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In the context of US kidney disease care in 2020, this chapter highlights challenges of managing COVID-19–related acute pathology, sustaining safe chronic dialysis treatment for individuals with kidney failure during a pandemic, and identifying ways to effectively address intersections of race/ethnicity, SES, and health.

Medical literature and American Society of Nephrology (ASN) online member forum review, and Emory School of Medicine Renal Grand Rounds participant observation: April 2020–March 2021.

Among persons infected with COVID-19, especially persons of African descent, acute kidney injury (AKI) risk was elevated and associated with need for long-term dialysis. Dialysis-dependent chronic kidney disease patients constituted a high-risk group for COVID-19 infection and hospitalization, due to underlying chronic conditions as well as required travel to clinics for multiple weekly dialysis treatments with exposure to possibly infected staff and other patients.

Findings that are discussed are based on a limited time frame. The longer-term impact of COVID-19 for patient outcomes and for the structure of kidney disease care is a fertile area for continued study, especially in relation to broad health equity goals.

Racial justice activism in 2020 highlighted the imperative to address socioeconomic and racially structured inequities in the United States, and health equity goals and strategies that target kidney disease care have been outlined. The acute/chronic continuum of kidney disease care is a fertile area for research that is informed by the COVID-19 experience and population health inequity challenges.

Disparities in transplant rates across social categories provide limited information about gatekeeping processes in access to kidney transplantation. We hypothesized that early opportunities for discussion of kidney transplantation potentially generate social capital that serves as a resource for patients as they navigate the transplantation pathway.

A national sample of first-year dialysis patients was surveyed and asked if kidney transplantation had been discussed with them before and after starting dialysis treatment. Associations between reported discussion and patient-specific clinical and nonclinical (sociodemographic) indicators of attributed utility for transplantation were investigated, and the association of reported transplant discussion with subsequent transplant waitlisting was analyzed.

Time to placement on the kidney transplant waiting list was significantly shorter for patients who reported that transplantation had been discussed with them before, as well as after, starting dialysis. Likelihood of reported discussion varied by patient age, employment and insurance status, cardiovascular comorbidity burden, and perceived health status; in addition, women were less likely to report early discussion.

It would be valuable to know more about the nature of the transplant discussions recalled by patients to better understand how social capital may be fostered through these discussions.

Indicators of attributed utility for successful transplantation were associated with transplant discussion both before and after starting dialysis, potentially contributing to observed disparities in access to kidney transplantation.

Predialysis nephrology care and patient participation in discussion of kidney transplantation may foster social capital that facilitates navigating the transplantation pathway.

According to the World Health Organization, by 2025, the contribution of chronic disease is expected to rise by 73% compared to all deaths and it is considered as global burden of disease with a rate of 60%. These diseases persist for a longer duration of time, which are almost incurable and can only be controlled. Cardiovascular disease, chronic kidney disease (CKD) and diabetes mellitus are considered as three major chronic diseases that will increase the risk among the adults, as they get older. CKD is considered a major disease among all these chronic diseases, which will increase the risk among the adults as they get older. Overall 10% of the population of the world is affected by CKD and it is likely to double in the year 2030. The paper aims to propose novel feature selection approach in combination with the machine-learning algorithm which can early predict the chronic disease with utmost accuracy. Hence, a novel feature selection adaptive probabilistic divergence-based feature selection (APDFS) algorithm is proposed in combination with the hyper-parameterized logistic regression model (HLRM) for the early prediction of chronic disease.

A novel feature selection APDFS algorithm is proposed which explicitly handles the feature associated with the class label by relevance and redundancy analysis. The algorithm applies the statistical divergence-based information theory to identify the relationship between the distant features of the chronic disease data set. The data set required to experiment is obtained from several medical labs and hospitals in India. The HLRM is used as a machine-learning classifier. The predictive ability of the framework is compared with the various algorithm and also with the various chronic disease data set. The experimental result illustrates that the proposed framework is efficient and achieved competitive results compared to the existing work in most of the cases.

