American Association of Kidney Patients

Chronic kidney disease (CKD) is a leading cause of global morbidity and mortality, affecting one in ten Swiss adults. Patient numbers are expected to increase due to demographic shift and increasing comorbidity rates, necessitating strategic healthcare planning. Holistic burden remains unknown and detailed projections-including expectations of prospective economic and environmental impact-are lacking. To inform Switzerland's public health strategies and support its 2050 net-zero healthcare goal, this study aims to forecast the multidimensional burdens of CKD. The IMPACT-CKD microsimulation model was utilised to project CKD-progression and clinical, healthcare resource utilisation, economic, societal, and environmental outcomes in Switzerland over 10years (2023-2032). Modelled individuals were assigned CKD-relevant characteristics-including kidney function, comorbidities and clinical events-based on real-world data. Individuals were categorised into non-CKD or one of six CKD stages and progressed through the disease, diagnosed or undiagnosed. Model inputs and outcomes were validated and calibrated against literature, real-world evidence, and expert consultation. By 2032, IMPACT-CKD projects Switzerland's cases of CKD to rise by 6.7% (0.96m to 1.03m) with late-stage CKD and kidney replacement therapy (KRT) surging by 18.1% (437k to 516k) and 57.2% (8.4k to 13.2k). CKD-related healthcare costs are projected to increase by 27.6% (Swiss francs [CHF] 3.3b to CHF4.2b), driven by a 77.3% rise KRT-related costs. CKD would account for 4.6% of the Swiss healthcare budget, incur CHF12.9b in lost productivity, 43.2m missed workdays and CHF606m in lost tax revenue. Greenhouse gas emissions are projected to increase by 12.9%, driven by rising dialysis demand. IMPACT-CKD projects substantial increases in the multidimensional burdens of CKD in Switzerland. Impact could be mitigated via earlier detection and broader uptake of guideline-directed medical therapy. Comprehensive health policies and strategic public health planning are necessary to reduce burden and sustain Switzerland's 2050 net-zero healthcare ambition.

BACKGROUND:Asymptomatic hyperuricemia is associated with poor outcomes in kidney and cardiovascular diseases, but its causative role remains controversial. Clinical studies have shown a positive correlation between increased dietary sodium intake and urinary uric acid excretion, suggesting that hyperuricemia may influence salt-sensitive hypertension and associated kidney damage.METHODS:To study the effects of mild hyperuricemia on salt-sensitive hypertension, male and female Dahl SS rats were fed a diet containing a uricase inhibitor (2% oxonic acid) and 4% NaCl (high salt) or a high salt-only diet for 3 weeks. Analyses were conducted using radiotelemetry, immunohistochemistry, and RNA-Sequencing.RESULTS:Uricase inhibition resulted in a ≈3.5-fold increase in plasma uric acid levels in both sexes compared with their respective high salt controls. However, only the male high salt/oxonic acid group exhibited a significant increase in uric acid excretion. The mild hyperuricemia significantly attenuated the progression of hypertension in male but not female rats. The male high salt/oxonic acid group showed reduced kidney hypertrophy and protein cast formation, indicating mitigated kidney damage. Supplementation with oxonic acid reduced oxidative damage in the tubules, as evidenced by the decreased fluorescence intensity of 8-oxodG. RNA-Sequencing analyses of male kidneys revealed that oxonic acid administration was associated with increased expression of genes linked to the activation of various vasodilatory pathways.CONCLUSIONS:Our study demonstrates that in male, but not female, Dahl salt-sensitive rats, mild hyperuricemia accompanied by hyperuricosuria slowed the progression of salt-sensitive hypertension, potentially due to reduced kidney damage.

