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    823 results match your criteria Advances in chronic kidney disease[Journal]

    1 OF 17

    Getting to the Heart of the Matter: Review of Treatment of Cardiorenal Syndrome.
    Adv Chronic Kidney Dis 2017 Jul;24(4):261-266
    Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI; and Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, OH.
    Acute decompensated heart failure is a common cause of hospitalization with worsening kidney function or acute kidney injury often complicating the admission, which can result in further dysfunction of both systems in the form of a cardiorenal syndrome. Therapy in this arena has been largely empiric as rigorous clinical trial data to inform therapeutic choices are lacking. Here we review and discuss the available clinical evidence for common approaches to the management of this condition. Read More

    Dual Organ Duel: The Hepatorenal Axis.
    Adv Chronic Kidney Dis 2017 Jul;24(4):253-260
    Albert Einstein College of Medicine Renal Division, Montefiore Medical Center, Bronx, NY.
    Recent developments in our understanding of the pathogenesis of kidney disease in the setting of liver failure have highlighted that kidney injury, rather than occurring in isolation, is a marker of systemic disease and poor prognosis. The differential diagnosis of kidney disease associated with liver failure is broader than formerly described and new biopsy data, along with better acute kidney injury classification tools, have increased appreciation for distinct pathophysiological mechanisms. Evidence suggests that acute kidney injury contributes to worsening hepatic failure by directly injuring hepatic cells and by imposing restrictions on therapeutic strategies for portal hypertension. Read More

    Follow-up Care in Acute Kidney Injury: Lost in Transition.
    Adv Chronic Kidney Dis 2017 Jul;24(4):246-252
    Division of Nephrology, University of Toronto, Toronto, Canada; Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA; Tennessee Valley Healthcare System (TVHS), Veterans Administration (VA) Medical Center, Veteran's Health Administration, Nashville, TN; Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; and Vanderbilt Center for Kidney Disease (VCKD) and Integrated Program for AKI Research (VIP-AKI), Nashville, TN.
    Acute kidney injury (AKI) is an increasingly common condition that is associated with long-term health outcomes. Recent studies have demonstrated that AKI, particularly when severe or persistent, is associated with all-cause mortality, CKD, ESRD, cardiovascular events, and reduced quality of life. However, data from multiple health care systems indicate that most patients do not see a nephrologist, although 1 study has suggested patients with AKI requiring dialysis may benefit from doing so. Read More

    Information Technology and Acute Kidney Injury: Alerts, Alarms, Bells, and Whistles.
    Adv Chronic Kidney Dis 2017 Jul;24(4):241-245
    Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT; and Veterans Affairs Medical Center, West Haven, CT. Electronic address:
    The goal of this review is to describe the rationale for alerting systems for acute kidney injury, the challenges associated with alert implementation, and the efficacy (or lack thereof) of acute kidney injury alerts to date. Read More

    Kidney Toxicities Associated With Novel Cancer Therapies.
    Adv Chronic Kidney Dis 2017 Jul;24(4):233-240
    Renal Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Canada; and Department of Medicine, Weill Cornell Medical College, New York, NY. Electronic address:
    Targeted therapies that act via unique molecular pathways and interfere with cancer cell growth and tumor progression have dramatically changed the cancer treatment paradigm. However, although, ideally, these therapies intend to target only cancer cells, they do often affect nonmalignant tissue. Numerous renal side effects have been reported to date. Read More

    Acute Kidney Injury in Transplant Setting: Differential Diagnosis and Impact on Health and Health Care.
    Adv Chronic Kidney Dis 2017 Jul;24(4):228-232
    Division of Nephrology, Kidney C.A.R.E. Program, University of Cincinnati, Cincinnati, OH; and Cincinnati VA Medical Center, Cincinnati, OH. Electronic address:
    Acute kidney injury (AKI) is common in kidney transplant recipients. In addition to the usual causes of AKI in native kidneys, certain features and risk factors are unique to kidney allografts. In this article, we will present an overview of the common transplant-specific AKI etiologies that include increased susceptibility to hemodynamic-mediated AKI, acute rejection, medication-induced AKI, recurrence of native kidney disease, infections, urinary tract obstruction, vascular thrombosis and post-transplant lymphoproliferative disorder. Read More

