Men Found to Be More Likely Than Women To Start Dialysis

IKF Common in Adolescent Anorexia

Impaired kidney function may offer a better way to judge anorexia severity, according to researchers

IMPAIRED KIDNEY function (IKF) in adolescent patients with anorexia is common and transiently worsens during hospitalization, according to a recent study.

In a study of 395 patients with a mean age of 14.6 years (81.6% girls) recently hospitalized with the psychiatric disorder, IKF was present in 146 (36.8%), Evgenia Gurevich, MD, of Schneider Children’s Medical Center of Israel in Petach Tikva, and colleagues reported in JAMA Network Open. The investigators defined IKF as an estimated glomerular filtration rate (eGFR, in mL/ min/1.73 m2) less than 90.

Among patients with IKF, the mean eGFR decreased during hospitalization, declining from 83.0 at admission to a nadir of 79.1 during hospitalization. It rose to 97.7 at the most recent measurement.

The investigators observed no significant difference in body mass index (BMI) at admission between the patients with and without IKF. The maximal serum creatinine level during hospitalization was significantly higher in the patients with IKF (mean 83 vs 59 mg/dL).

During hospitalization, serum creatinine increased in those with IKF but remained unchanged in those without IKF. “Since proper hydration could be assured during hospitalization, this finding suggests the presence of a unique yet undefined mechanism other than dehydration,” Dr Gurevich and colleagues wrote.

The patients with IKF had a significantly lower mean minimal eGFR (79.1 vs 112) and a significantly higher serum creatinine to BMI ratio (4.9% vs 3.6%).

Minimal heart rate and free triiodothyronine levels, both physiologic parameters of anorexia severity, correlated with eGFR but not with admission BMI, the investigators reported. The median length of hospital stay was significantly longer in the IKF than noIKF group (13 vs 8 days).

“Results of this case-control study suggest that impaired kidney function may be a better parameter of anorexia nervosa severity than body mass index,” Dr Gurevich and colleagues concluded.

The investigators compared with anorexia group with a control group of 495 age- and sex-matched patients hospitalized during the same period with other diagnoses. The median BMI percentile at hospital admission was significantly lower in the anorexia group compared with controls (12.3 vs 49). The minimal eGFR was significantly lower in the anorexia than control group (99.8 vs 124). The mean serum creatinine concentration was in the normal range for anorexia group as a whole, but was higher compared with controls (0.68 vs 0.54 mg/ dL), according to the investigators. The mean serum creatinine level increased significantly during hospitalization and then decreased to a lower than admission value in the anorexa group. The level was 0.66 mg/dL at admission and reached a maximum of 0.68 mg/dL, and was 0.60 mg/dL at hospital discharge. ■

Impaired kidney function observed in more than one third of patients.

Race Affects Role of SES In Use of PN

A STUDY OF patients in New York City showed that higher socioeconomic status (SES) is associated with a greater likelihood of undergoing partial nephrectomy (PN) for localized renal masses, and the effect of SES varies by race.

As neighborhood SES quartile increased, White patients were significantly more likely to undergo PN, whereas Black patients were not.

Using the New York State Cancer Registry (NYSCAPED), a team led by Christopher B. Anderson, MD, MPH, of Columbia University Irving Medical Center in New York, New York, identified 5,633 patients who underwent PN (61%) or radical nephrectomy (RN, 39%) for localized renal masses from 2004 to 2016. They identified patients’ home neighborhoods through Public Use Microdata Areas in NYSCAPED, which uses US Census-level socioeconomic and demographic data.

A significantly higher proportion of White patients than Black patients received PN (64.7% vs 57.4%), Dr Anderson and colleagues reported in Urologic Oncology. Compared with White patients, Black patients had significant 34% lower odds of undergoing PN. Compared with White patients in the lowest SES quartile (reference), Whites in the highest quartile had significant 1.2-fold higher odds of PN, whereas Blacks in the lowest and highest SES quartiles had significant 29% and 42% lower odds of PN, the investigators reported.

