Care of Undocumented Individuals With ESRD: A National Survey of US Nephrologists
, 27 March 2009
Laura Hurley, Allison Kempe, Lori A. Crane, Arthur Davidson, Katherine Pratte, Stuart Linas, L. Miriam Dickinson, Tomas Berl
American Journal of Kidney Diseases
June 2009 (Vol. 53, Issue 6, Pages 940-949) Abstract |
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Add-Ons
Reform of the US Healthcare System: Care of Undocumented Individuals With ESRD
Barry M. Straube
American Journal of Kidney Diseases
June 2009 (Vol. 53, Issue 6, Pages 921-924) Full Text |
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Long-term Risk of Mortality and Other Adverse Outcomes After Acute Kidney Injury: A Systematic Review and Meta-analysis
, 06 April 2009
Steven G. Coca, Bushra Yusuf, Michael G. Shlipak, Amit X. Garg, Chirag R. Parikh
American Journal of Kidney Diseases
June 2009 (Vol. 53, Issue 6, Pages 961-973) Abstract |
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Long-term Outcomes After Acute Kidney Injury: Where We Stand and How We Can Move Forward
, 23 March 2009
Lowell Lo, Kathleen D. Liu, Chi-yuan Hsu
American Journal of Kidney Diseases
June 2009 (Vol. 53, Issue 6, Pages 928-931) Full Text |
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Rapid Reversal of Acute Kidney Injury and Hospital Outcomes: A Retrospective Cohort Study
, 13 April 2009
Jianmin Tian, Fidel Barrantes, Yaw Amoateng-Adjepong, Constantine A. Manthous
American Journal of Kidney Diseases
June 2009 (Vol. 53, Issue 6, Pages 974-981) Abstract |
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Association of Body Mass Index With Decline in Residual Kidney Function After Initiation of Dialysis
, 17 February 2009
Christiane Drechsler, Renée de Mutsert, Diana C. Grootendorst, Elisabeth W. Boeschoten, Raymond T. Krediet, Saskia le Cessie, Christoph Wanner, Friedo W. Dekker, NECOSAD Study Group
American Journal of Kidney Diseases
June 2009 (Vol. 53, Issue 6, Pages 1014-1023) Abstract |
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The Importance of Residual Kidney Function for Patients on Dialysis: A Critical Review
, 27 April 2009
Jeffrey Perl, Joanne M. Bargman
American Journal of Kidney Diseases
June 2009 (Vol. 53, Issue 6, Pages 1068-1081) Abstract |
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See Hurley et al, pages 940-949; and Straube, pages 921-924.
Although Medicare covers most dialysis therapy for US citizens with ESRD, no national standards for dialysis provision exist for undocumented patients with ESRD. In this issue, Hurley et al describe a mail and internet survey conducted from October 2006 to February 2007 of American Society of Nephrology member nephrologists about provision of dialysis to such patients. 990 nephrologists responded out of 1,723 surveyed (57%), and 65%, representing 44 states, reported providing care to undocumented patients with ESRD and 61% reported increasing prevalence. Of the respondents, 91% reported that undocumented patients had access to emergent dialysis, but only 51% reported access to maintenance dialysis therapy. Geographic differences in access to maintenance dialysis were reported, with states having high undocumented populations associated with greater access, while southern states appeared to offer less access. Of respondents knowledgeable about reimbursement, most reported inadequate compensation and 35% reported that outpatient dialysis units provide uncompensated dialysis care to undocumented patients with ESRD. An editorial by Dr Straube points out that inadequate dialysis care in undocumented patients could lead to suboptimal quality of life and health status and that inadequate care could also lead to avoidable complications that further tax our limited healthcare funding sources, as well as potentially causing death in these patients. Dr Straube believes that building on available surveys and data collection is essential as a first step to solving these problems.
Credit:Francis Rolt-Wheeler's The Boy With the US Census (Project Gutenberg Ebook).
Long-term Outcomes After Acute Kidney Injury
See Coca et al, pages 961-973; Hsu and colleagues, pages 928-931; and Tian et al, pages 974-981.
Acute kidney injury (AKI) is common in hospitalized patients, but the impact of AKI on long-term outcomes is controversial. In this issue, Coca et al perform a systematic review and meta-analysis of MEDLINE and EMBASE articles from 1985 through October 2007 that included serum creatinine levels of AKI patients. Forty-eight studies of 47,017 AKI patients were reviewed. Fifteen studies reported long-term data for patients without AKI. The incidence rate of mortality was 2.5 times higher in patients with AKI compared with those without AKI. AKI was associated independently with mortality risk in 6 of 6 studies that performed multivariate adjustment and with myocardial infarction in 2 of 2 studies. The incidence rate of CKD after an episode of AKI was 7.8 events/100 patient-years, and the rate of ESRD was 4.9 events/100 patient-years. An editorial by Hsu and colleagues commend Coca et al for highlighting several critical methodological issues related to long-term outcomes after AKI, and stresses the need for achieving consensus on defining baseline kidney function. In a related article, Tian et al examine the outcomes of patients with rapidly reversible AKI and with increased serum creatinine levels on admission during 2 years to the medicine wards of a teaching hospital. They conclude that an increase in serum creatinine level of 0.3 mg/dL or greater during 48 hours of hospitalization predicts outcomes even if the value returns to normal.
See Dreschler et al, pages 1014-1023; and Perl and Bargman, pages 1068-1081.
Obesity is a risk factor for loss of kidney function in the general population, but it is unknown whether it affects residual kidney function after the onset of dialysis. In this issue, Dreschler et al study the effects of body mass index (BMI) on decline in kidney function and risk for developing anuria after initiation of dialysis therapy in 1,271 incident dialysis patients from 38 centers in The Netherlands participating in the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) between 1997 and 2006. They assessed BMI at 3 months after the initiation of dialysis therapy (baseline) and categorized the patients into 4 groups (less than 20, 20 or greater to 25, 25 or greater to 30, and 30 or greater kg/m2) then examined decrease in GFR among the groups, measured as the mean of creatinine and urea clearances. During 18-month follow up, the decrease in mGFR in patients with normal weight was 1.2 mL/min/y (95% CI, 0.7 to 1.6). Compared with those values, adjusted losses of mGFR were 0.4 mL/min/y (95% CI, 0.02 to 0.8) greater for overweight and 1.2 mL/min/y (95% CI, 0.5 to 1.8) greater for obese patients. In contrast, the decrease in underweight patients was 0.6 mL/min/y (−0.1 to 1.3) less. Anuria occurred in 297 patients; the risk was similar among BMI groups after adjustment for confounders and baseline diuresis. In a related Narrative Review, Perl and Bargman highlight the evidence supporting the impact of residual kidney function on survival and quality of life of dialysis patients and provide a mechanistic framework for this relationship. Current strategies to preserve residual kidney function also are reviewed, emphasizing those used in patients treated with peritoneal dialysis.
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