From the Chair

From the Chair: Remove the Medicare Restriction for Hospice Care for Dialysis Patients

Ajay K. Singh, MBBS, FRCP, MBABrigham and Women’s HospitalHarvard Medical School Nearly one-half of patients >75 years of age who initiate dialysis are dead within 6 months (almost one-half are dead within 1 month of initiation).1 These patients have a terminal illness. Among those who survive, withdrawal from dialysis occurs in only about 30%, and many patients suffer on dialysis ... Read More »

From the Chair: Dialysis Moonshot Revisited: Options for the Elderly

Ajay K. Singh, MBBS, FRCP, MBA Brigham and Women’s Hospital Harvard Medical School In a previous editorial, I made the case for the federal government funding a Dialysis Moonshot initiative, set up similarly to the Obama administration’s Cancer Moonshot that was spearheaded by Vice President Joe Biden. In occasional articles, I intend to cover areas of dialysis care where research ... Read More »

From the Chair: Machine Learning Comes to Acute Kidney Injury: Is this the Dawn of a New Age?

Ajay K. Singh, MBBS, FRCP, MBABrigham and Women’s HospitalHarvard Medical School Acute kidney injury (AKI) is a relatively common presentation in hospitalized patients, particularly among critically ill patients where it can be associated a high mortality. Patients who undergo cardiovascular procedures or are treated with chemotherapy, and those with diabetes mellitus and chronic kidney disease who receive intravenous contrast are ... Read More »

From the Chair: Time for a Dialysis Moon Shot

Two articles—in February 2019 by Mahesh Krishnan and Kent Thiry1 and by Ron Shinkman in June 20162—both published as New England Journal of Medicine Catalyst essays, coupled with a powerful critique in 2010 by Robin Fields in the Atlantic3, discuss the current state of dialysis care in the United States. Krishnan and Thiry, both senior leaders at DaVita, argue that ... Read More »

From the Chair: Nephrologists are Among the Most Happy Subspecialists in the US

Ajay K. Singh Recent data on happiness among nephrologists should be a reason to celebrate the New Year. In the 2019 Medscape Physician Lifestyle and Happiness Report1 for “happiness outside work,” 55% of nephrologists are happiest outside work (the best ratings were for rheumatologists at 65% and the worst was for neurologists at 45%). If that were not enough, 65% ... Read More »

Initiating Dialysis in the Elderly: When Is Right?

By Ajay K. Singh, MBBS, FRCP, MBA An elderly patient of mine with stage 3 CKD recently had an episode of acute kidney injury while visiting family in Puerto Rico. His bout of gastroenteritis tipped his eGFR into the 10 to 12 mL/min/1.73m2 range and he was initiated on maintenance hemodialysis. In speaking with his nephrologist it seemed quite obvious ... Read More »

From the Chair: Becoming Precise in Diagnosing Acute Kidney Injury

Ajay K. Singh, MBBS, FRCP, MBA Brigham and Women’s Hospital and Harvard Medical School BOSTON, MASSACHUSETTS From the time that I trained in nephrology more than 30 years ago, I have been teaching students and fellows the importance of framing the differential diagnosis of acute kidney injury (AKI) along anatomical lines: prerenal, renal, and postrenal, and contextualizing based on the ... Read More »

From the Chair: Treatment of Diabetic Nephropathy: Are we witnessing the dawn of a new era?

Ajay K. Singh, MBBS, FRPC, MBA Brigham and Women’s Hospital and Harvard Medical School Diabetic nephropathy is the most common cause of end-stage renal disease. With the rates of type 2 diabetes reaching epidemic proportions worldwide, it is likely that diabetes as a cause of kidney failure will continue to increase. The current treatment of diabetic nephropathy focuses on tight control ... Read More »

From the Chair: What’s the Best Way to Treat Metastatic Renal Cell Cancer?

Renal cell carcinoma (RCC) accounts for 2% to 3% of all adult malignancies.1,2 It is the most common type of kidney cancer in adults, responsible for approximately 90% to 95% of cases. Approximately, one-third of patients with RCC present, at the time of diagnosis, with metastatic disease. In addition, approximately one-third of patients who present with localized disease also end ... Read More »