    Antibiotic Dosing in Continuous Renal Replacement Therapy.
    Adv Chronic Kidney Dis 2017 Jul;24(4):219-227
    Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI. Electronic address:
    Appropriate antibiotic dosing is critical to improve outcomes in critically ill patients with sepsis. The addition of continuous renal replacement therapy makes achieving appropriate antibiotic dosing more difficult. The lack of continuous renal replacement therapy standardization results in treatment variability between patients and may influence whether appropriate antibiotic exposure is achieved. Read More

    Continuous Renal Replacement Therapy: Reviewing Current Best Practice to Provide High-Quality Extracorporeal Therapy to Critically Ill Patients.
    Adv Chronic Kidney Dis 2017 Jul;24(4):213-218
    Divisions of Pulmonary, Allergy, Critical Care, and Sleep Medicine; Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA; and Division of Nephrology, University of Arkansas for Medial Sciences, Little Rock, AK.
    Continuous renal replacement therapy (CRRT) use continues to expand globally. Despite improving technology, CRRT remains a complex intervention. Delivery of high-quality CRRT requires close collaboration of a multidisciplinary team including members of the critical care medicine, nephrology, nursing, pharmacy, and nutrition support teams. Read More

    Fluid Resuscitation: Principles of Therapy and "Kidney Safe" Considerations.
    Adv Chronic Kidney Dis 2017 Jul;24(4):205-212
    Division of Nephrology, Kidney C.A.R.E. Program, University of Cincinnati, Cincinnati, OH. Electronic address:
    Fluid resuscitation in the acutely ill must take into consideration numerous elements, including the intravenous solution itself, the phase of resuscitation, and the strategies toward volume management which are paramount. With the advancement in the understanding and implementation of aggressive fluid resuscitation has also come a greater awareness of the resultant fluid toxicity, especially in those that suffer acute kidney injury, and the realization that there is continued ambiguity with regard to volume mitigation and removal in the resuscitated patient. As such, the discussion regarding intravenous solutions continues to evolve especially as it pertains to their effect on kidney and metabolic function, electrolytes, and ultimately patient outcome. Read More

    Epidemiology of AKI: Utilizing Large Databases to Determine the Burden of AKI.
    Adv Chronic Kidney Dis 2017 Jul;24(4):194-204
    Kidney Disease@Farr Collaboration, University of Aberdeen, Aberdeen, UK; and Kidney Disease@Farr Collaboration, University of Southampton, Southampton, UK.
    Large observational databases linking kidney function and other routine patient health data are increasingly being used to study acute kidney injury (AKI). Routine health care data show an apparent rise in the incidence of population AKI and an increase in acute dialysis. Studies also report an excess in mortality and adverse renal outcomes after AKI, although with variation depending on AKI severity, baseline, definition of renal recovery, and the time point during follow-up. Read More

    A High-Content Screening Technology for Quantitatively Studying Podocyte Dynamics.
    Adv Chronic Kidney Dis 2017 May;24(3):183-188
    Department of Medicine, Rush University Medical Center, Chicago, IL. Electronic address:
    Podocytes form the visceral layer of a kidney glomerulus and express a characteristic octopus-like cellular architecture specialized for the ultrafiltration of blood. The cytoskeletal dynamics and structural elasticity of podocytes rely on the self-organization of highly interconnected actin bundles, and the maintenance of these features is important for the intact glomerular filtration. Development of more differentiated podocytes in culture has dramatically increased our understanding of the molecular mechanisms regulating podocyte actin dynamics. Read More