The performance of the proposed framework is validated by using the metric such as recall, precision, F1 measure and ROC. The predictive performance of the proposed framework is analyzed by passing the data set belongs to various chronic disease such as CKD, diabetes and heart disease. The diagnostic ability of the proposed approach is demonstrated by comparing its result with existing algorithms. The experimental figures illustrated that the proposed framework performed exceptionally well in prior prediction of CKD disease with an accuracy of 91.6.

The capability of the machine learning algorithms depends on feature selection (FS) algorithms in identifying the relevant traits from the data set, which impact the predictive result. It is considered as a process of choosing the relevant features from the data set by removing redundant and irrelevant features. Although there are many approaches that have been already proposed toward this objective, they are computationally complex because of the strategy of following a one-step scheme in selecting the features. In this paper, a novel feature selection APDFS algorithm is proposed which explicitly handles the feature associated with the class label by relevance and redundancy analysis. The proposed algorithm handles the process of feature selection in two separate indices. Hence, the computational complexity of the algorithm is reduced to O(n^k+1). The algorithm applies the statistical divergence-based information theory to identify the relationship between the distant features of the chronic disease data set. The data set required to experiment is obtained from several medical labs and hospitals of karkala taluk ,India. The HLRM is used as a machine learning classifier. The predictive ability of the framework is compared with the various algorithm and also with the various chronic disease data set. The experimental result illustrates that the proposed framework is efficient and achieved competitive results are compared to the existing work in most of the cases.

The purpose of this study is to evaluate the nutritional status of patients with end-stage kidney disease undergoing hemodialysis.

End-stage renal failure outpatients on hemodialysis were selected using simple random sampling technique from the dialysis unit of Sono Hospital Limited, Kushtia, Bangladesh. The nutritional status of 142 participant, of age 18-65 years, was screened. A direct method of nutritional assessment including anthropometric measurement, biochemical measurement, clinical assessment and dietary method was conducted. A logistic regression was applied to estimate the prevalence of malnutrition in hemodialysis patients.

In total 69.0 per cent participants were men and 31.0 per cent were women, whereas about 65.5 and 16.9 per cent patients of this study had a BMI of less than 23 kg/m² and 18.5 kg/m² (p < 0.05) where malnutrition was significantly prevalent. Mean ± SD hemoglobin level of both men and women participants was below the normal level which might increase the risk of malnutrition (p < 0.05). Of the total number of participants, 97.2 per cent were anemic, 66.9 per cent had anorexia, 63.4 per cent complained of nausea, 58.5 per cent complained of vomiting and 26.1 per cent complained of diarrhea, factors that can increase the risk of malnutrition in hemodialysis patients (p < 0.05). The creatinine and urea levels were higher in both men and women participants (p < 0.05). Results show significant difference in albumin levels among men and women (p < 0.05). The bicarbonate level was lower in both men and women, and the participants were suffering from metabolic acidosis (p < 0.05). About 87.3 per cent participants were taking inadequate amounts of protein which was a significant risk factor of malnutrition in hemodialysis patients (p < 0.01).

The result shows that renal failure is prevalent more in men than in women. The majority of patients on hemodialysis were at a risk of malnutrition including being underweight. Most of the patients were anemic. Malnutrition is related to low nutrient intake.

Chronic kidney disease (CKD) is a worldwide public health problem which imposes a significant financial burden not only on patients but also on the healthcare systems, especially under the pressure of the rapid growth of the elderly population in China. The purpose of this paper is to examine the hospitalization costs of patients with CKD between two urban health insurance schemes and investigate the factors that were associated with their inpatient costs in Guangzhou, China.

This was a prevalence-based, observational study using data derived from two insurance claims databases during the period from January 2010 to December 2012 in the largest city, Guangzhou in Southern China. The authors identified 5,803 hospitalizations under two urban health insurance schemes. An extension of generalized linear model – the extended estimating equations approach – was performed to identify the main drivers of total inpatient costs.

