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What we learned at kidney conferences this year
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Attending nephrology conferences each year is a way for the editors at Nephrology News & Issues to stay current on important issues and new developments. Now as part of Healio.com, we have increased our coverage, both online and in print, of these national conferences and the valuable information these meetings offer.
At the Annual Dialysis Conference held in early March, organizers placed a focus on home therapies, both peritoneal (PD) and home hemodialysis. Technology took the center stage when manufacturers showed off their latest equipment. While the pending completion of the sale of NxStage Medical, a leading manufacturer of home hemodialysis equipment, to Fresenius Medical Care could bring greater attention to what remains 2% of the dialysis market, growth may be backed by European manufacturers readying their dialysis machines for U.S. entry.
One study that garnered the attention of attendees looked at the value of combining hemodialysis (HD) and PD therapy. The case study involved a 51-year-old patient who received PD 5 days a week, HD for 1 day and 1 day off, for 10 years. Retaining residual renal function was a key benefit.
“These effects could bring not only the long-term continuation of dialysis but also the improvement in anemia, inflammation and nutritional status,” the presenters noted.
Survival of the nephrology practice
Concerns about the future of nephrology care and who will lead that effort have been circulating for some time. The takeover of kidney care in hospitals by intensivists and other medical professionals, along with the struggle by medical schools to fill nephrology residency slots, has led to numerous papers on how to preserve the specialty (and was Nephrology News & Issues’ Cover Story last month). The agenda at the Renal Physicians Association Annual Meeting always has a strong focus on preparing nephrologists for change – whether it be new Medicare-driven physician payment systems, how to work more effectively with electronic health records or better ways to manage your practice.
Multidisciplinary care
The patient-caregiver role in nephrology has no stronger place than in reviewing topics like end-of-life care. It is the multidisciplinary team that must help patients make decisions about the role of dialysis therapy in their lives. The National Kidney Foundation Spring Clinical Meetings captured the essence of the importance of each member of the dialysis team with multiple program tracks for social workers, dietitians, nurse practitioners, patient care technicians/technologists and physicians. However, it also served as a base for new important developments, like the presentation of a paper by Manley and colleagues which showed health care centers were able to cut the hospital readmission rate for patients on dialysis by almost half in the month following discharge through use of multidisciplinary medication therapy management (MTM).
“This is the first study to demonstrate that addressing medication-related problems post-hospital discharge through a structured and multidisciplinary MTM process can reduce 30-day readmission rates,” Harold J. Manley, PharmD, FASN, FCCP, BCPS, lead study author, said in a press release from the National Kidney Foundation.
Other key sessions, featured in the pages of this current issue of Nephrology News & Issues, include:
- A review of recent U.S. Renal Data System data that shows the drop-in mortality rate among patients on dialysis is now leveling off. The industry may be facing a new period of persistently high mortality, with no clear understanding of the cause.
- A study that showed no significant difference in long-term technique failure when looking at patients who have an urgent start on PD vs. a more conventional start. The study lead by Apameh Salari, MD, of the University of Southern California, “showed the rate of technique failure for urgent-start peritoneal dialysis is 0.118 case per person per year and for conventional peritoneal dialysis 0.085 cases per person per years, which is low for two groups.”
Lastly, our coverage of the American Nephrology Nurses Association National Symposium provided the backdrop for the release of initial results from an important ANNA/Nephrology News & Issues survey on nephrology nurses. See some of our initial analysis from the survey on page 24 and look for more articles from the survey results in upcoming issues.
A focus on all the disciplines in nephrology is key to understanding how quality of care can improve for patients with end-stage renal disease. It is a team effort. – by Mark E. Neumann