From the Medical Director

Contents

SPRING 2022 ■ VOLUME 21, ISSUE NUMBER 2

ONLINE

this month at renalandurologynews.com

Clinical Quiz

Test your knowledge by taking our latest quiz at renalandurologynews.com/ run-quiz

HIPAA Compliance

Read timely articles on various issues related to keeping protected health information secure.

Drug Information

Search a comprehensive drug database for prescribing and other information on more than 4000 drugs.

Job Board

Be sure to check our latest listings for professional openings across the United States.

News Coverage

Visit our website for daily reports on the latest developments in clinical research.

Urology

5 Diabetes May Complicate Renal Biopsy The presence of diabetes in patients undergoing percutaneous renal biopsy increases the risk for major bleeding.

11 Small Renal Mass Management Varies By Race The natural history of SRMs is similar in Black and White patients, but Black patients are more likely to undergo radical nephrectomy.

20 RCC Outcomes Not Worse With Minimally Invasive PN A minimally invasive vs open partial nephrectomy is not associated with increased risk for port-site incisional or peritoneal seeding.

21 Frailty Ups Risks After Sling Surgery A study of 54,112 women aged 66 years or older found that frailty increased the likelihood of complications, repeat procedures, and death.

Nephrology

14 Conservative Care for Advanced CKD Falls Short In a study, use of acute care services was common toward the end of life and intensi ed for a subset of patient.

18 Poor Nutrition at Dialysis Start Ups Mortality Odds New ndings suggest special attention be paid to diet as patients approach dialysis, investigators say.

19 In-Hospital AKD Tied to Adverse Outcomes Data reveal higher risks for heart failure hospitalizations, death, and major adverse kidney events.

26 Reduced Kidney Function Raises SCD Risk Investigators zeroed in on the association in a study of 9687 individuals in the general population.

Our results seem to support the view that

lowering circulating urate levels plays a role in improving kidney function in kidney transplant recipients. CALENDAR

Editor’s note: The 2022 conference listings below include information provided by the sponsoring organizations on their websites as this issue went to press.

American Urological Association

Annual Meeting New Orleans, LA May 13-16

European Renal Association

59th Congress Paris, France May 19-22

American Transplant Congress

Boston, MA June 4-8

Canadian Urological Association

Annual Meeting Prince Edward Island, Canada June 24-27

American Society of Clinical Oncology

Annual Meeting Chicago, IL June 3-7

27

Departments

2 From the Medical Director The emergence of value-based models in kidney care

4 News in Brief Same-day discharge feasible after RARP

27 Ethical Issues in Medicine Physicians have a duty to stop medical mis in for mation

FROM THE MEDICAL DIRECTOR

Implications of Value-Based Models in Kidney Care

President Richard Nixon signed into law the Social Security Amendments of 1972, which included creation of the National End Stage Renal Disease (ESRD) Program. This legislation authorized Medicare entitlement for dialysis therapy coverage under Parts A and B of Medicare without the age requirement of 65 years or older. Some consider the ESRD program the first and last socialist medicine initiative in the country. With subsequent legislation, dialysis therapy has emerged as one of the most statutorily regulated Medicare programs, with designated ESRD Network Organizations acting as the federal government’s oversight bodies to ensure quality and safety of the delivery of ESRD services.

Along with the resultant growth of dialysis industry, medical organizations issued practice guidelines in the late 1990s recommending earlier rather than later dialysis transition (when the estimated glomerular filtration rate [eGFR] reaches 15 mL/min/1.73 m2 or lower). During the first 2 decades of the 21st century, however, there has been a trend toward increasingly earlier dialysis transition, with almost a quarter of patients now having an eGFR value above 15 mL/min/1.73 m2 on dialysis therapy initiation.

In July 2019, the US Presidential Executive Order known as the “Advancing American Kidney Health Initiative” was issued. One of its goals is a 25% reduction in the ESRD rate by 2030, a target to be achieved by adding strong financial incentives for health care providers to manage the care of patients with advanced chronic kidney disease (CKD) as well as ESRD. The idea is to encourage clinicians to provide care that delays the need for dialysis and perform more preemptive kidney transplants. These so-called value-based models are being operationalized as of 2022 and include the “Kidney Care First” and “Comprehensive Kidney Care Contracting” initiatives.

