Hello. This is Jeffrey Berns, Editor-in-Chief of Medscape Nephrology.
In October I will begin a 2-year term as President of the National Kidney Foundation (NKF). I am very much looking forward to working with this organization, which I have been involved with for the past couple of years as President-Elect. They have a phenomenal team in New York, led by CEO Bruce Skyer; an absolutely amazing board of directors and staff; and physicians involved with the organization all over the country. I am happy to be part of this great organization.
Several days ago I was asked what the topic of my presidential address would be at the Spring Clinical Meeting in March 2015 in Dallas, Texas. (This is a great meeting, by the way, and I would encourage everyone to attend if you can.) I have been giving this some thought. The NKF has a few major initiatives and missions that they will spearhead during the next couple of years. One is to increase access to transplantation. Another is to assure that people have lifetime immunosuppressive coverage to take care of the cost of these medications. A third initiative is related to chronic kidney disease (CKD) and increasing the role of primary care providers in the care of patients with CKD, increasing awareness about CKD, providing educational information about the management of patients with CKD, and ensuring that the clinical practice guidelines that have been developed for CKD are well known to primary care providers. Finally, the NKF will again support clinical research initiatives, particularly those that are focused on other areas of importance to the NKF and its patients.
A Challenge to Do Better
Thus, as I considered which topic I want to address, I thought that I would probably talk about areas in which we nephrologists could be doing better in the care of patients with CKD who are on dialysis. This was highlighted by a recent paper that came out in the Clinical Journal of the American Society of Nephrology (CJASN)[1] in July 2014 from Michael Chan and colleagues at the University of Wisconsin.
This group used United States Renal Data System (USRDS) data to look at about 17,000 patients whose kidney transplants failed and who returned to hemodialysis. They looked at the vascular access these patients had. Because these were patients who had kidney transplants that failed, we can be pretty sure that they were under the care of a nephrologist. This is a different patient population from the average or more typical overall CKD population.
Of course, we all know some patients who land in our laps without having had much in the way of previous CKD care and who begin dialysis without an arteriovenous (AV) access, either fistula or graft. But what was remarkable in this population of about 17,000 patients is that only slightly more than one quarter, 27.7%, began dialysis with an AV fistula, and only 7% started with an AV graft. Approximately two thirds of the patients began dialysis with a central venous catheter. I find this remarkable, if not downright shocking. Perhaps I should not be shocked by anything, but it is striking that despite being under the care of a nephrologist who is watching the function of the transplanted kidney decline, and knowing that these patients would end up on dialysis, two thirds ended up on dialysis with a central venous catheter. I am sure there are many, many reasons for this, but again it highlights for me personally one of the areas where we can do better in the care of patients with CKD and end-stage renal disease.
I am going to challenge myself and those who hear my presidential address at the NKF Clinical Meeting, and I am going to challenge you, perhaps, to choose a few areas of your practice and try to do better in the upcoming year for your patients. I believe that you will be happier with your professional life and your contribution to the care of your patients, and your patients obviously will appreciate your efforts to improve the care that you provide for them.
This is Jeffrey Berns, from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and Editor-in-Chief of Medscape Nephrology. Thank you for listening.
Medscape Nephrology © 2014 WebMD, LLC
Cite this: 'We Can Do Better' With CKD and ESRD Patients - Medscape - Aug 29, 2014.
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