    The Impact of Excess Ligand on the Retention of Nonionic, Linear Gadolinium-Based Contrast Agents in Patients With Various Levels of Renal Dysfunction: A Review and Simulation Analysis.
    Adv Chronic Kidney Dis 2017 May;24(3):176-182
    Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC.
    The role of gadolinium (Gd)-based contrast agents (GBCAs) in the pathophysiology of nephrogenic systemic fibrosis (NSF) is now uncontested. Although the definitive mechanism has not been established, the association with weaker GBCA ligands and with reduced renal clearance supports a hypothesis that Gd release from the GBCAs is a key process in precipitating the disease. Prevention strategies often include the use of more stable GBCA ligands in patients with reduced kidney function, but animal models and some clinical data suggest that better patient outcomes can be achieved when excess ligand is administered with weaker GBCAs; this is particularly significant for OptiMARK, which contains a nonionic, linear ligand similar to gadodiamide, the active ingredient in Omniscan, but contains twice the amount of excess ligand. Read More

    Intravenous Contrast-Induced Nephropathy-The Rise and Fall of a Threatening Idea.
    Adv Chronic Kidney Dis 2017 May;24(3):169-175
    Department of Radiology, Columbia University Medical Center and New York Presbyterian Hospital, New York, NY. Electronic address:
    Contrast-induced nephropathy (CIN) has been considered to be a cause of renal failure for over 50 years, but careful review of past and recent studies reveals the risks of CIN to be overestimated. Older studies frequently cited the use of high-osmolality contrast media, which have since been replaced by low-osmolality contrast media, which have lower risks for nephropathy. In addition, literature regarding CIN typically describes the incidence following cardiac angiography, whereas the risk of CIN from intravenous injection is much lower. Read More

    Functional Magnetic Resonance Imaging of the Kidneys-With and Without Gadolinium-Based Contrast.
    Adv Chronic Kidney Dis 2017 May;24(3):162-168
    Department of Radiology and Imaging Sciences, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108. Electronic address:
    Assessment of renal function with magnetic resonance imaging (MRI) has been actively explored in the past decade. In this review, we introduce the principle of MRI and review recent progress of MRI methods (contrast enhanced and noncontrast) in assessing renal function. Contrast-enhanced MRI using ultra-low dose of gadolinium-based agent has been validated for measuring single-kidney glomerular filtration rate and renal plasma flow accurately. Read More

    The Role of PET Scanning in the Evaluation of Patients With Kidney Disease.
    Adv Chronic Kidney Dis 2017 May;24(3):154-161
    Section of Nephrology, Yale University School of Medicine, VA Medical Center, West Haven, CT; Section of Nephrology, Yale University School of Medicine, New Haven, CT; and VA Medical Center, West Haven, CT. Electronic address:
    Patients with underlying kidney disease are often required to undergo imaging for a variety of purposes including diagnosis and prognosis. A test that is being increasingly used with for this group of patients is the positron emission test (PET) scan. In addition, combining the nuclear medicine technique (PET) with computed tomography scan allows additional imaging advantages over either alone. Read More

    Recent Advances in Magnetic Resonance Imaging Assessment of Renal Fibrosis.
    Adv Chronic Kidney Dis 2017 May;24(3):150-153
    Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX; and Center for Translational Research on Inflammatory Diseases (CTRID) and Renal Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. Electronic address:
    CKD is a global public health problem. Renal fibrosis is a final common pathway leading to progressive loss of function in CKD. The degree of renal fibrosis predicts the prognosis of CKD. Read More

    Intravenous Contrast: Friend or Foe? A Review on Contrast-Induced Nephropathy.
    Adv Chronic Kidney Dis 2017 May;24(3):147-149
    Division of Nephrology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX. Electronic address:
    Intravenous iodinated contrast is used in many contrasted imaging studies ranging from computed tomography to angiography. The risks of contrast-induced nephropathy (CIN) and its incidence have not been clearly defined. Most iodinated contrast media used today are hypertonic compared with serum osmolality and pose biological risks. Read More

    Gadolinium Retention and Toxicity-An Update.
    Adv Chronic Kidney Dis 2017 May;24(3):138-146
    Department of Radiology, Hospital Garcia de Orta, Almada, Portugal; Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Department of Radiology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal. Electronic address:
    Until 2006, the main considerations regarding safety for all gadolinium-based contrast agents (GBCAs) were related to short-term adverse reactions. However, the administration of certain "high-risk" GBCAs to patients with renal failure resulted in multiple reported cases of nephrogenic systemic fibrosis. Findings have been reported regarding gadolinium deposition within the body and various reports of patients who report suffering from acute and chronic symptoms secondary to GBCA's exposure. Read More

