Postgraduate Education and Training for the Nephrology Physician Assistants and Nurse Practitioners.

There is no consistent educational model to introduce the physician assistant and/or nurse practitioner to nephrology. The job descriptions of the nephrology physician assistant/nurse practitioner may be similar, but the training, state and federal licensing, background, and recertification are different for the 2 professions adding a level of complexity to the training of the physician assistant/nurse practitioner new to nephrology. On-the-job training is the most common modality, but formats, content, mentors, and practices vary from organization to organization and even within organizations.

Reevaluating race and the glomerular filtration rate calculator.

Estimated glomerular filtration rate (eGFR) calculators have included a race adjustment to help approximate measured GFR. Over the past several years, as more attention has been directed toward uncovering racial bias, the appropriateness of including race in these calculators has been called into question. The American Society of Nephrology and the National Kidney Foundation convened an expert task force to review the inclusion of race in eGFR.

The changing landscape of nephrology physician assistants and nurse practitioners.

Background: Physician assistants (PAs) and nurse practitioners (NPs) have expanded roles in nephrology as both the patient load and acuity of care needed for this population have increased.

Purpose: To evaluate workforce patterns of PAs and NPs working in nephrology over the past decade.

Methods: Using the biannual survey from the National Kidney Foundation Council of Advanced Practitioners, data were collected and analyzed over the past decade.

The changing landscape of PAs and NPs in nephrology.

Background: Physician assistants (PAs) and NPs have expanded roles in nephrology as both the patient load and acuity of care needed for this population have increased.

Purpose: To evaluate the workforce patterns of PAs and NPs working in nephrology over the past decade.

Methods: Using the biannual survey from the National Kidney Foundation Council of Advanced Practitioners, data were collected and analyzed over the past decade.

Improving health disparities in PA practices: A quality improvement initiative.

Objective: To assess a quality improvement initiative designed to highlight awareness of health disparities and improve healthcare practices among participants.

Methods: Data were collected from 102 clinically practicing PAs over a 2-year timespan via the quality improvement initiative Outside the Box: Reducing Health Disparities. As part of the program, participants reviewed 10 random charts in their practice, documenting how they identified and/or managed common health disparities.

Longitudinal survey of clinician behavior change in CKD management.

Objective: To assess longitudinal improvement for a simple intervention to teach physician assistants (PAs) and NPs management of patients with diabetes and chronic kidney disease (CKD).

Methods: The original cohort from the Kidneys in a Box quality improvement project was revisited at the 3-year mark and asked about patient statin use, A1C measurement, urine albumin-creatinine ratio (UACR), CKD staging, distribution of over-the-counter (OTC) medication caution lists, and documentation of smoking history.

Results: A statistically significant increase in quality metrics was seen at 3 months postintervention for the original cohort.

The ABCs of chronic kidney disease.

Management of patients with chronic kidney disease has evolved since the last Kidney Disease Improving Global Outcomes clinical practice guideline was published in 2012. This article reviews the most recent guidelines, common management issues in primary care, kidney risk and outcome calculators, and over-the-counter medications that may cause community-acquired acute kidney injury.

Improving treatment for patients with chronic kidney disease.

Objective: Kidneys in a Box (KIB) was developed to identify the effect of a performance improvement CME (PI-CME) project on the management of patients with diabetes who are at risk for chronic kidney disease (CKD). The program provided nonnephrology practitioners with research-based interventions known to slow CKD progression.

Methods: PAs were given the KIB tool kit, which described the scope of CKD identified high-risk diagnoses such as diabetes, and listed six modifiable risk factors that have been shown to slow progression of diabetic kidney disease when implemented.

Acute kidney injury.

Acute kidney injury (AKI) complicates up to 20% of all hospital admissions. Responding to the increase in admissions, complications, mortality, morbidity, and cost of AKI, Kidney Disease: Improving Global Outcomes convened an expert panel to study the issue, review the literature, and publish guidelines to evaluate and treat patients with AKI in the acute setting. This article reviews those guidelines.

Kidney care beyond our borders.

Whether it is the heartland of America or a remote village in a developing country, one overriding theme to providing care for kidney patients is person power--or the lack of it. In the developed countries, notably the U.S.

Nursing homes: The new frontier.

As the population continues to age, we will see a larger percentage of end-stage CKD patients in nursing homes, both skilled and long-term facilities. This is a fragile population and will take buy-in from all practitioners to care for them. Even with the dietitian to manage a complicated and detailed menu, the social worker to manage the transportation and multiple issues with equipment, the therapy staff to protect against loss of ADLs, the recreational therapist to protect against loss of cognitive function and the medical staff (APs, nursing, physicians), this population will continue to present both challenges and opportunities.

Transplant in the 21st century.

Organ transplantation has enriched and prolonged the lives of many patients who otherwise would have died of organ failure. Many of these advances, which occurred in the later part of the 20th century, are due to improved techniques and pharmacological management. Today, almost every organ can be transplanted.

Managing hypertension in patients with chronic kidney disease.

Chronic kidney disease (CKD) and hypertension are intrinsically linked. Although 59% of the US population will be diagnosed with CKD during their lifetimes, mortality is usually due to a cardiovascular event. Sodium restriction and a combination of a renin-angiotensin-aldosterone medication and a calcium channel blocker are the most effective methods of managing hypertension in patients with CKD.