Chronic Kidney Disease

The coronavirus disease 2019 pandemic presents a new challenge: patients have severe flu-like symptoms, but the virus can also cause renal failure. Doctors and patients need analgesics that go easy on the liver and kidneys but are not addictive, and this week researchers at LSU Health New Orleans Neuroscience Center of Excellence announced they have discovered a new class of drugs that can do the job.

This week, the top managed care news included CMS planning to pay more for at-home dialysis equipment; ACR supports continued use of telemedicine after the COVID-19 pandemic passes; AJMC®’s coverage of AIDS 2020, the 23rd International AIDS Conference.

End-stage renal disease has long been one of the most expensive and debilitating conditions that affects Medicare beneficiaries. Not only does dialysis cost $90,000 a year—those awaiting a kidney transplant automatically qualify for Medicare—but the need to travel to a dialysis center multiple times a week disrupts employment and home life.

Results from the University of New South Wales appeared in the New England Journal of Medicine. The co-lead investigator said the results show the need for more treatment options in chronic kidney disease.

Previously, fat cells, called adipocytes, were not known to have a role in renal failure-associated cardiomyopathy.

A coauthor of the study said that if the noninvasive test was used more widely, before kidney cancers have spread, fewer people would die from the disease.

Acute kidney injury is a sudden onset of kidney damage that causes waste products to build up in the body. These episodes have become more common during the coronavirus disease 2019 pandemic, causing kidney failure in some previously healthy patients who had no prior history of renal problems.

In a poster titled “Basal Insulins in Advanced Renal Failure: Time for a Paradigm Shift,” authors compared the safety and efficacy of insulin degludec (Tresiba) with insulin glargine 100U (Lantus) among patients with stage 3 and stage 4 chronic kidney disease (CKD).

Two studies evaluated how well the dual inhibitor reduced glycated hemoglobin (A1C) while measuring instances of hypoglycemia and other safety measures.

Experiments with the protein Cx43 show that it could be a "druggable target" to prevent renal decline.

Recently, cardiorenal outcomes have gained attention, as SGLT2 inhibitors in particular have been shown to prevent renal decline and reduce the risk of patients with type 2 diabetes (T2D) progressing to kidney failure

The NKF, which works to address health issues for 37 million people in the United States with kidney disease, said Floyd’s death and the ongoing coronavirus disease (COVID-19) pandemic both highlight disparities in health outcomes between minority groups and whites.

Patients who have no history of kidney damage are ending up with acute kidney injury, which could leave them at higher risk of chronic kidney disease and dialysis.

The rate increase comes as the agency is easing up on quality reporting requirements to give health sytems breathing room amid the pandemic. Monday’s announcement also clarified some payment changes for end-stage renal disease.

This week, the top managed care news includes a CDC report says diabetes is the condition most linked with coronavirus disease 2019, CMS temporarily suspends rules to give hospitals more capacity during the COVID-19 pandemic, and a late-stage trial for dapagliflozin ends early after showing efficacy for chronic kidney disease.

The changes are aimed at helping hospitals increase their capacities for the sickest patients; expand the pool of local healthcare providers who are available to work; eliminating ordinary paperwork and documentation requirements; expanding Medicare coverage for respiratory-related devices and equipment for any medical reason; and expanding telehealth in Medicare by covering more than 80 additional services.

In a response to the coronavirus disease 2019 (COVID-19) pandemic, the American Society of Nephrology (ASN) has hosted series of webinars outlining CDC recommendations and policy changes for challenges in the dialysis setting.

Although many investigators have pushed the envelope in researching how patients with chronic kidney disease (CKD) experience disabilities, there is still a need for more knowledge on how those disabilities evolve over time, according to Cynthia Delgado, MD, associate professor of medicine at the San Francisco Veterans Affairs Medical Center and University of California San Francisco Medical Center.

Frailty significantly raises the risk of developing disabilities as a result of hemodialysis, so even patients who are intermediately frail should be monitored, said Cynthia Delgado, MD, associate professor of medicine at the San Francisco Veterans Affairs Medical Center and University of California San Francisco Medical Center.

Educating primary care clinicians on how to manage chronic kidney disease in the primary care setting can help avoid referrals for nephrology consults that aren’t needed, said Joseph Vassalotti, MD, clinical professor at Icahn School of Medicine at Mount Sinai and chief medical officer of the National Kidney Foundation.

The article identifies issues such as poor socioeconomic background and lack of family and social support as factors in poor medication adherence, which today are recognized as social determinants of health

The plan represents the latest element of the Trump administration’s comprehensive approach to renal care, which seeks to keep patients from advancing to dialysis. For those who do, the plan promotes transplants and home dialysis options.

CKDintercept, the primary care initiative of the National Kidney Foundation, involves multiple strategies aimed at improving the quality of kidney care, explained Joseph Vassalotti, MD, clinical professor at Icahn School of Medicine at Mount Sinai and chief medical officer of the National Kidney Foundation.

Physical disabilities may make it difficult for patients with chronic kidney disease to follow provider recommendations and achieve a good therapeutic alliance, which can lead to increased burden of illness, according to Cynthia Delgado, MD, associate professor of medicine at the San Francisco Veterans Affairs Medical Center and University of California San Francisco Medical Center.