    IgG4-Related Tubulointerstitial Nephritis.
    Adv Chronic Kidney Dis 2017 03;24(2):94-100
    Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN. Electronic address:
    Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is a fibroinflammatory disorder that can involve nearly any organ. The disorder has increasingly become known as a distinct clinical entity during the last decade. IgG4-related tubulointerstitial nephritis (IgG4-TIN) is the most common manifestation of IgG4-RD in the kidney. Read More

    Autosomal Dominant Tubulointerstitial Kidney Disease.
    Adv Chronic Kidney Dis 2017 03;24(2):86-93
    Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC; Institute for Inherited Metabolic Disorders, Prague, Czech Republic; and First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
    There are 3 major forms of autosomal dominant tubulointerstitial kidney disease (ADTKD): ADTKD due to UMOD mutations, MUC1 mutations, and mutations in the REN gene encoding renin. Lack of knowledge about these conditions contributes to frequent nondiagnosis, but with even limited knowledge, nephrologists can easily obtain a diagnosis and improve patient care. There are 3 cardinal features of these disorders: (1) the conditions are inherited in an autosomal dominant manner and should be considered whenever both a parent and child suffer from kidney disease; the presence of even more affected family members provides further support. Read More

    Tubulointerstitial Injury and Drugs of Abuse.
    Adv Chronic Kidney Dis 2017 Mar;24(2):80-85
    Department of Nephrology, Cleveland Clinic, Cleveland, OH; and Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH. Electronic address:
    Drug abuse is widespread in many populations, and patients abusing illicit substances are at a significantly increased risk of kidney injury. The tubulointerstitial compartment is a common target of these nephrotoxic agents. This review will cover some of the common illicit drugs and will focus on the tubulointerstitial injuries seen in the setting of drug abuse. Read More

    Medication-Induced Interstitial Nephritis in the 21st Century.
    Adv Chronic Kidney Dis 2017 Mar;24(2):72-79
    Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address:
    Interstitial nephritis is an immune mediated form of tubulointerstitial kidney injury that may occur secondary to drugs, autoimmune disease, infections, and hematologic disorders or as a reactive process. Drug-induced acute interstitial nephritis (DI-AIN) occurs in 0.5%-3% of all kidney biopsies and in 5%-27% of biopsies performed for acute kidney injury. Read More

    Mechanisms of Drug-Induced Interstitial Nephritis.
    Adv Chronic Kidney Dis 2017 Mar;24(2):64-71
    Division of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX.
    Drug-induced acute interstitial nephritis (DI-AIN) is a drug hypersensitivity reaction (DHR) that manifests 7 to 10 days after exposure to the culprit drug. DHRs account for fewer than 15% of reported adverse drug reactions. The kidneys are susceptible to DHR because: (1) the high renal blood flow whereby antigens are filtered, secreted, or concentrated, and (2) it is a major site of excretion for drugs and drug metabolites. Read More

    Clinical Approach to Diagnosing Acute and Chronic Tubulointerstitial Disease.
    Adv Chronic Kidney Dis 2017 Mar;24(2):57-63
    Section of Nephrology, Yale University School of Medicine, New Haven, CT. Electronic address:
    Tubulointerstitial diseases are a relatively common cause of acute and/or chronic kidney disease. Acute tubulointerstitial nephritis (ATIN) most commonly develops in patients exposed to various medications; however, it can occur from infections, autoimmune and systemic diseases, environmental exposures, and some idiopathic causes. Chronic tubulointerstitial nephritis may develop in patients with previous ATIN or may be the initial manifestation of an autoimmune, systemic, environmental, or metabolic process. Read More

