IDEAL Trial Results and Changes in Dialysis Initiation Timing in Canada

The optimal time to initiate dialysis for the treatment of kidney failure remains uncertain. Renal recovery is rare following dialysis initiation and patients receiving dialysis treatments are at high risk for morbidity and mortality and a diminishing quality of life. Further, early initiation of dialysis increases healthcare costs and may not provide optimal value from a health system perspective. Results ... Read More »

Transition versus Nontransition to Dialysis and Glycemic Status and Mortality

Because most previous trials of glycemic control excluded patients with advanced kidney disease, the optimal glycemic target in patients with chronic kidney disease (CKD) remains unclear. Earlier studies have shown microvascular and macrovascular benefits of intensive glycemic control in patients with both type 1 and type 2 diabetes with minimal to no kidney damage. However, more recent trials have shown ... Read More »

Cinacalcet Prescription Varies across US Hemodialysis Facilities

Since the implementation of the Medicare ESRD [end-stage renal disease] Prospective Payment System (PPS), i.e., bundle payments, dialysis facilities are reimbursed at a flat rate for a bundle of ESRD-related drugs, supplies, and services per dialysis treatment. Adjustment to the base rate is made to account for patient-level case-mix and facility-level factors that are associated with higher costs related to ... Read More »

Examining Short-Term Within-Person Variability in Clinical Markers of Kidney Function

Chronic kidney disease (CKD) is defined by abnormalities in glomerular filtration rate (GFR) and/or albuminuria; CKD affects approximately 10% of the US population. Endogenous plasma or serum filtration markers, most commonly creatinine, are used to estimate GFR; albuminuria is quantified by measuring urinary albumin concentration (UAC) or urinary albumin-creatinine ratio (UACR). There are well established reference ranges for estimated GFR ... Read More »

Metabolic Abnormality and Obesity Associated with Rate of CKD Progression

Obesity, a worldwide major health problem, is associated with increased risk for type 2 diabetes mellitus, cardiovascular disease, cerebrovascular events, and malignancy, resulting in increased rates of cardiovascular and all-cause mortality. Studies have also demonstrated an increased risk of developing incident chronic kidney disease (CKD); however, it is unclear whether obesity itself worsens kidney function in patients with CKD. Results ... Read More »

High Comorbid Condition Burden Associated with Withdrawal from Dialysis Therapy

Over the past decade, annual rates of dialysis therapy initiation have been relatively stable. Dialysis patients are living longer than before, creating an interest in issues such as conservative care for end-stage renal disease (ESRD), palliative care in nephrology, and withdrawal from dialysis therapy. Withdrawal from dialysis therapy is a cause of death in ~10% to 20% of patients in ... Read More »

Low Protein Intake Associated with Higher Mortality Risk

Glomerular filtration rate (GFR) is a key index of kidney function. Protein intake is a major dietary modulator of GFR and standard practice calls for low protein intake to slow the progression of chronic kidney disease (CKD). Results of studies on low protein intake in kidney disease have been inconsistent regarding decline in kidney function and/or mortality over time. Massimo ... Read More »