Clinical journal of the American Society of Nephrology : CJASN
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Clin J Am Soc Nephrol · Feb 2015
Comparative StudyAKI in low-risk versus high-risk patients in intensive care.
AKI in critically ill patients is usually part of multiorgan failure. However, nonrenal organ failure may not always precede AKI and patients without evidence of these organ failures may not be at low risk for AKI. This study examined the risk and outcomes associated with AKI in critically ill patients with and without cardiovascular or respiratory organ failures at presentation to the intensive care unit (ICU). ⋯ Patients admitted to ICU without respiratory or cardiovascular failure have a substantial likelihood of developing AKI. Although survival for low-risk patients is better than for high-risk patients, the relative increase in mortality associated with AKI is actually greater for low-risk patients. Strategies aimed at preventing AKI should not exclude ICU patients without cardiovascular or respiratory organ failures.
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Clin J Am Soc Nephrol · Feb 2015
Historical ArticleThe evolving role of the medical director of a dialysis facility.
The medical director has been a part of the fabric of Medicare's ESRD program since entitlement was extended under Section 299I of Public Law 92-603, passed on October 30, 1972, and implemented with the Conditions for Coverage that set out rules for administration and oversight of the care provided in the dialysis facility. The role of the medical director has progressively increased over time to effectively extend to the physicians serving in this role both the responsibility and accountability for the performance and reliability related to the care provided in the dialysis facility. This commentary provides context to the nature and expected competencies and behaviors of these medical director roles that remain central to the delivery of high-quality, safe, and efficient delivery of RRT, which has become much more intensive as the dialysis industry has matured.
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Clin J Am Soc Nephrol · Feb 2015
Multicenter StudyNT-proBNP and troponin T and risk of rapid kidney function decline and incident CKD in elderly adults.
Elevations in N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T are associated with poor cardiovascular outcomes. Whether elevations in these cardiac biomarkers are associated with decline in kidney function was evaluated. ⋯ Elevated N-terminal pro-B-type natriuretic peptide and troponin T are associated with rapid decline of kidney function and incident CKD. Additional studies are needed to evaluate the mechanisms that may explain this association.
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Clin J Am Soc Nephrol · Feb 2015
Observational StudyCKD in elderly patients managed without dialysis: survival, symptoms, and quality of life.
Survival, symptom burden, and quality of life (QOL) are uncertain for elderly patients with advanced CKD managed without dialysis. We examined these outcomes in patients managed with renal supportive care without dialysis (RSC-NFD) and those planned for or commencing dialysis. ⋯ Elderly patients who choose not to have dialysis as part of shared decision making survive a median of 16 months and about one-third survive 12 months past a time when dialysis might have otherwise been indicated. Utilizing the skills of palliative medicine helps provide reasonable symptom control and QOL without dialysis.
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Clin J Am Soc Nephrol · Feb 2015
Integrated renal care: are nephrologists ready for change in renal care delivery models?
The Affordable Care Act is the most visible element of health care reform. However, both before the Affordable Care Act and now with the acceleration since its passage, the Centers for Medicare and Medicaid have been and are testing integrated care models in medicine in general as well as nephrology. ⋯ More measurement of quality and the linking of quality measures to payments are also all but certain future elements of the health care economy. Nephrologists need to educate themselves on these trends and be prepared to engage them for the good of the profession and the improvement in care for patients.