American Board of Internal Medicine Nephrology Procedure Requirements for Initial Certification: Time for a Change and Pursuing Consensus in the Nephrology Community.

In 1988, the American Board of Internal Medicine (ABIM) defined essential procedural skills in nephrology, and candidates for ABIM certification were required to present evidence of possessing the skills necessary for placement of temporary dialysis vascular access, hemodialysis, peritoneal dialysis, and percutaneous renal biopsy. In 1996, continuous renal replacement therapy was added to the list of nephrology requirements. These procedure requirements have not been modified since 1996 while the practice of nephrology has changed dramatically.

Caring for patients with kidney disease: shifting the paradigm from evidence-based medicine to patient-centered care.

The last several decades have witnessed the emergence of evidence-based medicine as the dominant paradigm for medical teaching, research and practice. Under an evidence-based approach, populations rather than individuals become the primary focus of investigation. Treatment priorities are largely shaped by the availability, relevance and quality of evidence and study outcomes and results are assumed to have more or less universal significance based on their implications at the population level.

Dialysis for undocumented immigrants in the United States.

The United States offers near-universal coverage for treatment of ESRD. Undocumented immigrants with ESRD are the only subset of patients not covered under a national strategy. There are 2 divergent dialysis treatment strategies offered to undocumented immigrants in the United States, emergent dialysis and chronic outpatient dialysis.

Geographic variation in black-white differences in end-of-life care for patients with ESRD.

Background And Objectives: Patterns of end-of-life care among patients with ESRD differ by race. Whether the magnitude of racial differences in end-of-life care varies across regions is not known.

Design, Setting, Participants, & Measurements: This observational cohort study used data from the US Renal Data System and regional health care spending patterns from the Dartmouth Atlas of Healthcare.

Geographic information systems and chronic kidney disease: racial disparities, rural residence and forecasting.

The dynamics of health and health care provision in the United States vary substantially across regions, and there is substantial regional heterogeneity in population density, age distribution, disease prevalence, race and ethnicity, poverty and the ability to access care. Geocoding and geographic information systems (GIS) are important tools to link patient or population location to information regarding these characteristics. In this review, we provide an overview of basic GIS concepts and provide examples to illustrate how GIS techniques have been applied to the study of kidney disease, and in particular to understanding the interplay between race, poverty, rural residence and the planning of renal services for this population.

Trajectories of kidney function decline in the 2 years before initiation of long-term dialysis.

Background: Little is known about patterns of kidney function decline leading up to the initiation of long-term dialysis.

Study Design: Retrospective cohort study.

Setting & Participants: 5,606 Veterans Affairs patients who initiated long-term dialysis in 2001-2003.

Regional variation in health care intensity and treatment practices for end-stage renal disease in older adults.

Context: An increasing number of older adults are being treated for end-stage renal disease (ESRD) with long-term dialysis.

Objectives: To determine how ESRD treatment practices for older adults vary across regions with differing end-of-life intensity of care.

Design, Setting, And Participants: Retrospective observational study using a national ESRD registry to identify a cohort of 41,420 adults (of white or black race), aged 65 years or older, who started long-term dialysis or received a kidney transplant between June 1, 2005, and May 31, 2006.

Racial composition of residential areas associates with access to pre-ESRD nephrology care.

Referral to a nephrologist before initiation of chronic dialysis occurs less frequently for blacks than whites, but the reasons for this disparity are incompletely understood. Here, we examined the contribution of racial composition by zip code on access and quality of nephrology care before initiation of renal replacement therapy (RRT). We retrospectively studied a cohort study of 92,000 white and black adults who initiated RRT in the United States between June 1, 2005, and October 5, 2006.

Prognostic implications of the urinary albumin to creatinine ratio in veterans of different ages with diabetes.

Background: Albuminuria is associated with an increased risk of death independent of level of renal function. Whether this association is similar for adults of all ages is not known.

Methods: We examined the association between the albumin to creatinine ratio (ACR) and all-cause mortality after stratification by estimated glomerular filtration rate (eGFR) and age group in 94 934 veterans with diabetes mellitus.

White/black racial differences in risk of end-stage renal disease and death.

Background: End-stage renal disease disproportionately affects black persons, but it is unknown when in the course of chronic kidney disease racial differences arise. Understanding the natural history of racial differences in kidney disease may help guide efforts to reduce disparities.

Methods: We compared white/black differences in the risk of end-stage renal disease and death by level of estimated glomerular filtration rate (eGFR) at baseline in a national sample of 2,015,891 veterans between 2001 and 2005.

Characteristics of uninsured Americans with chronic kidney disease.

Background: In the United States, public health insurance is available for nearly all persons with end-stage renal disease (ESRD). Little is known about the extent of health insurance coverage for persons with non-dialysis dependent chronic kidney disease (CKD).

Objective: To describe patterns of health insurance coverage for adults with non-dialysis dependent CKD and to examine risk factors for progression of CKD to ESRD and management of hypertension among those lacking insurance.

Health disparities in chronic kidney disease: are we making any progress?

Health disparities in CKD remain widespread and deserve continued efforts towards elimination. Future research and policy goals should be targeted towards an understanding of the contribution of health care system practices, poor health literacy, lack of access to health care, urban segregation, and on rural isolation on the perpetuation of CKD health disparities. Eliminating these disparities will require understanding the contribution of health care system practices, geography, health care policy, biology, and genetics, which can lead to the development of novel interventions, innovative health care strategies, and ground-breaking policy interventions targeted at decreasing CKD associated health disparities.

Low rates of antiretroviral therapy among HIV-infected patients with chronic kidney disease.

Background: It is unknown whether chronic kidney disease (CKD) influences receipt of highly active antiretroviral therapy (HAART) among patients with the human immunodeficiency virus (HIV) and whether prescription practices contribute to excess mortality.

Methods: We conducted a retrospective observational study involving HIV-infected patients with established indications for HAART and an outpatient serum creatinine level measured in the Veterans Affairs health care system. Patients were followed up for the outcomes of HAART exposure (percentage of follow-up time treated with HAART), inadequate dose adjustment of renally eliminated antiretroviral medications, and time to death.

Racial differences in end-stage renal disease rates in HIV infection versus diabetes.

Few studies have compared the incidence of end-stage renal disease (ESRD) among individuals with the human immunodeficiency virus (HIV) and diabetes. We followed a national sample of 2,015,891 US veterans over a median peroid of 3.7 years for progression to ESRD.