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As Kidney Week closed, nephrologists gathered to hear policy updates and information about forthcoming payment models from CMS and seemed pleased with what they heard.

The federal government wants to lower the rate of end-stage renal disease (ESRD) and improve kidney care outcomes, but such efforts will require earlier identification of chronic kidney disease (CKD), especially in veterans. At the American Society of Nephrology's (ASN) Kidney Week 2019, one poster described the gaps in identifying CKD in this population.

Patients with immunosuppressive conditions, particularly those being treated with tumor necrosis factor inhibitors, are vulnerable to infections, but rheumatologists have mostly been hesitant to use any live virus vaccines in these patients, said Jeffrey R. Curtis, MD, MS, MPH, professor of medicine in the Division of Clinical Immunology and Rheumatology at the University of Alabama at Birmingham.

The Advancing American Kidney Health initiative launched by HHS has a broad range of focus that includes kidney disease awareness, early diagnosis, and improvements in transplantation, according to Holly Kramer, MD, MPH, professor of medicine and public health sciences at Loyola University Chicago and president of the National Kidney Foundation.

Grouping patients into clusters based on shared characteristics, such as disease control and general health, may be helpful in understanding and predicting clinical outcomes in patients with rheumatoid arthritis (RA), according to an abstract presented at the 2019 ACR/ARP Annual Meeting, held November 8-13 in Atlanta, Georgia.

Nondrug therapies that might have been dismissed 30 years ago are now the sorts of treatments physicians are turning to instead of overused treatments like surgical procedures, opioids, and injections, said Daniel Clauw, MD, professor of anesthesiology, medicine (rheumatology), and psychiatry; director of translational research; and director of the Center for Chronic Pain and Fatigue Research.

Disease activity assessments can help physicians treat to targets, but in some areas those targets have not been set yet, said Yusuf Yazici, MD, clinical associate professor in the Department of Medicine at NYU Langone Health.

This year has been an exciting time for rheumatologists with impressive clinical trial results and promising outcomes for patients, said Susan Manzi, MD, MPH, codirector of the Lupus Center of Excellence and chair of the Department of Medicine of West Penn Allegheny Health System, during a session at the American College of Rheumatology annual meeting in Atlanta, Georgia.

What should providers do about intentional nonadherence, and what strategies should they try to get their patients to take their hypertension medicine? At a session at the American Society of Nephrology (ASN)’s Kidney Week 2019, physicians discussed direct observation therapy (DOT), drug monitoring, case studies, and other published work about patients who don’t take their medications. Then they heard from a directly from a patient who shared why she stopped taking her medication and the scary consequence that developed as a result.

Patients receiving dialysis living in communities with a high percentage of black residents are known to have worse morbidity and mortality outcomes, and a study presented Saturday at the American Society of Nephrology Kidney Week 2019 meeting found that patients receiving dialysis in those communities also had higher hospitalization rates.

The evidence shows that chimeric antigen receptor (CAR) T-cell therapies are effective, but the price tags on these treatments are high and have raised concerns about how many patients will get treated. During a discussion at The American Journal of Managed Care®’s Patient-Centered Oncology Care® meeting, held Friday in Philadelphia, panelists outlined the efficacy of the 2 FDA-approved therapies, Medicare reimbursement for CAR T-cell therapies, and the pace of innovation in healthcare.

The results of phase 3 studies of roxadustat, a drug in the new class of hypoxia-inducible factor stabilizers, are satisfying in terms of both efficacy and safety, said Jay Wish, MD, professor of clinical medicine at Indiana University and chief medical officer for dialysis at Indiana University Health.

The risk of major adverse cardiovascular events was comparable with placebo in patients not treated with dialysis who received the investigational drug roxadustat, according to pooled cardiovascular safety data about the first-in-class oral therapy for patients with chronic kidney disease (CKD).

The large number of patient participants at the American Society of Nephrology’s Kidney Week 2019 meeting reflects the understanding that patients should be elevated in the conversations around kidney care, said Paul Conway, chair of global affairs and public policy and immediate past president, American Association of Kidney Patients.

