Seminars in Nephrology RSS feed: Current Issue. Seminars in Nephrology is a timely source for the publication of new concepts and research findings relevant to clinical practice. Each issue is an organized compendium of practical information that serves as a lasting reference for nephrologists, internists and physicians in training. 2009 Topics , Volume 29, Issues 1-6 January Nutrition in Kidney Disease Joel D. Kopple, MD March The Spectrum of Renal Bone Disease Meryl S. LeBoff, MD May Hyponatremia David B. Mount, MD July Pediatric Nephrology Frederick J. Kaskel, MD, PhD and Leonard G. Feld, MD September Human Resources, Training, and the Growing Worldwide Epidemic of Kidney Disease Adeera Levin, MD, and Jonathan Himmelfarb, MD November Aging and the Kidney Gary E. Striker, MDhttp://www.seminarsinnephrology.org/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Seminars in Nephrology0270-9295301January 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.seminarsinnephrology.org/article/PIIS027092950900182X/abstract?rss=yesMasthead10.1016/S0270-9295(09)00182-XSeminars in Nephrology 30, 1 (2010)2010-01-01Seminars in Nephrology2010-01-01301S0270-9295(09)X0007-0IFCIFChttp://www.seminarsinnephrology.org/article/PIIS0270929509001715/abstract?rss=yesHealth disparities are differences in health-related outcomes by race, sex, socioeconomic status, or some other relevant subgrouping. The 4-fold higher prevalence of end-stage renal disease among blacks compared with whites is an example of a racial disparity. Similarly, the 50% higher rate of kidney transplantation among men with permanent kidney failure compared with women is an example of a gender disparity.Health Disparities and the Kidney: IntroductionAshwini R. Sehgal, Michele Abraham10.1016/j.semnephrol.2009.10.005Seminars in Nephrology 30, 1 (2010)2010-01-01Seminars in Nephrology2010-01-01301S0270-9295(09)X0007-012http://www.seminarsinnephrology.org/article/PIIS0270929509001673/abstract?rss=yesSummary: End-stage renal disease represents a serious public health problem in Mexico. Close to 9% of the Mexican population has chronic kidney disease (CKD) and 40,000 patients are on dialysis. However, the fragmentation of our health care system has resulted in unequal access to renal replacement therapy. In addition, poor patients in Jalisco with kidney failure have very advanced disease at the time of dialysis initiation, suggesting lack of access to predialysis care. To address these issues, a number of strategies have been implemented. Among them a renal replacement therapy program for which the cost of treatment is shared by government, patients, industry, and charitable organizations; the implementation of a state-funded hemodialysis program that provides free dialysis for the poor; the establishment of a university-sponsored residency program in nephrology and a postgraduate training in nephrology nursing; and a screening program for early detection and control of CKD. In conclusion, access to renal care is unequal. The extension of the Seguro Popular to cover end-stage renal disease treatment nationwide and the implementation of community screening programs for the detection and control of CKD offers an opportunity to correct the existing disparities in renal care in Jalisco and perhaps in other regions of Mexico.Disparities in Renal Care in Jalisco, MexicoGuillermo Garcia-Garcia, Karina Renoirte-Lopez, Isela Marquez-Magaña10.1016/j.semnephrol.2009.10.001Seminars in Nephrology 30, 1 (2010)2010-01-01Seminars in Nephrology2010-01-01301S0270-9295(09)X0007-037http://www.seminarsinnephrology.org/article/PIIS0270929509001727/abstract?rss=yesSummary: The increased rate of type 2 diabetes among minority ethnic groups compared with Caucasians in the United Kingdom has been well documented. Diabetes complications, such as end-stage renal failure, are much more prevalent among the South Asian and African-Caribbean population in the United Kingdom. Inequalities do currently exist in diabetes and renal services and the solutions to rectifying this situation are complex, focusing both on disease prevention and disease management. However, the financial and human burden of not addressing these inequalities encourage some immediate action.Renal Health Disparities in the United Kingdom: A Focus on EthnicityGurch Randhawa10.1016/j.semnephrol.2009.10.006Seminars in Nephrology 30, 1 (2010)2010-01-01Seminars in Nephrology2010-01-01301S0270-9295(09)X0007-0811http://www.seminarsinnephrology.org/article/PIIS0270929509001806/abstract?rss=yesSummary: Canada is a geographically diverse and multicultural country where health care access is, in theory, universal. Despite this principle of universality, evidence suggests that disparities exist in several areas of renal health in Canada. Aboriginal Canadians suffer from higher rates of dialysis initiation and poorer access