Cover Stories

Pre-ESRD Nephrology Care in Medicare versus VA Healthcare Systems

There are few available data on the benefits of maintenance dialysis for older adults with kidney failure or end-stage renal disease (ESRD) in the setting of another serious illness or multimorbidity. In that patient population, survival with dialysis may be limited, functional outcomes are often poor, and patients commonly discontinue dialysis. Guidelines are designed to encourage sharing decision-making that considers ... Read More »

Policy Forum Perspective: Healthcare for Undocumented Immigrants with CKD

Undocumented immigrants represent 3% of the population in the United States and 27% of the uninsured, despite passage of the Affordable Care Act (ACA) and expansion of state-based insurance coverage. There is a need for countries to re-examine policies regarding healthcare for noncitizens with chronic illnesses, including chronic kidney disease (CKD). The issue centers on the question of providing equal ... Read More »

Location and Use of Vascular Access Models Vary Widely by International Region

A functional vascular access is crucial to the successful delivery of maintenance hemodialysis therapy. National organizations agree that a well-functioning arteriovenous (AV) fistula (AVF) is the preferred access for patients on hemodialysis, while also agreeing that vascular access should be tailored to an individual patient’s health status and other considerations. DOPPS (Dialysis Outcomes and Practice Patterns Study), an international prospective ... Read More »

Health Insurance Status Affects Dialysis Modality Choice

Each year, approximately 60,000 individuals <65 years of age develop end-stage renal disease (ESRD), requiring treatment with dialysis or kidney transplantation. Many patients are uninsured or covered by state-sponsored Medicaid at the onset of ESRD. While patients who are uninsured or covered by Medicaid may experience limited access to healthcare, access to dialysis care is generally available. Federal law provides ... Read More »

A Systematic Review of Vascular Access Outcomes Trials in Hemodialysis Patients

Maintenance dialysis patients with a reliably functioning vascular access experience improved outcomes and overall well-being. However, according to Andrea K. Viecelli, MD, and colleagues, it remains challenging to establish and maintain a complication-free vascular access, and to reduce the need for recurrent interventions. Complications related to vascular access account for ~20% of hospital admissions among patients with end-stage renal disease ... Read More »

Patient Survival Similar between Hemodialysis and Peritoneal Dialysis

The cost of caring for patients with end-stage renal disease (ESRD) is driven largely by the provision of maintenance, including costs related to dialysis. Healthcare costs for patients with ESRD in 2013 in the United States exceeded $25 million, approximately 7% of all Medicare expenditures (patients with ESRD made up <0.5% of the Medicare population in that year). Compared with ... Read More »

Survival of Pediatric Kidney Transplant Recipients with FSGS Improved from 1990 to 2009

One of the main causes of end-stage renal disease (ESRD) in children is focal segmental glomerulosclerosis (FSGS), the third most common diagnosis among pediatric kidney transplant recipients in the United States. Treatment of children with FSGS post-transplant is complicated by primary disease recurrence in 15% to 64% of patients, and is linked to increased risk for allograft loss. Loss of ... Read More »

Outcomes of Left Ventricular Assist Device Placement in Patients with ESRD

For patients with advanced heart failure, left ventricular assist devices (LVADs) are used as a bridge to heart transplant as well as destination therapy to prolong survival and improve quality of life. In results of the REMATCH (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure) trial, compared with medical therapy alone, survival was improved with placement ... Read More »