Kidney transplant (KT) is the optimal treatment for end-stage kidney disease (ESKD). The evaluation process for KT is lengthy, time-consuming, and burdensome, and racial and ethnic disparities persist. To investigate the potential association of the Kidney Transplant Fast Track (KTFT) evaluation approach with the likelihood of waitlisting, KT, and associated disparities compared with standard care. This nonrandomized clinical trial was a prospective comparative cohort trial with a historical control (HC) comparison and equal follow-up duration at a single urban transplant center. Study duration was 2015 to 2018 for KTFT, with follow-up through 2022, and 2010 to 2014 for HC, with follow-up through 2018. Adult, English-speaking patients with ESKD, no history of KT, and a scheduled KT evaluation appointment were included. Among 1472 eligible patients for the KTFT group, 1288 consented and completed the baseline interview and 170 were excluded for not attending an evaluation appointment; among 1337 patients eligible for the HC group, 1152 consented and completed the baseline interview and none were excluded. Data were analyzed from August 2023 through December 2024. Streamlined, patient-centered, coordinated-care KT evaluation process. Time to waitlisting for KT and receipt of KT. The study included 1118 participants receiving KTFT (416 female [37.2%]; mean [SD] age, 57.2 [13.2] years; 245 non-Hispanic Black [21.9%], 790 non-Hispanic White [70.7%], and 83 other race or ethnicity [7.4%]) and 1152 participants in the HC group (447 female [38.8%]; mean [SD] age, 55.5 [13.2] years; 267 non-Hispanic Black [23.2%], 789 non-Hispanic White [68.5%], and 96 other race or ethnicity [8.3%]). After adjusting for demographic and clinical factors, the KTFT compared with the HC group had a higher likelihood of being placed on the active waitlist for KT (subdistribution hazard ratio [SHR], 1.40; 95% CI, 1.24-1.59). Among individuals who were waitlisted, patients in the KTFT vs HC group had a higher likelihood of receiving a KT (SHR, 1.21; 95% CI, 1.04-1.41). Black patients (SHR, 1.54; 95% CI, 1.11-2.14) and White patients (SHR, 1.38; 95% CI, 1.16-1.65) receiving KTFT were more likely to be waitlisted for KT than those in the HC group, but no such difference was found for patients with other race or ethnicity. Among Black patients, those with KTFT were more likely than those in the HC group to undergo KT (SHR, 1.52; 95% CI, 1.06-2.16), but no significant differences were found for White patients or those with other race or ethnicity. This study found that KTFT was associated with a higher likelihood of waitlisting and KT than standard care. Findings suggest that KTFT may be associated with reduced disparities in KT by race and ethnicity. ClinicalTrials.gov Identifier: NCT02342119.

In May 2020, I began experiencing signs of AKI in my first kidney transplant. I spent approximately 2 weeks in the hospital for rejection treatment and a blood transfusion because of severe anemia. The coronavirus disease 2019 (COVID-19) shutdown meant I could not have my partner or caregiver with me, forcing me to face this challenge alone. The nurses and doctors would come in personal protective equipment every time they entered my room until my trash can overflowed with disposable gowns and gloves. Although I could leave my room for short walks, fear of coronavirus disease exposure, especially knowing others in my ward were infected, I declined. This "sterile isolation" brought on profound loneliness, fear, anxiety, and helplessness. I am deeply grateful for the care provided by my medical team during and after this stay. However, I often felt like a specimen under a microscope when my medical team, in full personal protective equipment and face shields, stood over me. My hospital experiences remained unchanged until after my second kidney transplant in November 2021. After this surgery, I spent 4 days in the intensive care unit, isolated from my mother and significant other, during a time when I needed their support the most. Patients with kidney disease often require in-person consultations. As a veteran, I accessed care at a military medical facility, a two-and-a-half-hour drive from my home before 2021. This often meant a total commute of 5–6 hours for significantly shorter appointments, causing both physical and financial strain. For morning appointments, I had to start driving before sunrise to arrive on time. By the time I returned home, I was too exhausted for anything else that day. If I could not drive, my partner would have to take time off work. Consequently, I was limited to freelance work, unable to fully commit to my business. After my transplant, I was fortunate to stay at the Fisher House during my recovery. The thought of enduring a daily commute during that time is unimaginable to me. Now, I primarily use telehealth to minimize in-person visits. Through Veterans Affairs (VA), I connect with health care providers through a computer or the VA Video Connect app on my phone or tablet. This has reduced my waiting time for appointments and alleviated the anxiety I typically felt for in-person visits. Being immunosuppressed, I feel safer accessing care from home, especially because mask-wearing is no longer mandatory in medical facilities. Although my commute to the VA hospital is now just an hour round trip, I am thankful for the reduced frequency of these commutes. I hope more nephrology clinics and dialysis centers will evolve from status quo practices and adopt telehealth for its numerous benefits: convenience, fewer commutes, more frequent interactions with physicians, improved care coordination, greater engagement than phone calls, and risk mitigation for immunocompromised patients. A study on video-based telemedicine for kidney disease care was conducted in 2021, and it reported improved efficiency with telemedicine, including a reduction in the waiting time to see a specialist, fewer clinic cancellations, and a reduction in travel time and distance traveled; patient satisfaction was high for video-based care (>95%), with most patients perceiving it to be the same level of care compared with being seen in person.1 Ensuring telehealth access for everyone, including those in rural and underserved areas, is crucial. Based on a survey conducted by the American Association of Kidney Patients' Center for Patient Research and Education in 2021 identified key takeaways on what kidney patients were doing to remain safe during COVID-19. More patients were asking their doctors about therapies that fit their safety regimen, like home hemodialysis (HHD) and peritoneal dialysis (PD) because home dialysis is more convenient (47%) and it is safer to social distance when on a home therapy (53%). The survey found an increased use of telehealth/telemedicine, by transplant patients (63%) and dialysis patients (35%) in response to the pandemic. Even 39% of healthcare professionals who took part in the survey shared they started using telehealth/telemedicine services for their patients' appointment(s) in response to the pandemic. In another interesting study from 2018 (prior to the pandemic), researchers wanted to determine whether adherence to appointments and outcomes would change if patients received "telenephrology" instead of traditional in-person care. Before implementing the telenephrology service, 53.1% of scheduled visits of rural Hudson Valley VA Medical Center patients to the Bronx Veterans Affairs Medical Center renal clinic were either canceled or were "no-shows." This was reduced by nearly half (28.5%) after instituting telenephrology (P < 0.001). Moreover, the frequency of attending appointments was greater in the telenephrology (71.9%) versus in-person Bronx VA cohort (61.0%).3 This shows that the integration of telenephrology has the potential to transform our experiences from ones marked by long, exhausting journeys for short appointments and heightened exposure risks to more frequent, efficient, and safer interactions with our health care providers. These studies are powerful reminders of why patient care choice and access to patient-centered medicine — as opposed to system-centered medicine — empowers patients to exercise greater control and responsibility for their health outcomes. My kidney journey of receiving two transplants and subsequent care has highlighted the invaluable role of telehealth in modern health care for patients with CKD. The isolation and challenges I faced during my in-hospital treatments were profound, yet they also underscored the need for accessible, compassionate care during the pandemic that respects both the physical and emotional well-being of patients. Telehealth, as I have experienced, offers a bridge over the logistical and emotional gaps that less evolved kidney care often presents. It is not just about patient convenience; it is about creating a health care delivery system that is responsive to patient needs and not simply anchored to the preferences or comfort zones of health systems and providers. For veterans like me, and indeed for all patients facing similar health battles, the integration of telehealth into our care regimens has been a game changer. Telehealth is not just a temporary fix or a convenience tool; the lessons of COVID-19 have taught us that it was a long-overdue evolution within our healthcare system that delivered more personalized care for patients. As we move forward, embracing and expanding telehealth services will not only make health care more accessible but also more compassionate, resonating with the needs of patients who are often at their most vulnerable.

