The Experience of Pruritus in CKD

How distress from itchy skin impacts patient health and quality of life

Recent findings from the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) advance our knowledge of the patient experience of pruritus, or itchy skin earlier in the lifecycle of kidney disease. This study demonstrates the high prevalence of pruritus and it's strong relationship to the quality of life, poor sleep, and symptoms of depression. Check out the work of Nidhi Sukul, MD and CKDopps collaborators in Clinical Journal of the American Society of Nephrology (CJASN).

Secular Trends in the Cost of Immunosuppressants after Solid Organ Transplantation in the United States

Generic medications reduce the lifetime costs of organ transplantation

The priceless gift of a transplanted organ comes with life-long costs of the critical immunosuppressant medications that prevent rejection. Although Medicare provides coverage for these drugs to kidney transplant recipients in the three years following a transplant, many transplant recipients have difficulty affording the related out-of-pocket costs post-transplantation.

Findings of a study conducted by Arbor Research Collaborative for Health indicate the potential of relief for these patients and Medicare. This work by Margaret E. Helmuth and her colleagues was published February 28, 2019, in the Clinical Journal of the American Society of Nephrology (CJASN). They examined cost changes following the introduction of generic variations of two commonly prescribed immunosuppressants and determined that the introduction of generic medications in this class has resulted in substantial savings for transplant patients and Medicare.

Study of self-reported symptom clusters may improve the diagnosis and treatment of women with lower urinary tract disorders

Currently, women with lower urinary tract symptoms (LUTS) are treated according to their most troubling symptom. This approach is not always completely successful, as it does not take into account that patients can have multiple symptoms that respond to different treatments.

The National Living Donor Assistance Center (NLDAC) produces dramatic federal savings through financial support for lower-income kidney donors

For each American who has kidney failure, the Centers for Medicare & Medicaid Services (CMS) spends more than $80,000 per year for dialysis treatment. This cost drops to only $30,000 when a patient receives a kidney transplant and no longer needs dialysis.

Long-term kidney transplant failure rates worse in United States compared to other countries

The best option for people with end-stage kidney disease is to receive a kidney transplant. Kidney transplantation is currently performed in nearly 100 countries, and yet failure of the transplanted kidney in the long term remains an important limitation. Are there differences across countries in the rates of kidney transplant failure?

Describing patients seeking care for lower urinary tract symptoms

The term “lower urinary tract symptoms” (LUTS) includes a wide range of symptoms, including urgency, frequency, dysuria (painful urination), nocturia (excessive nighttime urination), post-void dribbling, and urinary incontinence. Much is still unknown about the effects of LUTS, and treatments often fall short of fully addressing the problem.

Optimal IV iron dosing to manage anemia in hemodialysis patients

Almost all patients on hemodialysis experience anemia, a deficiency of red blood cells causing fatigue and weakness. For over two decades, nephrologists have treated anemia in hemodialysis patients with erythropoiesis-stimulating agents (ESAs) and intravenous (IV) iron. However, there is currently no consensus on the optimal IV iron dose to raise or sustain hemoglobin at appropriate levels, without very high ferritin or TSAT levels and without excessive use of ESAs.

Severe skin itching remains a problem for hemodialysis patients

Pruritus, severe and chronic itching of the skin, is common in people with chronic kidney disease. While mild pruritus may be a nuisance, severe pruritus has a major negative effect on patients’ lives. They are often bothered by the dryness and appearance of their skin and are annoyed by their itching, which has a considerable impact on their social and working lives. Many also suffer restless sleep, which is associated with depression and increased mortality. In a recent paper, investigators studied the prevalence, awareness, and treatment of pruritus to assess how well this important condition is currently managed internationally.

Successful use & placement of arteriovenous fistula (AVF) vascular accesses: US AVF placement trend of concern

People who receive chronic hemodialysis depend on a functional vascular access to allow use of this predominant form of treatment for end stage kidney failure. Vascular access practice varies greatly internationally, with better outcomes typically seen when using an arteriovenous fistula (AVF). Generally, placing the AVF in the lower arm is preferred as there is less risk of exhausting available sites for future AVFs. Given the large international variation in vascular access practice and outcomes, researchers sought to further understand international differences by examining data from the Dialysis Outcomes and Practice Patterns Study (DOPPS).

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