Renal & Urology News - April 2016 Issue

Page 1

APRIL 2016

VOLUME 15, ISSUE NUMBER 3

www.renalandurologynews.com

Nephrology Attracting Fewer Doctors Fellowship positions go unfilled as the U.S. faces expanding population of kidney disease patients BY JODY A. CHARNOW RESEARCHERS EXPECT the population of patients with kidney disease to swell in coming years as a result of a growing elderly population, increasing diabetes incidence and prevalence, and other factors. The trend has raised concerns about whether the nation will have sufficient nephrologists and other kidney care specialists to keep pace with this expanding population of complex patients. A report titled “US Nephrology Workforce 2015: Developments and Trends,” which was prepared for the American Society of Nephrology (ASN), noted that “changes in the general health care system and delivery of kidney care make it unclear how increases in need will be translated into demand

INTEREST IN NEPHROLOGY WANING The proportion of filled nephrology fellowship positions in the United States has been in decline. 100 80

91%

89% 76%

60

68%

40 20 0

2012

2013

2014

2015

Source: National Resident Matching Program Specialties Matching Service.

PD Growing Faster than HHD SEATTLE—The number of patients on home hemodialysis (HHD) grew rapidly while the number of those on peritoneal dialysis (PD) grew slowly in the United States prior to the debut of the Medicare prospective payment system for dialysis care in 2011, but the pattern subsequently reversed, according to data presented at the 2016 Annual Dialysis Conference.

Possible explanations for the trend include a higher profit margin potentially associated with PD and lack of adequate reimbursement for HHD training, said Eric D. Weinhandl, PhD, MS, who presented study findings. Under the prospective payment system (PPS), PD is reimbursed at the same rate continued on page 7

MANAGEMENT OF ADPKD

An analysis and interpretation of the latest evidence by Ronald D. Perrone, MD. PAGE 15

Incompatible Live Donors a Good Option BY JODY A. CHARNOW RECIPIENTS OF a kidney from an HLA-incompatible live donor have substantially better survival than individuals who receive a kidney from a deceased donor or who remain on the transplant waiting list, according to a study. After 8 years, patients who received a kidney from an HLA-incompatible donor had a survival rate of 76.5%, which was significantly higher than the survival rates for 2 control groups: patients who remained on the transplant waiting list or received a kidney from a deceased donor (62.9%) or those who remained on the waiting list and did not receive a transplant from a deceased donor (43.9%). The survival benefit was observed across all donorspecific antibody levels, researchers reported in The New England Journal of Medicine (2016;374:940-950). “For the first time, we have definitively shown that incompatible live continued on page 7

for nephrologists.” If the demand does increase, however, the country may not have enough young doctors entering the subspecialty to meet it. The number of medical residents filling nephrology fellowship positions has been declining. The proportion of filled nephrology fellowship positions dropped from about 91% in 2012 to 89% in 2013, 76% in 2014, and 68% in 2015, according to the National Resident Matching Program Specialties Matching Service. Reasons for the relative lack of interest in nephrology are varied and speculative. Ruediger W. Lehrich, MD, director of the nephrology fellowship program at Duke University Medical Center in Durham, N.C., offered some possible explanations. continued on page 7

IN THIS ISSUE 5

Sildenafil may improve passage of distal ureteric stones

6

Death risk higher among black vs. white children on dialysis

6

Intradialytic hypotension predicts greater long-term mortality

11

NKF Preview: Treating anemia in cancer patients with CKD

15

NKF Preview: Update on the management of ADPKD

18

A chewable iron-based binder improves phosphorus control

19

Finasteride may lower the risk of bladder cancer diagnosis in men A review of anemia management for cancer patients with CKD by Jeffrey S. Berns, MD. PAGE 11


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