Kidney360 Podcast

This episode highlights a study that aimed to analyze the time-varying effect of assistance on the risk of PD cessation. This study was conducted using data from the RDPLF of 15675 incident PD patients between 2002 and 2018. Patients treated with assisted PD had a greater risk of death and a lower risk of transfer to HD. However, the protective effect of assisted PD on the risk of transfer to HD was not constant over time; it started between the first 6 to 12 months on PD. Assisted PD programs should be sustainable for at least 6 months to observe their benefits.

In an analysis of patients undergoing kidney transplantation, depression and health related quality of life (HRQOL) were measured using the Beck Depression Inventory-II (BDI-II) and Kidney Disease Quality of Life Short Form Version 1.3 (KDQOL) physical health composite score (PCS) and mental health composite score (MCS) at 3-months and 1-year post-transplantation. Depression and HRQOL improve with KT. While depression improves in all ages, the improvement in HRQOL, especially PCS, is more evident in younger patients. This improvement in depression and HRQOL is sustained until at least 1-year post-KT.

In a Kidney 360 article of 31 patients with native kidney biopsy proven oxalate nephropathy described from the Cleveland Clinic Kidney Biopsy Epidemiology Project, 10 of 31 patients had multifactorial etiologies of oxalate nephropathy, such as enteric hyperoxaluria and excessive precursor intake. 10 of 31 had a single etiology and 11 had risk factors but the etiology was unknown. Key findings included additional diagnoses such as ATN and diabetic kidney disease in 27 of 31 patients, moderate to severe interstitial fibrosis on biopsy at diagnosis in 90% of patients, with 21 of 26 patients with 1 year follow up data being dialysis dependent at 1 year.

Utilizing a multinational collaborative network, a study provided the first systematic description of urinary vacuolar casts in patients with acute or chronic kidney disease. Notably, these casts are not included in most textbooks of urinalysis and/or urine microscopy. The investigators reported that these distinct type of casts are associated with the presence of a glomerular disease and overt proteinuria. Moreover, individuals in which vacuolar casts were identified via urinary sediment microscopy had greater degree of proteinuria and greater percentage of glomerular obsolescence than a control group of patients without vacuolar casts. Further studies will be needed to examine the prognostic value of vacuolar casts.

Evidence based approaches to care, like a personalized group visit model, can provide education, coaching, and peer support to patients with late-stage diabetic disease and their caregivers and, as a result, improve outcomes and quality of life. Telehealth or virtual care is increasingly common but there is little guidance on how to adapt existing, evidence-based approaches designed to be delivered in-person for virtual delivery. A new Kidney360 study describes the Duke Center for Personalized Health Care's experience adapting and pilot testing a group visit approach using existing telehealth infrastructure.

We found that most PD patients enrolled in the units surveyed did not have to change their home accommodations during the pandemic or have issues getting their dialysis supplies and medications delivered. Most of the patients felt comfortable coming to the dialysis unit if they needed to during the pandemic. Most of the patients felt supported by their dialysis staff during the peak of COVID-19 and had modified PHQ-2 and GAD-2 scores not consistent with depression or anxiety. Finally, less than 10% of patients considered changing their dialysis modality. Our survey findings demonstrate that the adjustments made by the dialysis units during the peak of the pandemic were effective in maneuvering the challenges faced by our patients during the COVID-19 pandemic while providing high-quality medical care.

There have been several reports of IgA nephropathy patients with gross hematuria and acute deterioration of urinary findings and kidney function after SARS-CoV 2 mRNA vaccination. Recent case series studies have indicated a possible link between the status of urinary findings at the time of vaccination and the subsequent appearance of gross hematuria. A new Kidney360 study describes the association between the pre-vaccination microscopic hematuria or proteinuria and post-vaccination gross hematuria.

After kidney transplantation, it is still not well established what we should do with the functioning arteriovenous fistula of kidney transplant recipients with stable renal function. To close or not to close: this question remains debatable. In this prospective study including 43 kidney transplant recipients, we have investigated the impact of the surgical closure of functioning arteriovenous fistula on blood pressure levels, as well as on the cardiac and renal functions.

Acute kidney injury occurs in approximately half of critically ill patients and increasing evidence indicates that quality of life of these patients may be impacted after hospital discharge. A new study in Kidney 360 examines the health utility of patients at 60 days after dialysis-requiring acute kidney injury and identifies 3 subgroups of AKI survivors with distinct health utility profiles. The study further examines risk factors associated with these patient subgroups as well as the 1-year outcomes of these 3 subgroups.

There is no published literature evaluating the exposure to transplant patients by pediatric nephrology fellows. The survey results reveal a highly varied fellowship experience when it comes to pediatric kidney transplant patient care. Pediatric Nephrology Fellowship graduates are lacking in exposure to observation of the actual transplant procedures, care of the post-transplant patient (immediately following, first 6 months after, and long-term), and advocacy opportunities. Given the lack of a transplant-specific curriculum within the ACGME guidelines, the Transplant Interest Group (under the American Society of Pediatric Nephrology) has worked to create a transplant specific curriculum, which is available on the ASPN website.