Within the highest neighborhood SES quartile, Black patients had significant 56% lower odds of receiving PN compared with White patients. In the other quartiles, the races did not differ significantly in the odds of PN, according to the investigators.

The authors acknowledged that their study had limitations. The New York State Cancer Registry database does not describe tumor location in the kidney or patients’ comorbid conditions. In addition, the database does not include information on the location and specific details about the treating hospitals.

Dr Anderson and colleagues pointed out that guidelines support PN as the preferred treatment for small localized renal masses when technically feasible because it offers similar oncologic outcomes to RN but with a lower risk for chronic kidney disease. Despite increasing use of PN for these renal masses, however, many patients who are eligible for PN but receive RN instead are disproportionately patients of color and those with low SES, they noted. ■

Men Found to Be More Likely Than Women to Start Dialysis

AMONG PATIENTS with chronic kidney disease (CKD), men are more likely than women to start dialysis, a sex-related difference not explained by CKD progression alone, a study found.

“Although the causal mechanisms are uncertain, this finding helps interpret the preponderance of men in the dialysis population,” Manfred Hecking, MD, PhD, of the Medical University of Vienna in Austria, and colleagues reported in Kidney International Reports.

Dr Hecking and colleagues studied 8237 patients (4811 men and 3426 women) with CKD stages participating in the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps). The patients were from the United States, Brazil, France, and Germany.

During a median follow-up duration of 2.57 years, 23% of the men initiated KRT compared with 18% of women. Men had a significant 50% increased likelihood of starting dialysis compared with women, after adjusting for age, Black race, diabetes, cardiovascular disease, albuminuria, and estimated glomerular filtration rate (eGFR) slope during the first 12 months after study enrollment and first eGFR value after enrollment. After adjusting for all of these variables, the investigators found no significant difference between the sexes in the likelihood of kidney transplantation or death prior to kidney replacement therapy (KRT).

For the overall study population, 93% of KRT initiations among men and women were dialysis. Interestingly, the investigators noted, France had a markedly higher percentage of patients whose initial mode of KRT was kidney transplantation (13% for both men and women) compared with the other countries.

Dr Hecking’s team stressed that they were unable to identify factors explaining why men and women differed in their likelihood of starting KRT, “as all the available variables adjusted for in the analysis did not explain this difference.”

They added, “Awareness that treatment of women may differ from the treatment of men is important for the nephrological community and should be openly discussed and further investigated.” ■

How to Protect Your Online Reputation

Medical practices need to ensure they show up in Google local search results with correct information

BY JOHN SCHIESZER IT IS TIME to show up and look good on the Internet just to protect your medical practice’s reputation, according to Brian Dooley, founder of Independence Digital of Niles, Michigan, a medical practice marketing agency specializing in reputation management and digital marketing. Dooley led a session called “Reputation Management in 2021 and Beyond: 5 Keys to Standing Out on Google” at the LUGPA 2021 annual meeting.

Patient Reviews Important “Most patients looking for a new doctor start on Google. Making sure your practice shows up in Google’s local search results is critical for attracting these new patients,” Dooley said. However, showing up in these results is only half the battle. Google also displays star ratings alongside these listings. “If your practice shows up but has a poor rating, you could be losing out on new patients. Getting more reviews from your patients will help increase your visibility and likelihood of attracting new patients,” Dooley said.

He presented an example of someone searching for a “urologist near me.” It is not enough just to show up in the top 3 search results. Physicians also have to make sure their rating is high enough to attract new patients. Google listings are their own entity, separate from a website. Each doctor or practice should have full control over their listings. Once urologists have access, they need to update their listings with correct information. Most important are the name, address, and phone number.

“Google thinks it’s being helpful by creating listings and guessing [at] the information, but often that does more harm than good. Sometimes a doctor will have several listings that Google has created automatically, but only 1 or 2 have accurate information,” Dooley warned. He noted that a urologist in Minnesota had 8 different listings created by Google with different phone numbers and addresses. Only 1 phone number and 1 address were correct. “We helped remove the bogus listings, so it was crystal clear to patients how to contact and find this doctor,” Dooley said.