    Treatment of Renal Fibrosis-Turning Challenges into Opportunities.
    Adv Chronic Kidney Dis 2017 Mar;24(2):117-129
    Institute of Pathology, RWTH University of Aachen, Aachen, Germany; Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands; and Division of Nephrology, RWTH University of Aachen, Aachen, Germany. Electronic address:
    Current treatment modalities are not effective in halting the progression of most CKD. Renal fibrosis is a pathological process common to all CKD and thereby represents an excellent treatment target. A large number of molecular pathways involved in renal fibrosis were identified in preclinical studies, some of them being similar among different organs and some with available drugs in various phases of clinical testing. Read More

    The Tubulointerstitial Pathophysiology of Progressive Kidney Disease.
    Adv Chronic Kidney Dis 2017 Mar;24(2):107-116
    Division of Kidney Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. Electronic address:
    Accumulating evidence suggests that the central locus for the progression of CKD is the renal proximal tubule. As injured tubular epithelial cells dedifferentiate in attempted repair, they stimulate inflammation and recruit myofibroblasts. At the same time, tissue loss stimulates remnant nephron hypertrophy. Read More

    Toward a Comprehensive Hypothesis of Chronic Interstitial Nephritis in Agricultural Communities.
    Adv Chronic Kidney Dis 2017 03;24(2):101-106
    National Health Institute (INS) and National Renal Health Research Coordinator, Ministry of Health (MINSAL), San Salvador, El Salvador; Nephrology Institute, Havana, Cuba; Division of Clinical Research in Nephrology, Massachusetts General Hospital, Boston, MA; Department of Medicine, Mount Sinai St. Luke's-West, New York, NY; and Division of Nephrology, Harbor-UCLA Medical Center, Los Angeles, CA.
    Over the past 20 years, there has been an increase in chronic interstitial nephritis in agricultural communities (CINAC) not associated with traditional risk factors. This disease has become an important public health problem and is observed in several countries in Central America and Asia. CINAC predominantly affects young male farmers between the third and fifth decades of life with women, children, and adolescents less often affected. Read More

    Managing CKD by Telemedicine: The Zuni Telenephrology Clinic.
    Adv Chronic Kidney Dis 2017 Jan;24(1):6-11
    National Kidney Disease Education Program, National Institutes of Health, Bethesda, MD; Zuni Comprehensive Community Health Center, Indian Health Service, Zuni, New Mexico; and Center for Information Technology, National Institutes of Health, Bethesda, MD.
    Telemedicine has significant potential to extend nephrology consultation to rural and isolated communities. We describe a telenephrology clinic that has delivered ongoing consultative care from a nephrologist based at the National Institutes of Health in Bethesda, MD, to the Zuni Comprehensive Health Center in western New Mexico. Over the past 9 years, the clinic has conducted 1870 patient visits managing patients using a collaborative approach engaging a nurse case manager, nephrologist, primary clinicians, pharmacists, and community health nurses. Read More

    Medicare Telehealth Services and Nephrology: Policies for Eligibility and Payment.
    Adv Chronic Kidney Dis 2017 Jan;24(1):46-50
    Centers for Medicare and Medicaid Services, Center for Clinical Standards and Quality, Division of Value, Incentives and Quality Reporting, Baltimore, MD. Electronic address:
    The criteria for Medicare payment of telehealth nephrology services, and all other Medicare telehealth services, are set forth in section 1834(m) of the Social Security Act. There are just over 80 professional physician or practitioner services that may be furnished via telehealth and paid under Medicare Part B, when an interactive audio and video telecommunication system that permits real-time communication between a beneficiary at the originating site and the physician or practitioner at the distant site substitutes for an in-person encounter. These services include 16 nephrology billing codes for furnishing ESRD services for monthly monitoring and assessment and two billing codes for chronic kidney disease education. Read More

    Telehealth Applications to Enhance CKD Knowledge and Awareness Among Patients and Providers.
    Adv Chronic Kidney Dis 2017 Jan;24(1):39-45
    Division of Nephrology, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA; Center for Innovation in Access and Quality, University of California, San Francisco, San Francisco, CA; and Division of General Internal Medicine, Duke University School of Medicine, Durham, NC.
    CKD affects 13% of the US adult population, causes excess mortality, and is associated with significant sociodemographic disparities. Optimal CKD management slows progression of disease and reduces cardiovascular-related outcomes. Resources for patients and primary care providers, major stakeholders in preventive CKD care, are critically needed to enhance understanding of the disease and to optimize CKD health, particularly because of the asymptomatic nature of kidney disease. Read More

