| |  | | |
| This Month in AJKD | Hemodialysis Patient Outcomes in a Long-term Care Hospital Setting
See Thakar et al, pages 300-306; and Jassal and Watson, pages 209-212.
|
Outcomes of hemodialysis patients admitted to long-term care hospitals (LTCHs) are not known. In this issue, Thakar et al perform a retrospective observational study of dialysis-dependent patients with either ESRD or acute kidney injury admitted to a single LTCH and followed them through until their discharge. They found that only 31% of patients were able to return home from LTCH, and patients were more likely to be discharged to a nursing home (40%) or to be transferred back into an acute care hospital (24%) than to return home. In an accompanying editorial, Drs Jassal and Watson praise the work by Thakar et al to shift the emphasis to consider outcomes in addition to survival. They stress that future studies should continue to address quality of life, functionality, rehabilitation, and considering whether patients die “good deaths” or “bad deaths.”
| Tubular Toxicity With Sirolimus and Cyclosporine
See Franz et al, pages 335-343; and Chapman and Rangan, pages 213-216.
|
Sirolimus is an immunosuppressive agent used for kidney transplantation that is believed to have less nephrotoxicity than calcineurin inhibitors; however, several reports have observed proteinuria in patients treated with sirolimus, ranging from low grade to nephrotic range. In this issue, Franz et al report a randomized trial in which 127 kidney transplant recipients were randomly assigned to receive either (1) sirolimus, mycophenolate mofetil, and steroids or (2) cyclosporine, mycophenolate mofetil, and steroids. Their results show that, while kidney function was similar in both groups, urine excretion of albumin and transferrin (glomerular proteinuria), a1-microglobulin and transferrin (tubular proteinuria), and glucose were all increased in the sirolimus-treated group at days 90 and 180 following transplant. An editorial by Drs Chapman and Rangan notes that further research that will assess the benefit of conversion from a calcineurin inhibitor to sirolimus following transplant is ongoing, and that, in this context, the study of Franz et al provides important information regarding both the nature as well as the likely reversibility of incident proteinuria associated with sirolimus following a therapeutic conversion.
| The New CMS Proposed Payment System for ESRD: Providers' Views
See Prospective ESRD Payment Editorials, pages 217-236.
|
After the September 2009 publication of the proposed Prospective Payment System for ESRD but prior to the deadline for public commentary to the Centers for Medicare and Medicaid Services, the American Journal of Kidney Diseases solicited a series of editorials from various provider groups. In this issue are 6 editorials: Drs Weiner and Watnick introduce the editorials by outlining economic aspects of dialysis care in the United States. Dr Nissenson and colleagues at DaVita write from the perspective of a large dialysis organization that includes over 1,300 units. Dr Moran of Satellite Health writes from the perspective of a medium-sized dialysis organization comprising approximately 40 freestanding units in the western United States. Dr Sadler of Independent Dialysis Foundation writes from the perspective of a small, not-for-profit dialysis provider in Maryland comprising 9 freestanding or hospital-based units. Drs Bhat and Bhat of Atlantic Dialysis Management Services write as the owner and operators of an independent dialysis unit. Last, Drs Kristensen and Wish of the ESRD Network Forum write from the perspective of a not-for-profit organization that advocates for quality oversight of ESRD care and provides technical assistance to providers and patients in ESRD-related issues.
| Is There a Role for Intradialytic Parenteral Nutrition?
See Dukkipati and colleagues, pages 352-364.
| |
Protein-energy wasting (PEW) is highly prevalent in people with stages 4 and 5 CKD, particularly in maintenance dialysis patients, and many indicators of PEW correlate strongly with mortality. It is widely believed that a major cause of PEW is insufficient intake of nutrients, especially protein and calories. Intradialytic parenteral nutrition (IDPN) is a form of nutritional support which provides an intravenous infusion of essential nutrients during hemodialysis treatments that can be used to treat PEW. In this issue, Dukkipati and colleagues examine 3 questions about IDPN in maintenance dialysis patients: (1) can IDPN prevent or ameliorate PEW? (2) Does IDPN improve quality of life or reduce morbidity or mortality? And (3) is IDPN safe? They conclude that although IDPN may partially satisfy the nutritional needs of maintenance hemodialysis patients who have or are at risk of PEW and who have substantial but not adequate protein and/or energy intake, longer-term randomized prospective clinical trials with appropriate control groups are necessary to more definitively evaluate the clinical effectiveness and indications for IDPN.
|
| |
| | AJKD News | AJKD marks World Kidney Day (2010-03-11) in its March issue with articles describing kidney disease screening in Mexico and Nicaragua, reviewing hypertension in the developing world, and presenting the CDC’s latest health policy models of CKD.
Stay up to date with the latest AJKD content – sign up today for AJKD’s new table of contents e-mail alert.
Put yourself in your patients’ shoes: read this month’s “In a Few Words” feature, and share your own perspective on kidney disease by submitting an essay for consideration (email AJKD@tuftsmedicalcenter.org).
According to the 2008 Journal Citation Reports®, published by Thomson Reuters, the 2008 impact factor for AJKD is 4.822! | NKF | The National Kidney Foundation, Inc., a major voluntary health organization, seeks to prevent kidney and urinary tract diseases, improving the health and well being of individuals and families affected by these diseases, and increase the availability of all organs for transplantation.
NKF Spring Clinical Meetings
KDOQI Guidelines
GFR Calculator
| Receive Free Email Alerts | |
AJKD is published by Elsevier for The National Kidney Foundation. |
See our companion journals, Journal of Renal Nutrition and Advances in Chronic Kidney Disease, also published by Elsevier for the NKF.
| Sponsored Articles | | American Journal of Kidney Diseases offers authors the option to sponsor non-subscriber access to their articles on Elsevier's electronic publishing platforms. For more information please visit our Sponsored Articles page.
|
| |
|
|
| |
|
RSS
