ASN Kidney News | March 2016

March 2016 | Vol. 8, Number 3 Living Donor Protections Included in Act Introduced by Congress Inside Services. The number of people affected by kid- Keeping Nephrology The proposed legislation would pro- ney disease is staggering. According to the Great hibit providers of life, disability, and National Institute of Diabetes, Digestive, Through a series of long-term care insurance from denying or and Kidney Diseases, 1 in 10 American “Distinguished Conversations” limiting coverage to living organ donors. adults—more than 20 million people— during ASN’s 50th year, KN It would also prevent insurers from are affected by some level of chronic kid- readers will hear from leaders charging higher premiums. In addi- ney disease (CKD), and the numbers are and colleagues about what tion, the bill clarifies that living organ increasing. A patient is added to the kid- makes nephrology great donors may use time allotted to ney waitlist every 14 minutes, and despite them through the Family the fact that this list is always growing, liv- and Medical Leave Act ing donation rates are decreasing. In all, Practice Pointers to recover from dona- 12 Americans die each day waiting for a The latest on kidney stone tion surgery and thus transplant. prevention, recurrence, and maintain their job se- The Living Donor Protection Act of treatment curity (Table 1). 2016 was introduced with bipartisan sup- “By creating job port by both houses of Congress, with security for living or- Reps. Jerrold Nadler (D-NY) and Michael Policy Update gan donors and ensur- Burgess (R-TX) and Sens. Mark Kirk (R- President’s 2017 budget new bill introduced ing them time to recover IL), and Kirsten Gillibrand (D-NY) pro- disappoints by Congress in February from their donation surger- posing the legislation. 2016 aims to encourage living ies, as well as ensuring education The American Society of Nephrology Findings Aorgan donations and protect the rights of was one of 16 kidney health organizations concerning these new protections, this im- New genetic risk factors for living organ donors. The bill would also portant legislation will likely help count- that united to advance the legislation on kidney disease in type 2 set the stage for education efforts on liv- less Americans receive the gift of life,” said Kidney Community Advocacy Day in diabetes ing organ donation to be instituted by the ASN President Raymond C. Harris, MD, 2015. ASN will continue to work toward US Department of Health and Human FASN. Continued on page 2 Detective Nephron Will Nephron and medical student Glom crack a difficult History of Hemodialysis Could Help Guide Ethical case of hyponatremia? Use of Medical Resources By Tracy Hampton ngoing advances in technology healthcare dollars, many questions arise re- CJN.04780515 [published online Febru- and drug discovery continue to garding the most appropriate use of expen- ary 11, 2016]). Otransform numerous aspects of sive tests and therapies. “The medical research community is health, but making such breakthroughs A new paper in the Clinical Journal of feverishly developing new technologies and available to all who may benefit from them the American Society of Nephrology addresses drugs offering a plethora of treatment op- is often not possible, especially in the early such questions, using the history of the tions; however, the existence of these treat- days of their use. Furthermore, as society development and dissemination of main- ments does not direct how and for whom strives to address rising healthcare costs and tenance dialysis as a guide (Butler CA, et they should be used,” said lead author consider responsible distribution of limited al. Clin J Am Soc Nephrol. doi: 10.2215/ Catherine Butler, MD, of the University of Washington. “Increasingly, medical practi- tioners, lawmakers, and laypeople take part in debate about this complex distribution. This discourse is best coordinated by partic- ipants understanding a common structure of ethical evaluation.” Continued on page 5 2 | ASN Kidney News | March 2016 Living Donor Figure 1. Transplantation rates, 1988–2015 Continued from page 1 its passage into law. “Introduction of this bill is very timely since living kidney donation has been in a downward trend for a decade—6647 donors in 2004 compared with 5075 donors in 2015 (Figure 1). Quite paradoxically there has been a significant rise in ‘paired- exchange donations’ since 2008, account- ing for >1700 transplants so far in the US, and without this novel undertaking it is likely that the total number of living NOW AVAILABLE donor transplants would have been much worse,” said KN Editorial Board member Uday S. Nori, MD, a nephrologist with Ohio State University Wexner Medical Center in Columbus. “This observation underscores that there are serious systemic problems that need to be addressed urgently,” Nori said. “Although the specific causes for this trend remain unclear, it is widely believed that loss of wages during the donation time along with the fear of