to renal transplant compared with whites. Similar disparities in access to renal transplant exist for other ethnic minorities including East and Indo Asians and African Canadians. Interestingly, in Canada, East and Indo Asian Canadians have higher rates of peritoneal dialysis uptake than whites initiating dialysis, and significantly better survival on dialysis. Further research into these health disparities could improve access and outcomes in renal disease.Health Disparities in Renal Disease in CanadaKaren Yeates10.1016/j.semnephrol.2009.10.014Seminars in Nephrology 30, 1 (2010)2010-01-01Seminars in Nephrology2010-01-01301S0270-9295(09)X0007-01218http://www.seminarsinnephrology.org/article/PIIS0270929509001739/abstract?rss=yesSummary: American Indians and Alaska Natives comprise a diverse population with an increased burden of chronic kidney disease (CKD), largely owing to diabetes. Although transportation to rural dialysis units impairs access, quality of dialysis care appears similar to the US population. Similar to other racial and ethnic minorities, American Indians and Alaska Natives are less likely to receive kidney transplants. The causes of these disparities are as diverse as the population. The application of the chronic care model to CKD by the Indian Health Service is associated with a decrease in incidence of end-stage renal disease among diabetic patients and may be a useful model for reducing disparities in other populations at risk for CKD.Reducing Health Disparities in American Indians With Chronic Kidney DiseaseAndrew S. Narva, Thomas D. Sequist10.1016/j.semnephrol.2009.10.007Seminars in Nephrology 30, 1 (2010)2010-01-01Seminars in Nephrology2010-01-01301S0270-9295(09)X0007-01925http://www.seminarsinnephrology.org/article/PIIS0270929509001697/abstract?rss=yesSummary: Racial and gender differences in the prevalence and treatment of chronic kidney disease in US children have been reported. Girls have lower rates of kidney transplantation than boys. Incidence of end-stage renal disease is twice as high among black patients compared with whites. African Americans are less likely than white patients to achieve hemoglobin targets on dialysis, are more likely to be treated with hemodialysis, and to wait longer for a transplant. Reasons for these disparities in disease burden and treatment choices are not known, but possible causes include genetic factors and socioeconomic and sociocultural influences on accessing medical care.Sex, Race, and Socioeconomic Disparities in Kidney Disease in ChildrenMaria Lourdes Minnick, Sara Boynton, Jaqueline Ndirangu, Susan Furth10.1016/j.semnephrol.2009.10.003Seminars in Nephrology 30, 1 (2010)2010-01-01Seminars in Nephrology2010-01-01301S0270-9295(09)X0007-02632http://www.seminarsinnephrology.org/article/PIIS0270929509001776/abstract?rss=yesSummary: Disparities in the occurrence and outcomes of chronic kidney disease (CKD) are associated with individual and community socioeconomic (SES) risk factors. The pathways by which SES contribute to increased CKD risk are under active investigation and access to adequate health care appears to be an important contributor to these disparities. Changes in the US health system have eliminated barriers to access for end-stage renal disease care for most US citizens and reduced disparities in outcomes of care after the onset of renal replacement therapy. The purpose of this review is to summarize the empiric evidence for the association between SES and disparities in CKD occurrence and outcomes of care and to describe existing and planned interventions to reduce these SES-associated variations in CKD care. In particular, we describe a 10-state pilot project initiated by the Centers for Medicare and Medicaid Services in August of 2008 to reduce disparities and improve the detection and treatment of early diabetic kidney disease. This pilot project represents an important step in developing interventions to reduce CKD disparities in the US health care system.Population-Based Interventions To Reduce Socioeconomic Disparities in Chronic Kidney DiseaseWilliam M. McClellan, Mary Teresa Casey, JoVonn Hughley, Eugene Freund10.1016/j.semnephrol.2009.10.011Seminars in Nephrology 30, 1 (2010)2010-01-01Seminars in Nephrology2010-01-01301S0270-9295(09)X0007-03341http://www.seminarsinnephrology.org/article/PIIS0270929509001685/abstract?rss=yesSummary: Epidemiologic studies of populations continue to emerge showing that early-life factors influence the risk of developing several chronic diseases of adulthood. Susceptibility to environmental factors is particularly problematic during renal development, which is not complete until 36 weeks of gestation. Environmental deprivation may lead to adaptations including early growth restriction, whereas late insults may alter the kidney during the final stages of development. Because