AstraZeneca, Author Interviews, Kidney Disease, Mineral Metabolism / 08.07.2019

MedicalResearch.com Interview with: [caption id="attachment_50153" align="alignleft" width="142"]Steven Fishbane MD Chief, Division of Kidney Disease and Hypertension Vice President, Northwell Health for Network Dialysis Services, Northwell Health Professor of Medicine Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York Dr. Fishbane[/caption] Steven Fishbane MD Chief, Division of Kidney Disease and Hypertension Vice President, Northwell Health for Network Dialysis Services, Northwell Health Professor of Medicine Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York  MedicalResearch.com: What is the background for this study? Response: Patients on hemodialysis have a great frequency of hyperkalemia. The hemodialysis treatment removes some potassium but not enough to get rid of this problem. Available medications to bind potassium have not been tested among these patients. The purpose of the study was to see if sodium zirconium cyclosilicate could be used as a potassium binder to reduce the risk of hyperkalemia in patients on a hemodialysis.
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, 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.
Author Interviews, Kidney Disease, Neurological Disorders, Pain Research, UCSF / 06.06.2018

MedicalResearch.com Interview with: [caption id="attachment_42216" align="alignleft" width="150"]Dr. Julie H. Ishida MD Department of Medicine, Division of Nephrology University of California, San Francisco and San Francisco Veterans Affairs Medical Center Dr. Ishida[/caption] Dr. Julie H. Ishida MD Department of Medicine, Division of Nephrology University of California, San Francisco and San Francisco Veterans Affairs Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Gabapentin and pregabalin are used for the management of symptoms such as neuropathic pain, itching, and restless leg syndrome in patients receiving hemodialysis. However, hemodialysis patients may be particularly vulnerable to adverse events related to these agents, which are cleared by the kidney, but there is limited data evaluating their risk in this population. Gabapentin and pregabalin use were associated with risk for altered mental status, fall, and fracture, and in some cases, even at doses that would be considered safe for use in this population. 
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, Kidney Disease, UCLA / 07.04.2015

MedicalResearch.com Interview with: Bryan B. Shapiro Harold Simmons Center for Kidney Disease Research and Epidemiology and Division of Nephrology and Hypertension Los Angeles Biomedical Research Institute Harbor–UCLA Medical Center Torrance, California Medical Research: What is the background for this study? What are the main findings? Response: The inverse relationship between body mass index (BMI) and mortality rates is well-documented in maintenance hemodialysis (MHD) patients. Virtually everyone has assumed that this relationship reflects the effect of body weight, and especially fat mass, on mortality in these patients. However, height is also a component of the BMI equation (BMI = body weight (kg)/height (m²)) and may be independently associated  with mortality in MHD patients. The results of this study, which examined 117, 644 MHD patients and was controlled for many demographic and laboratory variables, indicate that height, adjusted for body weight, is directly associated with mortality in a manner that is opposite to the weight-mortality relationship. Moreover, we found that the contribution of height to the inverse BMI-mortality relationship in dialysis is essentially as great as the contribution of weight.
Author Interviews, Kidney Disease, Pharmacology / 14.11.2014

MedicalResearch.com Interview with: Naoka Murakami MD PhD Mount Sinai Beth Israel Department of Medicine Medical Research: What is the background of the study? What are the main findings?  Dr. Murakami: Dialysis patients live in a complex sociomedical situation and are highly dependent on technologies to sustain their lives; such as transportation, electricity and water for the dialysis apparatus. Interruption of this infrastructure by a natural disaster can result in devastating outcomes. During triage of patients arriving at Mount Sinai Beth Israel in the immediate aftermath of hurricane Sandy, we observed that many dialysis patients did not know about their medications, their comorbid conditions nor their dialysis prescriptions. Therefore we conducted a cross-sectional follow-up study of 357 hemodialysis patients in five dialysis units in lower Manhattan, New York. Using checklists prepared by the National Kidney Foundation and the Department of Homeland Security, we found that 26.3% subjects missed dialysis sessions and 66.1% received dialysis at non-regular dialysis unit(s). We observed that the distribution of a “Dialysis emergency packet” significantly improved retention of medical records at home. Analysis showed that dialysis-specific preparedness, racial ethnicity (non-African American, Hispanic or Caucasian), reception of dialysis in affiliated units, and older age, were associated with a significant reduction in missed dialyses.
Author Interviews, Dermatology, Kidney Disease / 30.09.2014

MedicalResearch.com Interview wth: Mei-Ju Ko, MD, PhD Department of Dermatology, Taipei City Hospital Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. Medical Research: What are the main findings of the study? Dr. Ko: In this study, not only did we find that serum levels of interleukin (IL)-31 were significantly higher in hemodialysis patients with pruritus symptoms, but we also demonstrated a positive exposure-response relationship between IL-31 levels and visual analog scale (VAS) scores of pruritus intensity. We also noted an inverse correlation between the severity of pruritus and the dialysis dose assessed by Kt/V.
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.