A Retrospective Study of Patiromer as Adjunct to Insulin Therapy for Acute Hyperkalemia in the Emergency Department.

Objective: To investigate the clinical utility of administering patiromer as an adjunct to insulin for potassium reduction in patients presenting to the emergency department (ED) with hyperkalemia.

Methods:  This retrospective cohort study used electronic health record data to identify adults treated with at least one intravenous dose of regular insulin for hyperkalemia within the ED. Patients who were administered patiromer within one hour before or after their insulin dose were categorized as the intervention group.

Multidisciplinary proactive e-consults to improve guideline-directed medical therapies for patients with diabetes and chronic kidney disease: an implementation study.

Introduction: We hypothesized that multidisciplinary, proactive electronic consultation (MPE) could overcome barriers to prescribing guideline-directed medical therapies (GDMTs) for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD).

Research Design And Methods: We conducted an efficacy-implementation pilot study of MPE for T2D and CKD for primary care provider (PCP)-patient dyads at an academic health system. MPE included (1) a dashboard to identify patients without a prescription for sodium-glucose cotransporter-2 inhibitors (SGLT2i) and without a maximum dose prescription for renin-angiotensin-aldosterone system inhibitors (RAASi), (2) a multidisciplinary team of specialists to provide recommendations using e-consult templates, and (3) a workflow to deliver timely e-consult recommendations to PCPs.

Developing and Evaluating the DiabetesXcel Mobile Application for Adult Patients With Type 2 Diabetes.

The authors trialed a mobile application, DiabetesXcel, which included type 2 diabetes-focused educational videos and modules, in 50 adults of Bronx, NY, a region with a high prevalence of diabetes and diabetes complications. From baseline to 4 months and from baseline to 6 months, there was significantly improved quality of life, self-management, knowledge, self-efficacy, depression, A1C, and LDL cholesterol among those who used DiabetesXcel. There was also a significant decrease in diabetes-related emergency department visits and hospital admissions from baseline to 6 months.

Geographic Dialysis Facility Density and Early Dialysis Initiation.

Importance: The decision of when to start maintenance hemodialysis may be affected by health system-level support for high-intensity care as manifested by area dialysis facility density. Yet an association between early hemodialysis initiation and higher area density of dialysis facilities has not been shown.

Objective: To examine whether there is an association between area dialysis facility density and earlier dialysis initiation.

Proceedings of a Workshop to Promote Community Health Worker Interventions in Nephrology.

Latinx populations face a higher burden of kidney failure and associated negative outcomes compared with non-Latinx White populations, despite sharing a similar prevalence of CKD. Community health worker (CHW) interventions have been shown to improve outcomes for Latinx individuals, but they are largely underutilized in kidney disease. We convened a workshop of four ongoing kidney disease CHW programs to identify successes, challenges, potential solutions, and needed research to promote CHW programs for Latinx individuals with kidney disease.

Receiving hemodialysis in Hispanic ethnic dense communities is associated with better adherence and outcomes among young patients: a retrospective analysis of the Dialysis Outcomes and Practice Patterns Study.

Background: Hispanic ethnic density (HED) is a marker of better health outcomes among Hispanic patients with chronic disease. It is unclear whether community HED is associated with mortality risk among ethnically diverse patients receiving maintenance hemodialysis.

Methods: A retrospective analysis of patients in the United States cohort of the Dialysis Outcomes and Practice Patterns Study (DOPPS) database (2011-2015) was conducted (n = 4226).

Diabetic Kidney Disease: An Update.

Diabetes is a major public health challenge and diabetic kidney disease (DKD), a broader diagnostic term than diabetic nephropathy, is the leading cause of chronic kidney disease and end-stage kidney disease in the United States and worldwide. A better understanding of the underlying pathophysiological mechanisms of DKD, and recent clinical trials testing new therapeutic interventions, have shown promising results to curb this epidemic. Given the global health burden of DKD, it is extremely important to prioritize prevention, early recognition, referral, and aggressive management of DKD in the primary care setting.

Feasibility of a Peer Mentor Training Program for Patients Receiving Hemodialysis: An Educational Program Evaluation.

Rationale And Objective: The 'PEER-HD' multicenter study tests the effectiveness of peer mentorship to reduce hospitalizations in patients receiving maintenance hemodialysis. In this study, we describe the feasibility, efficacy, and acceptability of the mentor training program.