disparities among those who are more likely to have low birth weight mirrors the disparities observed among those more likely to develop kidney-related disorders, fetal origins have been presumed to explain some of the observed disparities. Although current empiric evidence supports a link between fetal programming and childhood/adult kidney disease, affected pathways may vary by race.Fetal Origins of Renal DisparitiesUptal D. Patel10.1016/j.semnephrol.2009.10.002Seminars in Nephrology 30, 1 (2010)2010-01-01Seminars in Nephrology2010-01-01301S0270-9295(09)X0007-04250http://www.seminarsinnephrology.org/article/PIIS0270929509001740/abstract?rss=yesSummary: The incidence and prevalence of metabolic syndrome and chronic kidney disease (CKD) are increasing in the US population as a whole, but much more rapidly among ethnic minorities. Recent studies have shown that metabolic syndrome is an independent risk factor for the development of incident CKD in African Americans and American Indians distinct from its impact on cardiovascular and all-cause mortality. The pathogenesis of metabolic syndrome in ethnic minorities often is multifactorial. We review the myriad facets of the impact of the metabolic syndrome on the pathophysiology of CKD in minorities. In addition to classic biochemical and physiologic factors, increasing attention is being drawn to the major role of novel factors such as adiponectin and socioeconomic and cultural factors in the development of obesity and insulin resistance; an understudied area that may modulate clinically relevant consequences of biochemical and pathophysiologic aberrations. We present an integrated pathophysiologic viewpoint that incorporates insights from basic science, socioeconomic inquiry, and clinical studies into a framework for clinical practice and investigation.Metabolic Syndrome and Mild to Moderate Chronic Kidney Disease Among MinoritiesSankar D. Navaneethan, Jesse D. Schold, Titte R. Srinivas10.1016/j.semnephrol.2009.10.008Seminars in Nephrology 30, 1 (2010)2010-01-01Seminars in Nephrology2010-01-01301S0270-9295(09)X0007-05158http://www.seminarsinnephrology.org/article/PIIS027092950900179X/abstract?rss=yesSummary: Administrative data suggest familiar socioeconomic, race, sex, and age disparities in renal patients' receipt of services such as cardiac rehabilitation. Dialysis facility characteristics and disparities in access to transplantation, home-based dialysis, and more frequent dialysis also may influence patients' access to rehabilitation opportunities. Tested models exist for interdisciplinary inpatient rehabilitation, exercise/physical conditioning programs, and psychosocial interventions, and several of these programs consider the special needs of particular age groups. Recognition of the importance of physical activity/exercise and depressed mood as predictors of patient outcomes, and research addressing the concept of frailty, effectively may increase the salience of rehabilitation objectives throughout the renal community.Rehabilitation in the Renal Population: Barriers to AccessNancy G. Kutner10.1016/j.semnephrol.2009.10.013Seminars in Nephrology 30, 1 (2010)2010-01-01Seminars in Nephrology2010-01-01301S0270-9295(09)X0007-05965http://www.seminarsinnephrology.org/article/PIIS0270929509001703/abstract?rss=yesSummary: The Kidney Early Evaluation Program (KEEP) is a free, community-based, kidney disease screening program designed to detect chronic kidney disease (CKD) early and promote follow-up evaluation with clinicians to ultimately improve outcomes. This program screens individuals with diabetes, hypertension, or those with a first-degree relative with diabetes, hypertension, and/or kidney disease. Data based on 89,552 KEEP participants screened in 49 states from early August 2000 until end of December 2007 disclosed a prevalence of 34% African Americans, 12.4% Hispanics, 5.6% Asian/Pacific Islanders, and 4.5% Native Americans. Compared with the random US population sample in National Health and Nutrition Examination Survey 1999 to 2006 and the US Census Bureau 2000, KEEP represented 3-fold more African Americans and Native Americans and a similar proportion of Hispanics and Asians/Pacific Islanders. Analysis of KEEP data confirm that control of CKD risk factors and awareness of CKD remains low. In conclusion, KEEP is an enriched source of populations at high risk for CKD, and control of the two major CKD risk factors, diabetes and hypertension, remains disappointingly low, especially in high-risk populations, despite disease awareness. A longitudinal component of KEEP will evaluate the impact of the program on health disparities over time and holds promise for improving awareness and possibly future management of CKD risk factors.Kidney Early Evaluation Program: A Community-Based Screening Approach to Address Disparities in Chronic