At this writing, it is not clear how dialysis initiation should be delayed in patients with CKD. The most likely scenarios include more effective nutritional management of CKD using low-protein and plant-dominant diets, along with adjunct pharmacotherapy for fluid management, anemia, acidosis, potassium and phosphorus load, and symptom management such as pruritus. Just how effective such an integrated multimodal approach can be in delaying dialysis is unknown. And when dialysis becomes necessary, clinicians might want to consider a more conservative approach, such as increasing the frequency of dialysis incrementally or using dialysis only as needed.

Going forward, nephrologists and dietitians will be eager to apply and enhance their knowledge in their attempt to improve kidney care so patients can avoid or delay dialysis.

Kam Kalantar-Zadeh, MD, PhD, MPH

Professor & Chief, Division of Nephrology, Hypertension & Kidney Transplantation UC Irvine School of Medicine, Orange, CA Twitter/Facebook: @KamKalantar

EDITORIAL ADVISORY BOARD

Medical Director, Urology

Robert G. Uzzo, MD, MBA, FACS

G. Willing “Wing” Pepper Chair in Cancer Research Professor and Chairman Department of Surgery Fox Chase Cancer Center Temple University School of Medicine Philadelphia Urologists

Christopher S. Cooper, MD

Director, Pediatric Urology Children’s Hospital of Iowa Iowa City

R. John Honey, MD

Head, Division of Urology, Endourology/Kidney Stone Diseases St. Michael’s Hospital University of Toronto

Stanton Honig, MD

Department of Urology Yale University School of Medicine New Haven, CT

J. Stephen Jones, MD

Chief Executive Officer Inova Health System Falls Church, VA Professor and Horvitz/Miller Distinguished Chair in Urologic Oncology (ret.) Cleveland Clinic Lerner College of Medicine Cleveland

Jaime Landman, MD

Professor of Urology and Radiology Chairman, Department of Urology UC Irvine School of Medicine Orange, CA

James M. McKiernan, MD

John K. Lattimer Professor of Urology Chair, Department of Urology Director, Urologic Oncology Columbia University College of Physicians and Surgeons New York

Kenneth Pace, MD, MSc

Assistant Professor, Division of Urology St. Michael’s Hospital University of Toronto Vancouver, Canada Medical Director, Nephrology

Kamyar Kalantar-Zadeh, MD, PhD, MPH

Professor & Chief, Division of Nephrology, Hypertension & Kidney Transplantation UC Irvine School of Medicine Orange, CA

Nephrologists

Anthony J. Bleyer, MD, MS

Professor of Internal Medicine/Nephrology Wake Forest University School of Medicine Winston-Salem, NC

David S. Goldfarb, MD

Professor, Department of Medicine Clinical Chief New York University Langone Medical Center Chief of Nephrology NY Harbor VA Medical Center

Csaba P. Kovesdy, MD

Chief of Nephrology Memphis VA Medical Center Fred Hatch Professor of Medicine University of Tennessee Health Science Center Memphis

Edgar V. Lerma, MD

Clinical Associate Professor of Medicine Section of Nephrology Department of Medicine University of Illinois at Chicago College of Medicine Chicago

Allen Nissenson, MD

Emeritus Professor of Medicine The David Geffen School of Medicine at UCLA Chief Medical Officer, DaVita Inc. Denver

Rulan Parekh, MD, MS

Associate Professor of Pediatrics and Medicine University of Toronto

Robert Provenzano, MD

Associate Professor of Medicine Wayne State University School of Medicine Detroit Vice President of Medical Affairs, DaVita Healthcare Denver

Renal & Urology News Staff

Editor Jody A. Charnow Web editor Natasha Persaud Production editor Kim Daigneau Group creative director Jennifer Dvoretz Production manager Brian Wask Vice president, sales operations and production Louise Morrin Boyle National accounts manager William Canning Editorial director, Haymarket Oncology Lauren Burke Vice president, content, medical communications Kathleen Walsh Tulley Chief commercial officer James Burke, RPh President, medical communications Michael Graziani Chairman & CEO, Haymarket Media Inc. Lee Maniscalco