Author Interviews, Cost of Health Care, JAMA, Kidney Disease, Transplantation / 01.07.2024

MedicalResearch.com Interview with: Amal Trivedi, MD, MPH Professor of Health Services, Policy & Practice Brown University School of Public Health MedicalResearch.com: What is the background for this study? Response: On January 1st, 2021, the Centers for Medicare & Medicaid Services (CMS) launched the mandatory End-Stage Renal Disease Treatment Choices (ETC) Model, which randomly assigned approximately 30% of U.S. dialysis facilities and managing clinicians to financial incentives to increase the use of home dialysis and kidney transplantation. The program is set to run through 2027, with financial incentives and penalties increasing as the model progresses. Our study sought to assess the ETC’s effect on these outcomes of interest in the first two years, as well as to examine outcome changes by race, ethnicity and socioeconomic status. (more…)
Author Interviews, Heart Disease, JACC, Kidney Disease, Transplantation / 21.02.2023

MedicalResearch.com Interview with: Shinobu Itagaki, MD, MSc Assistant Professor Cardiovascular Surgery Icahn School of Medicine at Mount Sinai, New York, NY MedicalResearch.com: What is the background for this study? Were the transplants from a single donor? Response: The heart transplantation is the gold standard therapy for end-stage heart failure patients. As the kidney is affected by the heart function, it is common that the heart transplant candidates have some degree of kidney dysfunction as well. In these cases, the candidates are considered for simultaneous heart and kidney transplantation from a same donor. Unlike isolated heart transplantation, where the indication and benefits have been well established, simultaneous heart and kidney transplantation has less clear indication and benefits. This uncertainty is also complicated by the competing interest with isolated kidney transplantation candidates who in general wait longer on the waiting list. (more…)
Author Interviews, Biomarkers, Gender Differences, Kidney Disease, NEJM, Race/Ethnic Diversity / 26.01.2023

MedicalResearch.com Interview with: Prof. dr. Hans Pottel KU Leuven Kulak Department of Public Health and Primary Care Belgium MedicalResearch.com: What is the background for this study? Response:  The glomerular filtration rate (GFR) is used to diagnose patients with chronic kidney disease and is also used to adjust the dose of drugs that are eliminated by the kidneys. An accurate estimation of GFR is considered of importance in the management of kidney health in patients. In 2021 we published a new serum creatinine based equation, called the European Kidney Function Consortium (EKFC) equation (Pottel H. et al, Development and Validation of a Modified Full Age Spectrum Creatinine-Based Equation to Estimate Glomerular Filtration Rate : A Cross-sectional Analysis of Pooled Data. Ann Intern Med (2021) 174: 183-191): EKFC-eGFR = 107.3 / [Biomarker/Q]a x [0.990(Age – 40) if age > 40 years] With a = 0.322 if Biomarker/Q is less than 1, and a = 1.132 if Biomarker/Q is 1 or more. The equation can easily be interpreted: the leading coefficient equals the glomerular filtration rate (GFR) of 107.3 mL/min/1.73m², which is the average GFR in healthy children (aged > 2 years), adolescents and young adults. The average healthy GFR remains constant until the age of 40 years, and starts decreasing beyond that age. The GFR is inversely related to the ‘rescaled’ biomarker. The rescaling factor (Q) is the average biomarker value for healthy people of a specific population (e.g. children, adult men, adult women, white people, black people, …). Biomarker/Q equals ‘1’ for the average healthy person, corresponding with eGFR = 107.3 mL/min/1.73m² (up to 40 years of age). It should be noted that for serum creatinine, the Q-value depends on sex and race. Our hypothesis was that the above equation is valid for any renal biomarker, on the condition that the biomarker is appropriately scaled. We showed that the same equation was able to estimate GFR from 2 years to oldest ages. In the current study we tested and validated our hypothesis by applying the above formula for appropriately ‘rescaled’ cystatin C. (more…)