Doctors need to optimize their Google listings by adding as much information as possible. This includes adding relevant keywords to their bio, uploading pictures, and posting more reviews, he said. Removing Friction They also need to reduce friction, the unnecessary expenditure of time, effort, or money in performing a task. Reducing friction in any process makes it more efficient and therefore more likely to happen, Dooley said. When asking for reviews for a medical practice, doctors should make the process as easy as possible for patients. “We’ve found email requests with direct links to be the most effective way to get more reviews,” Dooley said. “We recommend personal-looking emails to increase the response rate. It also reduces the chances of an upset patient writing a bad review.”

If patients are upset, they will usually respond to this type of email because it gives them a chance to solve the problem before it turns into a bad review online. One of the best ways to leverage reviews is on a medical provider’s website. Testimonials can be a powerful form of persuasion. “This is especially true if the content is relevant to the reader. Adding reviews to your website also adds additional content and keywords to your website, which can help people find you on Google searches,” Dooley said.

Reputation management, however, is more than just getting good reviews. Accurately listing information improves patient access and reduces the no-show rate. By taking these simple steps a medical practice can have a good rating and hopefully attract new patients who can improve the payer mix, Dooley said.

“Leaving your online reputation up to chance usually means profiles filled with errors and ratings determined by your most unreasonable patients, not the happy majority,” he said. ■

Most patients start their search for a new doctor using Google.

Strategies for Recruiting Women Urologists

BY JOHN SCHIESZER MANY UROLOGY PRACTICES are actively recruiting women urologists, but tough competition for available candidates means practices need to do more than post a job listing.

During a panel session titled LUGPA Forward Session – Strategies to Recruit and Retain Female Urologists in Your Practice at the LUGPA 2021 annual meeting, urologists were told a great compensation package is mandatory, and due to higher amounts of educational debt for women, offering debt forgiveness as part of the package may be helpful. Further, all urology practices must to have a maternity/paternity leave policy.

What Census Data Show Data presented from the 2019 Resident & Fellow Census showed female residents took 6.4 weeks maternity leave on average compared with 1.6 weeks paternity leave among male residents. The data showed that 85% of residents and 72% of fellows reported paid maternity/paternity leave. Approximately 10.3% of practicing urologists and 30% of urology residents are women. The census showed that roughly

23% of female urology residents planned on entering private practice compared with 39% of male residents.

Panel moderator Tim Richardson, MD, chair of LUGPA Forward, said there is high demand and a shortage of new urologists wanting to enter independent practice. “A growing proportion of urologists in training are women. However, very few of them decide to enter into independent practice. We in independent urology need to adapt and conform to be a more attractive option for women coming out of training,” Dr Richardson said.

Having a maternity leave policy is extremely important, and often a paid maternity leave policy is required to entice a woman urologist to join a group. “Be open-minded and if possible, reach out to women urologists in training and find out what is important to them and what is needed to be an attractive option for them entering a practice,” Dr Richardson said.

‘Not a Vacation’ Panelist Jennifer Miles-Thomas, MD, president of Urology of Virginia, agrees, noting that maternity leave is a much bigger factor today than it was 10 years ago. “Maternity leave is important,” Dr MilesThomas said. “We should not require one gender to be penalized professionally or economically for biological differences. Policies matter. Maternity leave is not a vacation. The world is constantly changing and urology will need to adapt.”

Most women residents are not interested in becoming the first woman to join a medical practice. Panelists said it may be easier to recruit and retain women if the group already has women urologists. Surveys suggest that the culture of a medical practice is paramount for women candidates. It was noted that the “frat boy culture” is a turn-off.

Recruitment of women urologists should begin with practices’ websites, panelists said. This is where women candidates will usually start when sizing up a practice. Urology practice websites that show no signs of diversity among physicians could be a turnoff. The panelists recommend having an “about our providers” section on the website to highlight the culture and diversity of an organization. ■