May 2014 | Vol. 6, Number 5 Certain Prenatal Risk Factors Linked with Increased Kidney Disease Risk for Children Inside Journal View obesity were linked with an increased risk They studied nearly 2000 patients How many ESRD patients of developing chronic kidney disease with childhood CKD and more than undergoing dialysis regain (CKD) in children, reports a study 20,000 controls without the disease. kidney function? in the Journal of the American So- They linked maternal and infant charac- ciety of Nephrology. Additional teristics in Washington state birth records research may help determine from 1987 to 2008 to hospital discharge Diet and nutriton for whether modifying these fac- data, and they assessed factors including CKD management tors could help protect chil- birth weight, maternal diabetes, and ma- Kidney care professionals dren’s kidney health. ternal overweight/obesity. The Washing- are on the front lines when it “Data suggest that CKD is ton state birth record linkage enabled the comes to recognizing barriers on the rise in both children and investigators to conduct the largest study to quality food sources adults and in the absence of any to date of potential prenatal determi- and managing potential available cures for CKD, identify- nants of CKD. interactions among patients’ ing potentially modifiable risk fac- The prevalence of CKD in Washing- meds and nutritional or herbal tors may underscore novel targets in ton state was 126.7 cases per 100,000 supplements order to reduce or even prevent CKD,” births, based on a CKD definition that said lead author Christine Hsu, MD, of included renal dysplasia/aplasia and ob- the University of Washington in Seattle. structive uropathy according to Interna- tional Classification of Diseases, version Policy Update umerous studies have shown Risk factors at play 9 (ICD-9) coding at hospital discharge. In testimony before a congressional committee, ASN that maternal health and the Because some risk factors that contrib- Infants with low birth weight were nearly President Sharon Moe, MD, uterine environment may affect ute to the development of CKD may be three times more likely to develop child- calls for efforts to spur kidney Ncertain aspects of an offspring’s well-being. hood CKD than infants with normal programmed prenatally, Hsu and her care innovation Kidney health appears to be no exception. colleagues looked for an association of birth weight, after adjustments were Low birth weight and maternal con- childhood CKD with various prenatal made for potential confounding factors. ditions such as diabetes and overweight/ risk factors. Continued on page 2 Industry Spotlight Water and filter experts team up to distribute dialysis filters Latest “Doc Fix” Legislation Contains New Provisions for Medicare ESRD Program he “doc fix”— or Protecting Ac- for treating Medicare patients. These Modifications to the Medicare cess to Medicare Act of 2014— laws “patch” required payment decreases ESRD program that President Obama signed into T calculated by the sustainable growth rate Of main interest to the kidney care team law in April narrowly averted a 24 percent (SGR) formula. In addition to preventing are four revisions to the Medicare End- reduction in Medicare physician payments physician payment cuts, this year’s SGR Stage Renal Disease (ESRD) Prospective that was about to go into effect. It was the patch law includes provisions that affect Payment System (PPS). Outlined in Sec- 17th time Congress enacted legislation to all health care providers, and in particular tion 217 of the bill, the new ESRD provi- bypass mandated cuts to reimbursements members of the kidney community. sions range in scope from changes to the ESRD bundled payment rate to man- dated cost report auditing for dialysis providers. The first ESRD provision delays again the inclusion of oral-only medi- cations into the ESRD PPS, or bun- Continued on page 2 2 | ASN Kidney News | May 2014 Prenatal Risk gramming, resulting in abnormal kidney nificantly reduces the risk of congenital “The work by Hsu and colleagues development. Hsu and her colleagues malformations in children. We hope our nicely complements those initiatives by Factors noted that obesity has also been linked work leads to future studies to investigate providing unique insights into the de- with malformations of the urogenital whether strict control of maternal dia- velopment of two of the most common Continued from page 1 system, although the data are conflict- betes and/or reducing maternal obesity/ causes of CKD in childhood, with the ing and the mechanism that might be overweight reduces childhood CKD.” identification of multiple and most im- Infants also had a 54 percent increased involved may be independent of those in- The serious nature