Cover Stories

Risk of Mortality Higher in Patients with Kidney Disease and Pulmonary Hypertension

Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) commonly experience pulmonary hypertension. Depending on the methods used to diagnose pulmonary hypertension and evaluate the stages of CKD, the prevalence ranges from 10% to 70%. One factor in the presence of pulmonary hypertension in patients with kidney disease is the pathophysiologic sequelae of CKD, including volume overload, congestive ... Read More »

Medicare Paid $2.3 Billion in 2013 for Vascular-Access Related Services

Reliable access to the bloodstream is essential to successful treatment of end-stage renal disease (ESRD) with maintenance hemodialysis. Patients typically receive hemodialysis three times a week; the vascular access is the patient’s lifeline. There are three types of hemodialysis vascular access: (1) arteriovenous fistula (AVF); (2) arteriovenous graft (AVG); and (3) central venous catheter (CVC). Numerous studies have found reduced ... Read More »

Outcomes and Care Associated with Residential Area Life Expectancy in Patients with ESRD

The general population of the United States faces significant geographic variation in health status due to complex factors that include regional differences in health indicators such as morbidity, mortality, and physical and mental disability. There is also regional variation in social determinants of health that include environmental and behavioral risk factors, access to healthcare and a healthy diet, education level, ... Read More »

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 »