Among 5,803 inpatients with CKD, the mean age was 60.6. The average length of stay (LOS) was 14.4 days. The average hospitalization costs per inpatient were CNY15,517.7. The mean inpatient costs for patients with Urban Employee-based Basic Medical Insurance (UEBMI) scheme (CNY15,582.0) were higher than those under Urban Resident-based Basic Medical Insurance (URBMI) scheme (CNY14,917.0). However, the percentage of out-of-pocket expenses for the UEBMI patients (19.8 percent) was only half of that for the URBMI patients (44.5 percent). Insurance type, age, comorbidities, dialysis therapies, severity of disease, LOS and hospital levels were significantly associated with hospitalization costs.

The costs of hospitalization for CKD were high and differed by types of insurance schemes. This was the first study to compare the differences in hospitalization costs of patients with CKD under two different urban insurance schemes in China. The findings of this study could provide economic evidence for understanding the burden of CKD and evaluating different treatment of CKD (dialysis therapy) in China. Such useful information could also be used by policy makers in health insurance program evaluation and health resources allocation.

Health promotion and rehabilitation models of care are valuable for persons with chronic health conditions, but when these individuals are dependent on a life-maintaining technology, such as kidney dialysis, a cure-oriented model may dominate the system within which they receive care. Providers can preserve their monopoly over expert treatment knowledge by defining the key care issues, by limiting patients’ access to expert knowledge, and by discrediting the patient as a responsible actor. Multiple care paradigms can benefit patients with chronic conditions, however, empowering the patient-actor to collaborate with the clinician to maximize functioning and well-being as well as patient survival.

The purpose of this study was to identify factors that affect willingness to donate kidneys posthumously among Malaysians.

A questionnaire-based cross-sectional study assessing demographics, attitude, spirituality, knowledge and willingness to donate a kidney was conducted among adult Malaysians with oral informed consent. The total number of samples was 1,001 respondents. Univariate and multivariate logistic regression was performed.

A total of 29.17% (n = 292) were willing to donate kidneys, while the remaining 70.83% (n = 709) were not. The mean spirituality score was 80.95 ± 13.79 (maximum score 100), mean attitude score was 52.88 ± 8.074 (maximum score 70) and mean knowledge score was 1.84 ± 0.99 (maximum score 5). A higher score demonstrated a stronger spiritual level, positive attitude and better knowledge. Factors affecting willingness to donate a kidney were ethnicity (odds ratio [OR] = 15.625, 95% confidence interval [CI] = 0.043–0.094) and attitude toward kidney donation score (OR = 0.924, 95% CI = 0.902–0.945).

Culture-specific steps to improve programs that may contribute toward improving kidney donation posthumously among Malaysians should be developed. Results drawn from this work demonstrate that policymakers, health-care workers and stakeholders should work together to promote effective policies and program implementation to reduce the ever-increasing gap between the need and shortage crisis of kidney donation.

Pharmaceutical company Genzyme has created a new drug, Renvela, which is a phosphate binder designed to be used primarily by patients with kidney failure. Renvela is a slightly different version of Genzyme's highly successful Renagel. Company executives must now decide how best to launch Renvela. Should it replace Renagel? Should it be a premium version of Renagel? Is it worth launching the product at all? The case appears rather simple on the surface, but the questions are challenging to work through.

This case, launched with great success in the 2009 Kellogg Biotech and Healthcare Case Competition, can be used to teach growth strategy and new product strategy. It also provides an introduction to the pharmaceutical industry. Students will be given the opportunity to think critically about the role of innovation, risk, and ethics in healthcare-related firms.

Obesity is a major risk factor for chronic renal fibrosis and kidneys’ structural and inflammatory impairments. This study aims to examine the possible therapeutic effects of vitamin D supplementation against renal inflammatory and kidney’s structural fibrosis and degeneration.