Investigations of health-related quality of life (HRQoL) in AKI have been limited in number, size, and domains assessed. We surveyed AKI survivors to describe the range of HRQoL AKI-related experiences and examined potential differences in AKI effects by sex and age at AKI episode. AKI survivors among American Association of Kidney Patients completed an anonymous online survey in September 2020. We assessed: (1) sociodemographic characteristics; (2) effects of AKI-physical, emotional, social; and (3) perceptions about interactions with health care providers using quantitative and qualitative items. Respondents were 124 adult AKI survivors. Eighty-four percent reported that the AKI episode was very/extremely impactful on physical/emotional health. Fifty-seven percent reported being very/extremely concerned about AKI effects on work, and 67% were concerned about AKI effects on family. Only 52% of respondents rated medical team communication as very/extremely good. Individuals aged 22-65 years at AKI episode were more likely than younger/older counterparts to rate the AKI episode as highly impactful overall (90% versus 63% younger and 75% older individuals; P=0.04), more impactful on family (78% versus 50% and 46%; P=0.008), and more impactful on work (74% versus 38% and 10%; P<0.001). Limitations of this work include convenience sampling, retrospective data collection, and unknown AKI severity. These findings are a critical step forward in understanding the range of AKI experiences/consequences. Future research should incorporate more comprehensive HRQoL measures, and health care professionals should consider providing more information in their patient communication about AKI and follow-up.

The novel coronavirus disease 2019 (COVID-19) pandemic has spread worldwide, and finding a safe therapeutic strategy and effective vaccine is critical to overcoming severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Therefore, elucidation of pathogenesis mechanisms, especially entry routes of SARS-CoV-2 may help propose antiviral drugs and novel vaccines. Several receptors have been demonstrated for the interaction of spike (S) protein of SARS-CoV-2 with host cells, including angiotensin-converting enzyme (ACE2), ephrin ligands and Eph receptors, neuropilin 1 (NRP-1), P2X7, and CD147. The expression of these entry receptors in the central nervous system (CNS) may make the CNS prone to SARS-CoV-2 invasion, leading to neurodegenerative diseases. The present review provides potential pathological mechanisms of SARS-CoV-2 infection in the CNS, including entry receptors and cytokines involved in neuroinflammatory conditions. Moreover, it explains several neurodegenerative disorders associated with COVID-19. Finally, we suggest inflammasome and JaK inhibitors as potential therapeutic strategies for neurodegenerative diseases.