of CKD in children portantly, potentially modifiable prenatal odds of developing CKD if their moth- volving maternal diabetes. For example, has led to various multicenter research risk factors,” Warady said. “Replication ers developed diabetes during pregnancy, obese women may be at increased risk of efforts within the pediatric nephrology of these data in additional patient cohorts a 24 percent increased odds if their moth- metabolic conditions such as hyperglyce- community, including the Chronic Kid- would provide strong support for the ag- ers were overweight, and a 26 percent in- mia or hyperinsulinemia independent of ney Disease in Children (CKiD) study gressive management of these factors with creased odds if their mothers were obese. the presence of diabetes, and these may in North America and the Effect of Strict the hope of actually being able to decrease In a subgroup analysis by CKD sub- affect developmental risk in offspring. Blood Pressure Control and ACE Inhibi- the incidence of this chronic disorder.” type, low birth weight and maternal tion on the Progression of Chronic Renal pregestational diabetes were linked sig- Attempting to reduce risk Failure in Pediatric Patients (ESCAPE) Study co-authors include Kalani nificantly with increased risk of renal The study’s findings will likely serve as a trial in Europe, noted Bradley Warady, Yamamoto, MD, Rohan Henry, MD, dysplasia/aplasia, while low birth weight, starting ground for future investigations MD, who was not involved with the re- Anneclaire De Roos, PhD, and Joseph maternal gestational diabetes, and mater- on ways to target CKD at the earliest search. Warady is senior associate chair Flynn, MD. nal overweight/obesity were linked sig- stages in life. for the department of pediatrics at Chil- nificantly with obstructive uropathy. “We hope this research leads to further dren’s Mercy Hospitals and Clinics and a Disclosures: The authors reported no fi- While the mechanisms by which vari- research on ways to reduce kidney disease professor of pediatrics at the University nancial disclosures. ous prenatal factors may affect CKD risk through either early treatment or preven- of Missouri-Kansas City School of Medi- were not assessed in this study, other tion that might begin even before birth,” cine. These studies were designed to de- The article, entitled “Prenatal Risk Fac- research suggests that maternal diabe- Hsu said. “Previous studies show that lineate risk factors for CKD progression tors for Childhood CKD,” is available tes may adversely compromise fetal pro- strict control of maternal diabetes sig- in affected patients. online at http://jasn.asnjournals.org/. planned reimbursement cuts of up to growth rates. If Medicare expenditures ICD-10 would be implemented on Oc- Medicare ERSD $30 per dialysis treatment, Congress re- exceed the SGR target growth, auto- tober 1, 2014. The law pushes this back Program placed the ATRA bundled payment de- matic physician payment reductions are to October 1, 2015, and it remains un- creases with a 1.25 percent cut in 2016 triggered. Since its passage, Congress clear if this is the last of the delays. Continued from page 1 and 2017, and a 1 percent decrease in has avoided implementing the required Introduced in 1990 by the World 2018. cuts or replacing the legislation with a Health Organization, the ICD-10 (In- dled payment. Previously scheduled for more sound approach to cost contain- ternational Classification of Diseases, January 1, 2016, the date for adding The fourth ESRD provision imple- ments auditing of Medicare cost reports ment, relying instead on passing tem- 10th revision) diagnostic and proce- oral medications without equivalent IV porary patches. dural codes are already in wide use preparations into the bundle has now of service providers and dialysis facili- ties. The legislation directs the HHS ASN, along with the American Col- around the world. Designed to provide been pushed back 8 years to January 1, lege of Physicians, the American Medi- more detail about physician encoun- 2024. The Health and Human Services secretary to audit a random sample of ESRD cost reports beginning with cal Association (AMA) and numerous ters, ICD-9’s replacement is broader (HHS) secretary is also required to de- other medical societies, have called for and more detailed, containing 68,000 velop a process by 2016 that determines those from 2012. The SGR patch also addresses the ef- the repeal and replacement of the SGR codes. when a drug is no longer considered an with a more stable, predictable system. fects of the budget sequestration, which The granularity of the new coding oral-only medication, and for inclusion The odds of successfully repealing and reduces Medicare provider payments, system has garnered attention