Study Design: Educational program evaluation including the following aspects: (1) description of training content, (2) quantitative analysis of feasibility and acceptability of the program, and (3) quantitative pre-post analysis of efficacy of the training to impart knowledge and self-efficacy.

Does comorbidity burden explain the higher COVID-19 mortality risk among men? A retrospective cross-sectional analysis of a well-defined cohort of patients in Bronx, New York.

Objectives: Men have a higher mortality rate and more severe COVID-19 infection than women. The mechanism for this is unclear. We hypothesise that innate sex differences, rather than comorbidity burden, drive higher male mortality.

Care Gaps in Sodium-Glucose Cotransporter-2 Inhibitor and Renin Angiotensin System Inhibitor Prescriptions for Patients with Diabetic Kidney Disease.

Background: Renin and angiotensin system inhibitors (RAASi) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recommended for patients with diabetic kidney disease (DKD) to reduce the progression to end-stage kidney disease; however, they are under-prescribed.

Objective: To evaluate the frequency of care gaps in RAASi and SGLT2i prescription by patient demographic, health system, and clinical factors in patients with DKD.

Design: Retrospective cohort study.

Associations of Dysnatremia with COVID-19 Status and Mortality.

Background: In patients without COVID-19, dysnatremia is associated with mortality. These relationships are not well established in patients with COVID-19. We tested the hypotheses that patients with COVID-19 were more likely to have dysnatremia than those without COVID-19 and that, among those with COVID-19, dysnatremia is associated with mortality.

Sex Differences in Acute Kidney Injury.

Female sex confers renoprotection in chronic progressive kidney disease. It is less well recognized that sexual dimorphism also is evident in the development of ischemic and nephrotoxic acute kidney injury (AKI). Animal studies consistently have shown that female sex protects against the development of renal injury in experimental models of ischemic AKI.

Interdisciplinary Care and Preparedness for Kidney Failure Management in a High-Risk Population.

Rationale & Objective: Interdisciplinary care may improve health outcomes in patients with chronic kidney disease (CKD). Few studies have evaluated this model of health care delivery in racial and ethnic minorities.

Study Design: Retrospective cohort study.

Peer mentorship to improve outcomes in patients on hemodialysis (PEER-HD): a randomized controlled trial protocol.

Background: Patients receiving in-center hemodialysis experience disproportionate morbidity and incur high healthcare-related costs. Much of this cost stems from potentially avoidable hospitalizations. Peer mentorship has been used effectively to improve outcomes for patients with complex chronic diseases.

Impact of technology-based interventions on linking potential kidney donors and transplant candidates: a scoping review.

Despite the demonstrated survival advantage in end-stage kidney disease (ESKD) patients of a preemptive living donor kidney transplantation (LDKT), there has been a decline in LDKT among African American and Hispanic populations. We performed a scoping review and summarized the evidence about the use of technology-based interventions (TBI) to not only increase knowledge and awareness of LDKT but also link living donors with transplant candidates. We evaluated 31 studies and characterized them into "transplant-candidate facing" TBI, "transplant donor facing" TBI, and "interactive websites" targeting both donors and candidates.

The changing epidemiology of acute kidney injury syndromes in the face of emerging respiratory viral pandemic illnesses.

In this issue, Birkelo et al. performed a rigorous analysis of acute kidney injury (AKI) differences in patients hospitalized with coronavirus disease 2019 versus influenza. Coronavirus disease 2019 AKI was more severe, with worse outcomes, than influenza, despite adjustment for confounders.

Medical Student Experience and Outcomes, as Well as Preceptor Experience, with Rapid Conversion of a Preclinical Medical School Course to a Remote-Based Learning Format in the Setting of the COVID-19 Pandemic.

Objectives: To assess student outcomes and experiences, as well as preceptor experiences, after emergently converting a preclinical medical school renal course to a remote setting during the COVID-19 pandemic.

Methods: First-year medical student examination scores and responses to Likert-scale questions on end-of-course evaluations from the 2018-2019 (traditional) and 2019-2020 (remote) academic years were compared. Free-text responses from students and preceptors were analyzed using a qualitative summative approach to extract major themes in perceptions of remote learning.