A simple risk-assessment tool that helps physicians with early identification of patients at increased risk of chronic kidney disease (CKD) could lead to improved and targeted surveillance strategies, according to research published Friday.

Some of the most common safety risks for patients receiving dialysis include medication safety, infections, and falls, according to Alan Kliger, MD, clinical professor of medicine at Yale University School of Medicine.

A study published in the November issue of The American Journal of Managed Care® provides evidence from an intervention for chronic kidney disease (CKD), explained lead author Joseph Vassalotti, MD, clinical professor at Icahn School of Medicine at Mount Sinai and chief medical officer of the National Kidney Foundation.

Investigators presented data about 3 phase 3 trials of roxadustat at a national nephrology meeting to a standing-room only crowd, but the information the audience is really waiting to hear will have to wait until early Friday afternoon. While the trials showed promising results, day 2 of American Society of Nephrology's (ASN) Kidney Week 2019 will see the release of highly anticipated efficacy and pooled cardiovascular safety data about the first-in-class oral drug to treat chronic kidney disease in patients with anemia.

Clinicians treating kidney disease should view patients as stakeholders whose opinions can help drive a holistic approach to care, said Cynthia Delgado, MD, associate professor of medicine at the San Francisco Veterans Affairs Medical Center and University of California San Francisco Medical Center.

Because exercise capacity is known to be linked with several key outcome measures in patients with chronic kidney disease (CKD), routine exercise testing can help clinicians prescribe individualized exercise interventions, said Danielle Kirkman, PhD, assistant professor at Virginia Commonwealth University.

Pediatric nephrologists are a key piece of the care team for children with metabolic syndrome because they have continual opportunities to identify and treat risk factors for cardiovascular disease, according to Tammy Brady, MD, PhD, medical director of the Pediatric Hypertension Program and associate professor of pediatrics at Johns Hopkins University.

HHS is taking additional steps to improve care for those with end-stage renal disease (ESRD), Secretary Alex Azar announced Thursday. Speaking at a tightly packed session during the American Society of Nephrology’s Kidney Week 2019, Azar said HHS is looking to speed organ transplants to those who need them as part of an overall shift away from dialysis in kidney care centers and as part of its overall desire to lower spending while improving outcomes.

Discussions around healthcare spending have been ignored for decades, but Robert Dubois, MD, PhD, chief science officer and executive vice president at National Pharmaceutical Council, believes we have the ability to start those discussions now.

By using the available evidence, data, and facts surrounding healthcare spending, we can begin conversations on necessary innovations, said Ceci Connolly, BA, president and chief executive officer of Alliance of Community Health Plans.

Although the number of people with nonalcoholic fatty liver disease, which progresses to nonalcoholic steatohepatitis (NASH), is growing, the health system is still trying to get a handle on which patients to target and how to identify them before the first treatments come to market, explained panelists during a session at AMCP Nexus 2019.

In a session at AMCP Nexus 2019, Melissa Andel, MPP, vice president of health policy, Applied Policy, covered the current state of health insurance coverage in the United States, major actions from the Trump administration impacting the Affordable Care Act (ACA), public sentiment around the ACA, and what stances presidential candidates have taken on healthcare.

Using value assessment models and data that predict real-world performance can assist in valuing drugs with limited or no real-world data, said Roger Longman, MA, chief executive officer of Real Endpoints.

The lack of FDA approvals for the treatment of nonalcoholic steatohepatitis (NASH) and safety concerns surrounding 2 recommended treatments contribute to the barriers blocking effective progress, said Karen Watkins, PharmD, pharmacist for emerging therapeutics strategy, MedImpact Healthcare Systems.

Increased competition is making its way into the specialty drug market, affecting orphan conditions, cancer types, and even common specialty conditions, which is presenting some cost savings opportunities, explained Aimee Tharaldson, PharmD, senior clinical consultant for emerging therapeutics at Express Scripts, who presented on the specialty pharmaceutical pipeline during her regular session at AMCP Nexus 2019.

Value needs to be considered early in the development life cycle of a therapy and should be continued throughout, even into the postlaunch space using real-world studies, according to a presentation on value-based services and their life cycles at the AMCP Nexus 2019 meeting.