Forty male Wistar rats were divided into two groups for 16 weeks: normal diet (ND) and high-fat diet (HFD); then, each group was subdivided into two groups including ND, ND + vitamin D and HFD, HFD + vitamin D. Vitamin D supplementation was done for five weeks at 500 IU/kg dosage. Renal tissue concentrations of tumor necrosis factor (TNF)-α, interleukin 6, interleukin 1 beta, monocyte chemoattractant protein (MCP)-1 and transforming growth factor-beta (TGF-β), serum values of lipids, markers of glucose homeostasis and urea, creatinine and uric acid and renal tissue histological and structural changes were determined.

HFD feeding caused remarkable histological and structural changes including higher TNF-α, MCP-1 and TGF-β concentrations in renal tissues of rats, whereas vitamin D has potent anti-inflammatory effects (P = 0.036, 0.047 and 0.02, respectively). Vitamin D administration also reduced urea and uric acid concentrations (P = 0.023 and 0.049, respectively). Moreover, vitamin D reduced glomerulomegaly, reduced lipid accumulation and limited dilated Bowman’s space in rats and improved glycemic status by increasing insulin (P = 0.04) and reducing insulin resistance (P = 0.006).

The current study has some limitations. It was better to measure the level of inflammatory cytokines’ expression in the kidney tissues. Additionally, the measurement of baseline values of inflammatory cytokines was not possible because of the possibility of animals’ drop-out.

According to the study findings, vitamin D treatment in the current report showed a significant therapeutic role in reducing inflammation, improving glycemic and lipid abnormalities and structural and histological modifications in renal tissues of rats. These findings have a great value because after confirming in a human model, vitamin D can be suggested as a potential therapeutic tool in clinical practice.

After being confirmed by other animal or human researches, the results of the current work could have great social implications by reducing the prevalence of obesity-related renal complications and highlighting the beneficial roles of vitamin D.

To the best of the authors’ knowledge, this is the first study to investigate the histological and inflammatory changes in the kidneys and metabolic parameters in the HFD induced rats and also clarified the therapeutic roles of vitamin D in ameliorating the inflammatory, histological, metabolic and functional changes in the kidneys of obese rats.

This study aims to investigate the association of the dietary inflammatory index (DII), kidney function and high-sensitivity C-reactive protein (hs-CRP) among the senior population (60-83 years).

This cross-sectional study was conducted in 221 elderly subjects who are living in Tehran, Iran. The DII was calculated from validated semi-quantified food frequency questionnaire, combining putatively pro-inflammatory and anti-inflammatory effects of nutrients, vitamins and trace elements. Biochemical measurements of blood and urine samples were measured. The estimated glomerular filtration rate (eGFR) was assessed from serum creatinine.

A total of 221 subjects with mean BMI of 29.75 and age ranged 60-83 years old were included in the current study. Multiple linear regression analysis showed that eGFR (ß = –0.471; p = 0.48; 95 per cent CI: –2.90, 2.63), albumin/creatinine ratio (ACR) (ß = 0.041 p = 0.55; 95 per cent CI: –5.12, 9.46) and hs-CRP (ß = 0.004; p = 0.55; 95 per cent CI: –0.96, 1.79) were not associated with the DII before and after adjusting for potential confounders, including energy intake, age, sex, BMI, smoking status, physical activity, hypertension, diabetes, use of lipid-lowering medication, angiotensin II receptor blockers (ARB) and angiotensin-converting enzyme inhibitor (ACEI), steroidal and non- steroidal anti-inflammatory medications.

Due to the cross-sectional nature of this study, it is difficult to find the cause-and-effect relationship between the DII and the serum hs-CRP concentration. Another limitation of our study is concerning a possible overestimation or underestimation of dietary intakes, because the participants in the study were elderly and FFQ is a memory-based questionnaire.

Our findings suggest that the DII score is not associated with serum hs-CRP and kidney function markers in elderly people.