faculty of Health Sciences, University of Copenhagen 1455 København K, Denmark Department of Infectious Diseases Copenhagen University Hospital, Rigshospitalet, Denmark MedicalResearch.com: What are the main findings of the study? Dr. Rasch: In the study “Increased risk of dialysis and end-stage renal disease among HIV patients in Denmark compared with the background population” we found that the risk of acute renal replacement therapy (aRRT) and the risk of chronic renal replacement therapy (cRRT) was increased substantially in HIV patients compared with the background population. The risk of aRRT was highest the first year after HIV diagnosis. Factors associated with increased risk of aRRT were intravenous drug use, hypertension and an AIDS-defining illness. Risk factors for cRRT were hypertension and baseline estimated glomerular filtration rate.