Articles in PressThis Month in AJKD
Renal Cysts: Markers of Kidney Damage?
See Rule et al and Grantham.Simple renal cysts are usually considered to have little clinical significance. In this month’s AJKD, Rule et al turn their attention to these largely ignored structures. The authors retrospectively examined 1,957 contrast enhanced CT scans of potential kidney donors undergoing standardized evaluation. Higher numbers and larger sizes of cysts were associated with male sex and older age. Moreover, the authors found an association between renal cysts in the cortex or medulla that were larger than 5mmand albuminuria, hyperfiltration, and hypertension in relatively healthy adults, implying that these cysts may be markers of kidney damage. In the accompanying editorial, Grantham applauds Rule and colleagues for remaining undeterred by the widespread lack of interest in solitary cysts and calls for other clinicians and researchers to follow their lead in investigating renal cysts more closely.
CVD Medication Costs for Dialysis Patients
See Frankenfield et al and Straube.Cardiovascular disease (CVD) is a major source of morbidity and mortality in dialysis patients, but information is currently lacking on patient use of CVD medications. Frankenfield et al examine CVD medication use and costs for adult dialysis patients who were continuously enrolled in Medicare’s Part D program throughout 2007.The authors report that β-blockers were the most-used CVD medication among dialysis patients, and that the use and costs of all CVD medications varied by demographic characteristics, geographic region, and low-income subsidy status. The authors call for further study to compare the efficacy of these medications in patients with CKD. Straube’s accompanying editorial considers the implications of this study in light of the CMS programs implemented 2011 and 2012 to deal with these cost issues. The author hopes that the article by Frankenfield et al will stimulate further research and discussion regarding the economic, guideline, and policy issues surrounding CVD medications for dialysis patients.
ESRD Employment Rates
See Helanterä et al and Böhlke.ESRD patients are faced with many challenges, including balancing employment with health care needs. Helanterä et al investigated employment rates across different modes of kidney replacement therapy among all Finnish dialysis and transplant patients as of December 31, 2007 by combining data from the Finnish Registry for Kidney Diseases with the official individual-level employment statistics of Finland to perform a cross-sectional registry analysis. The authors found that that home dialysis modalities were associated with higher employment rate not only duringmaintenancedialysis, but also after transplant,and that the employment rate of patients on home dialysis modalities was comparable to transplant patients. In the accompanying editorial, Böhlke reflects upon the complex relationship between choosing peritoneal dialysis and being employed. The author emphasizes that maintaining or reinserting patients with kidney disease into the labor market brings economic and psychological advantages to the patient while also benefiting the health care systemandsociety as a whole.
ACOs and Kidney Disease
See Nissenson and Williams et al.Accountable care organizations (ACOs) are voluntary groups of hospitals, physicians,andhealth care teams that provide care for a defined group of Medicare beneficiaries and assume responsibility for providing high quality care through defined quality measures at below the expected cost. The current ACO regulations focus on primary care and secondary prevention in earlier stages of chronic diseases; accordingly, the low overall prevalence of dialysis patients relative to the number of Medicare beneficiaries and lack of expertise and experience in dialysis care within primary-care focused ACOs may lead to suboptimal care for these patients. In this month’s World Kidney Forum, Nissenson et al discuss ACOs and how they affect nephrologists and kidney disease patients. The authors postulate a renal-specific ACO based on the general ACOmodel that puts nephrologists and dialysis centers at the hub of a redesigned kidney care delivery system as a compelling alternative for dialysis patients. In their accompanying editorial, Williams et al assert that the cost of collaborative care will be ultimately lowered by delivering improved health. The authors stress that trust and shared accountability are essential for any such network model to successfully manage patients with complex chronic disease.
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CKD–Mineral and Bone Disorder: Core Curriculum 2011December 2011 (Vol. 58 | No. 6 | Pages 1022-1036)
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This Month in AJKDMarch 2012 (Vol. 59 | No. 3 | Pages A25-A26)
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This Month in AJKDFebruary 2012 (Vol. 59 | No. 2 | Pages A27-A28)
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New Anemia Therapies: Translating Novel Strategies From Bench to BedsideMarch 2012 (Vol. 59 | No. 3 | Pages 444-451)
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Managing Older Adults With CKD: Individualized Versus Disease-Based ApproachesFebruary 2012 (Vol. 59 | No. 2 | Pages 293-302)
The "Most Read" list is updated quarterly and includes the most highly read articles for the three-month period.