Kidney DiseaseJoseph A. Vassalotti, Suying Li, Peter A. McCullough, George L. Bakris10.1016/j.semnephrol.2009.10.004Seminars in Nephrology 30, 1 (2010)2010-01-01Seminars in Nephrology2010-01-01301S0270-9295(09)X0007-06673http://www.seminarsinnephrology.org/article/PIIS0270929509001788/abstract?rss=yesSummary: The treatment of renal disease is expensive, and only a few Indians can afford it. The vast majority of Indians are poor. Nephrologists and facilities for treating renal disease are found only in larger cities. The renal unit of Apollo Hospital uses the new communications network of the country to guide patients with chronic kidney disease in increasing the dose of angiotensin converting enzyme inhibition to the maximum and thereby slow down the decline of renal function. The rate of decline of estimated glomerular filtration rate in diabetic nephropathy has decreased from 16 mL/min/y in 1993 to 2.7 mL/min/y in 2008, and in chronic glomerulonephritis from 28 to 2.8, respectively. In the entire group of patients with renal failure of all causes, the projected increase in time to reach the end stage from a glomerular filtration rate of 50 mL/min is 26 years, which is 17 years longer than the controls. Because hardly any of these patients can afford dialysis or transplantation, this is indeed an extra lease of life.Treating Renal Disease in India's Poor: The Art of the PossibleM. Krishna Mani10.1016/j.semnephrol.2009.10.012Seminars in Nephrology 30, 1 (2010)2010-01-01Seminars in Nephrology2010-01-01301S0270-9295(09)X0007-07480http://www.seminarsinnephrology.org/article/PIIS0270929509001752/abstract?rss=yesSummary: Sociocultural and socioeconomic disparities in graft survival, graft function, and patient survival in adult kidney transplant recipients are reviewed. Studies consistently document worse outcomes for black patients, patients with low income, and patients with less education, whereas better outcomes are reported in Hispanic and Asian kidney transplant recipients. However, the distinct roles of racial/ethnic versus socioeconomic factors remain unclear. Attention to potential pathways contributing to disparities has been limited to immunologic and nonimmunologic factors, for which the mechanisms have yet to be fully illuminated. Interventions to reduce disparities have focused on modifying immunosuppressant regimens. Modifying access to care and health care funding policies for immunosuppressive medication coverage also are discussed. The implementation of culturally sensitive approaches to the care of transplant candidates and recipients is promising. Future research is needed to examine the mechanisms contributing to disparities in graft survival and ultimately to intervene effectively.Disparities in Kidney Transplant Outcomes: A ReviewElisa J. Gordon, Daniela P. Ladner, Juan Carlos Caicedo, John Franklin10.1016/j.semnephrol.2009.10.009Seminars in Nephrology 30, 1 (2010)2010-01-01Seminars in Nephrology2010-01-01301S0270-9295(09)X0007-08189http://www.seminarsinnephrology.org/article/PIIS0270929509001764/abstract?rss=yesSummary: One potential mechanism for reducing racial/ethnic disparities in the receipt of kidney transplants is to enhance minorities' pursuit of living donor kidney transplantation (LDKT). Pursuit of LDKT is influenced by patients' personal values, their extended social networks, the health care system, and the community at large. This review discusses research and interventions promoting LDKT, especially for minorities, including improving education for patients, donors, and providers, using LDKT kidneys more efficiently, and reducing surgical and financial barriers to transplant. Future directions to increase awareness of LDKT for more racial/ethnic minorities also are discussed including developing culturally tailored transplant education, clarifying transplant-eligibility practice guidelines, strengthening partnerships between community kidney providers and transplant centers, and conducting general media campaigns and community outreach.Addressing Racial and Ethnic Disparities in Live Donor Kidney Transplantation: Priorities for Research and InterventionAmy D. Waterman, James R. Rodrigue, Tanjala S. Purnell, Keren Ladin, L. Ebony Boulware10.1016/j.semnephrol.2009.10.010Seminars in Nephrology 30, 1 (2010)2010-01-01Seminars in Nephrology2010-01-01301S0270-9295(09)X0007-09098http://www.seminarsinnephrology.org/article/PIIS0270929509001831/abstract?rss=yesEditorial Advisory Board10.1016/S0270-9295(09)00183-1Seminars in Nephrology 30, 1 (2010)2010-01-01Seminars in Nephrology2010-01-01301S0270-9295(09)X0007-0FrontmatterA1A1http://www.seminarsinnephrology.org/article/PIIS0270929509001843/abstract?rss=yesTable of Contents10.1016/S0270-9295(09)00184-3Seminars in Nephrology 30, 1 (2010)2010-01-01Seminars in Nephrology2010-01-01301S0270-9295(09)X0007-0FrontmatterA3A4