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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.

This study aims to evaluate the prevalence of depression and associated risk factors among patients on hemodialysis in Jazan area, Saudi Arabia.

The study was conducted on 211 randomly selected hemodialysis patients in Jazan area, Saudi Arabia, using an observational cross-sectional design. Patients were screened for depressive symptoms using the depression, anxiety and stress scale 42 (DASS-42). Descriptive statistics were used to present sociodemographic data. Multiple logistic regression was implemented to identify the predictors of depression. Data were entered and analyzed using SPSS 22.0 software.

The study found the overall prevalence of depression among patients on hemodialysis to be 43.6 per cent. Of them, 12.8 per cent were mildly depressed, 15.6 per cent were moderately depressed and 15.1 per cent fell in the severe or extremely severe category. Depression was significantly associated with marital status, education level and the presence of sleep disturbances. The study indicates a high prevalence of depressive symptoms among patients on hemodialysis in Jazan. A higher rate of depressive symptoms was observed in currently unmarried, lower-educated patients and those with sleep disturbance.

Periodic evaluation of patients on hemodialysis for depression is needed to allow for early intervention.

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.

Environmental sustainability in health care is an important issue due to the limited available healthcare resources and increase in demand. For instance, organ recycling and transplantation may reduce the increasing pressure on healthcare resources. The purpose of this paper is to set out to identify and interrelate the inhibitors that significantly influence the recycling of human organs and their implications to the environment in developing economies such as India.

The study uses Delphi–ISM–regression, a three-step method, to investigate the possible reasons for the poor supply chain efficiency of organ recycling and to explore the consequence of excessive use of healthcare resources on the environment. The Delphi technique facilitates the identification, synthesis, and prioritization of the inhibitors. Then, using focused group discussion, the interpretive structure modeling (ISM) presents the interaction among the inhibitors into a hierarchy. Further, on the basis of 257 valid responses received on the structured survey instrument, the regression model examines the influence of identified constructs on one of the identified root causes.

The ISM presents the hierarchy-based model that depicts high driving power and low dependence inhibitors leading to reduced organ recycling rate. “Negative Intentions of family members” toward organ donation t “Willingness to discuss with family” and “Perceived Behavioral Control” emerged as the significant factors influencing organ recycling rate, which adversely impact the environment sustainability.

The patients on the organ waiting list put pressure on the availability of medical resources and, ultimately, on the environment through the consumption of different drugs and disposable of medical wastes. The study suggests policymakers and hospitals improve on the existing policies for an efficient supply chain of human organ recycling. The Indian situation echoes the situation in most of the emerging economies, and similar solutions can apply there too.