Renal support: A time to reassess the direction!

Malchesky, Paul S.

doi:10.1111/aor.13466

Cited by 7 publications

(7 citation statements)

References 8 publications

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“…In addition, clinical experience suggests that the time dynamics of eGFR decline may also be different with many patients remaining in stable clinical status for several years with a low but stable eGFR while others experience a more rapid decline or become symptomatic at relatively high eGFR. As pointed out in a recent Editorials in this journal as well, after a period of relative stagnation in the last few decades, innovation and new initiatives are challenging the inertia and current practice of renal replacement therapies and prevention of progressive renal diseases 8 and new, disruptive technological innovation in renal medicine is likely to emerge soon 9 . In such context, it is critical to be able to recognize the potential disconnect between safety and efficacy of a single session (or period) of therapy and the patients’ global well‐being and state of health.…”

Section: Introductionmentioning

confidence: 99%

Subjective global assessment of nutrition, dialysis quality, and the theory of the scientific method in Nephrology practice

Zsom¹,

Zsom

Salim

et al. 2020

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In an era of evidence‐based medicine and dialysis performance measures, there is strong motivation to find specific, objective, quantifiable, and reproducible parameters to characterize the clinical condition of chronic kidney disease patients and to present population‐wide statistics that may describe quality of care in dialysis centers. Yet, in the last three decades, several studies demonstrated that while parameters including Kt/V urea, serum phosphorus, parathyroid hormone, serum cholesterol fulfill all these criteria, efforts to optimize these lab parameters failed to improve survival on dialysis. However, subjective assessments of nutrition including subjective global assessment and malnutrition–inflammation score, while not ideally suited for statistical analysis and not optimal from the point of view of scientific methodology due to their general, semi‐quantifiable, subjective nature have, nevertheless, proved themselves as some of the strongest predictors of clinical outcomes in the dialysis population. Where does this paradox leave us? We propose that a deeper understanding of relevance of these variables in the dialysis population may improve appreciation of the clinical situation of individual patients and may result in a paradigm shift from dialysis adequacy to quality dialysis.

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Section: Introductionmentioning

confidence: 99%

Subjective global assessment of nutrition, dialysis quality, and the theory of the scientific method in Nephrology practice

Zsom¹,

Zsom

Salim

et al. 2020

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“…• Consider referring to the ISN roadmap for Prevention aspects: It is time to reassess directions within the renal field. 25 To formulate medically meaningful and commercially viable product milestones, one first needs to consider possible disease prevention strategies before elaborating upon any therapeutic technology. This starts with efforts toward earlier diagnosis.…”

Section: Possible Next Steps For Khi Considerationmentioning

confidence: 99%

The Kidney Health Initiative innovation roadmap for renal replacement therapies: Building the yellow brick road, while updating the map

Wieringa

Sheldon

2020

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“…Clearly, the demand does not meet the need in the United States and worldwide, and the burden of treatment for end‐stage kidney disease falls on dialysis, a treatment on which there are now over 2 million patients worldwide. Such therapies are financially unsustainable even for the developed world, 19 and it is time to reassess the direction of renal support 20 . Technologies and approaches to dialysis therapy vary across the world with different outcomes.…”

Section: Reflections On Renal Supportmentioning

confidence: 99%