    Telemedicine to Promote Patient Safety: Use of Phone-Based Interactive Voice-Response System to Reduce Adverse Safety Events in Pre-dialysis CKD.
    Adv Chronic Kidney Dis 2017 Jan;24(1):31-38
    Division of General Internal Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD; and Safe Kidney Care Program, University of Maryland School of Medicine, Baltimore, MD.
    CKD patients have several features conferring on them a high risk of adverse safety events, which are defined as incidents with unintended harm related to processes of care or medications. These characteristics include impaired kidney function, polypharmacy, and frequent health system encounters. The consequences of such events in CKD can include new or prolonged hospitalization, accelerated kidney function loss, acute kidney injury, ESRD, and death. Read More

    Targeting Access to Kidney Care Via Telehealth: The VA Experience.
    Adv Chronic Kidney Dis 2017 Jan;24(1):22-30
    Department of Medicine, Section of Nephrology, VA Connecticut Healthcare System, West Haven, CT; Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT; Department of Medicine, Section of Nephrology, Salem VA Medical Center, Salem, VA; Department of Medicine, Section of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA; Department of Medicine, Section of Nephrology, VA Puget Sound Healthcare System, Seattle, WA; Division of Nephrology, University of Washington School of Medicine, Seattle, WA; Department of Medicine, Section of Nephrology, VA White River Junction VAMC, White River Junction, VT; Department of Medicine, Section of Nephrology, Dartmouth School of Medicine, Hanover, NH; Department of Medicine, Section of Nephrology, VA Northport Healthcare Systems, Northport, NY; and Department of Medicine, Section of Nephrology, State University of New York at Stony Brook School of Medicine, Stony Brook, NY.
    The Veterans Affairs (VA) is the largest integrated health care system in the United States and is responsible for the care of a population with a disproportionately high rate of CKD. As such, ensuring access to kidney health services is a VA imperative. One facet of the VA's strategy to reduce CKD is to leverage the use of teletechnology to expand the VA's outreach to Veterans with kidney disease. Read More

    Overview on the Challenges and Benefits of Using Telehealth Tools in a Pediatric Population.
    Adv Chronic Kidney Dis 2017 Jan;24(1):17-21
    The Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA. Electronic address:
    Telehealth in Pediatric Medicine presents many of the same benefits and challenges noted in adult-based medicine. In terms of health care delivery, the promise of improving access and reducing costs using telehealth in Pediatrics, particularly chronic care, is high. The ability to address clinician shortages and provide remote guidance for chronic care pathways from pediatric subspecialists to rural-based referring physicians is a developing model that represents a sustainable and cost-effective strategy to improve pediatric care. Read More

    Telehealth in the Delivery of Home Dialysis Care: Catching up With Technology.
    Adv Chronic Kidney Dis 2017 Jan;24(1):12-16
    Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL; and Alabama Department of Public Health, Montgomery, AL. Electronic address:
    Geographic and socioeconomic barriers may pose a significant difficulty in delivering home dialysis care to remote underserved populations leading to low utilization rates and poor outcomes. Telehealth may serve as a solution to overcome geographic barriers in delivering home dialysis care. Although technologic advances in telehealth have progressed rapidly making it accessible and inexpensive, it has been underused by nephrologists. Read More

    The ESRD Quality Incentive Program: The Current Limitations of Evidence and Data to Develop Measures, Drive Improvement, and Incentivize Outcomes.
    Adv Chronic Kidney Dis 2016 Nov;23(6):377-384
    Quality Health Care Advisory Group, Huntington, NY; and Metropolitan Nephrology Associates, Clinton, MD. Electronic address:
    This article describes the current state of facilitating the integration of evidence into practice to support initiatives focused on patients with ESRD. We will use the Centers for Medicare and Medicaid Services (CMS) ESRD Quality Incentive Program (QIP) as an example, including a description of the health information infrastructure needed to support the translation of evidence into practice and some of the challenges encountered. The process from the generation of evidence to integration of this evidence into practice includes policy development leading to clinical practice guidelines, clinical performance measures, and clinical decision support tools. Read More