penalization by in- Courtesy: United Network for Organ Sharing, https://optn.transplant.hrsa.gov/ surance providers in the long-term are A NEW once-daily significant deterrents for living donor can- Table 1. Provisions of the Living Donor Protection Act didates. Successful passage of this new legislation would offer important incentives The bill promotes access to living kidney donations by: to heighten the interest in living donation.” Douglas Keith, MD, of the Univer- • Protecting Donors: prohibiting insurance companies from charging higher premiums and from denying or limiting sity of Virginia Medical Center, present- life, disability and long term care insurace to living donors • Securing Jobs: clarifying that living organ donors can use Family and Medical Leave Act time time to recover from treatment for ed findings at Kidney Week 2015 that showed a much lower living kidney dona- donation surgery and maintain their job security tion rate for African Americans compared • Educating Americans: directing HHS to improve efforts to educate Americans about living kidney donation with that for Caucasians, Hispanics, and Asians. His study looked at the impact have a large effect on African Americans. in the African American population of to recover from donation and keep their of organ transplant candidates’ socioeco- The gap in donation between Caucasians recipients and donors in the US. I sus- job—they have no benefits that allow for nomic environment on living kidney or and African Americans is driven in my pect few if any of the donors have life or this. The other issue is the loss of income hyperkalemia kidney-pancreas donation rates. opinion by two major issues. One is the disability insurance so that is not likely a while recovering from donation. Reim- Kidney News asked Keith whether pro- African American donor population has factor in their decision,” Keith said. bursing donors for lost wages while re- visions of the Living Donor Protection high rates of obesity, diabetes mellitus, “Family leave for donation could po- covering from donation may have a larger Act might help close the gap in living and hypertension, making them much tentially help this group since loss of em- effect on low socioeconomic groups. organ donation rates among those from higher risk for donation and more likely ployment due to donation in low socioec- Unfortunately, this legislation only pre- different socioeconomic environments. to be found unsuitable for donation and onomic populations is an issue,” he said. vents job loss but does not compensate “I think it may have a modest effect declined as donors. Second, socioeco- “Many people in low wage jobs cannot be employed donors for lost wages, a major on donation in general but I doubt it will nomic status is much lower on average off work for the 6 to 12 weeks required factor that may influence donation.” HYPERKALEMIAtreatment.com World Kidney Day Puts Spotlight on Kidney Disease in Children “Kidney Disease and Children” is the focus of World Kidney Day on March 10, 2016. ach year, World Kidney Day seeks to raise that manifests in adulthood may occur more often awareness about the importance of the kid- in those with risk factors that could be detected in neys to overall health and to increase support childhood.” Efor reducing the incidence and impact of kidney dis- The American Society of Nephrology is working eases and associated health problems worldwide. with the American Society of Pediatric Nephrology Kidney diseases can affect children in various (ASPN) to recognize the importance of preventing and ways, ranging from treatable disorders without long- treating childhood kidney diseases on World Kidney term consequences to life-threatening conditions. Day in the US. Other events are being held around the Some children are born with kidney diseases and world from Japan to Buenos Aires, Argentina. others develop symptoms while very young. These The ASPN and Congressional Kidney Caucus symptoms in children are often nonspecific, and can will host a congressional briefing, “Kidney Disease be missed. Yet the missed symptoms can grow over in Children . Act Early to Prevent It,” on March are ASN, the Polycystic Kidney Disease Founda- time and result in adult chronic kidney disease. 10, 2016. The briefing aims to inform policymak- tion, National Renal Administrators Association, PP-US-PAT-00186 ©2016 Relypsa, Inc. “Early detection and a healthy lifestyle in chil- ers about the impact on families of having a child American Association of Kidney Patients, and Renal All rights reserved. All product names, trademarks, dren are crucial to mitigating the incidence of with kidney disease and the role Congress and regu- Physicians Association. The hearing is provided in and service marks are the property of Relypsa, Inc. 2/16 adult chronic kidney disease,” said ASN President latory agencies can play in the pediatric kidney dis- cooperation with the American Nephrology Nurses Raymond C.

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