    Identifying Potential Biases in the Nephrology Literature.
    Adv Chronic Kidney Dis 2016 Nov;23(6):373-376
    Section of Nephrology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; and Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada. Electronic address:
    Observational studies are common in the nephrology literature, particularly given the lack of large randomized trials. While these studies have identified important associations, potential biases, if unrecognized, can result in misinterpreted conclusions. In this review, we present an example of four potentially important biases (lead time bias, survivor bias, immortal time bias, and index event bias) that can result in inaccurate estimates of association between risk factors or treatments and outcomes. Read More

    Observational Research Using Propensity Scores.
    Adv Chronic Kidney Dis 2016 Nov;23(6):367-372
    Department of Anesthesiology, Duke University Medical Center, Durham VA Medical Center, Durham, NC; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and the Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.
    In most observational studies, treatments or other "exposures" (in an epidemiologic sense) do not occur at random. Instead, treatments or other such interventions depend on several patient-related and patient-independent characteristics. Such factors, associated with the receipt vs nonreceipt of treatment, may also be-independently-associated with outcomes. Read More

    Use of Surrogate Outcomes in Nephrology Research.
    Adv Chronic Kidney Dis 2016 Nov;23(6):363-366
    Pediatric Nephrology and Hypertension, University of Texas McGovern Medical School at Houston, Houston, TX. Electronic address:
    Clinical trials are large and expensive and could require exceedingly long-term follow-up for subjects to reach clinically meaningful end points. To combat these methodologic issues, researchers sometimes use biomarkers as surrogate end points. A biomarker is an objectively measured characteristic that is indicative of some underlying phenomenon or process, while a surrogate is a biomarker that "takes the place" of a clinically meaningful outcome, usually earlier in the disease process. Read More

    An Evidence-Based Approach to Conducting Systematic Reviews on CKD.
    Adv Chronic Kidney Dis 2016 Nov;23(6):355-362
    Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI. Electronic address:
    With the growing need to integrate best evidence to inform clinical care, systematic reviews have continued to flourish. Although this type of review is integral to the synthesis of evidence-based information, systematic reviews are often conducted omitting well-established processes that ensure the validity and replicability of the study; elements of which are integral based on standards developed by the Cochrane Collaboration and the National Academy of Medicine. This review article will share best practices associated with conducting systematic reviews on the topic of CKD using an 8-step process and an evidence-based approach to retrieving and abstracting data. Read More

    Unique Study Designs in Nephrology: N-of-1 Trials and Other Designs.
    Adv Chronic Kidney Dis 2016 Nov;23(6):351-354
    Division of Pediatric Nephrology and Hypertension, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX.
    Alternatives to the traditional parallel-group trial design may be required to answer clinical questions in special populations, rare conditions, or with limited resources. N-of-1 trials are a unique trial design which can inform personalized evidence-based decisions for the patient when data from traditional clinical trials are lacking or not generalizable. A concise overview of factorial design, cluster randomization, adaptive designs, crossover studies, and n-of-1 trials will be provided along with pertinent examples in nephrology. Read More

    Cognitive Bias and the Creation and Translation of Evidence Into Clinical Practice.
    Adv Chronic Kidney Dis 2016 Nov;23(6):346-350
    Division of Renal Diseases and Hypertension, Center for Clinical Research and Evidence-based Medicine, McGovern Medical School University of Texas, Houston, TX. Electronic address:
    The optimal translation of evidence into the clinical practice of nephrology follows validated evidence-based medicine (EBM) principles. Most importantly, the evidence-based medicine practitioner requires that the evidence, as much as possible, addresses in an unbiased manner clinical questions of importance to patients and reflects the truth. In this chapter, we evaluate how cognitive biases that affect medical decision making might systematically bias the overall management of patients with kidney disease and, thus, distort the observations about disease causation, prognosis, diagnosis, and management that are derived from analysis of administrative databases or electronic medical records of health care systems. Read More

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