Kidney Week Edition October/November 2019 | Vol. 11, Number 10 & 11 Time on Dialysis, Cause of Kidney Failure Appear to Affect Likelihood of Pregnancy in Women on Dialysis Analysis examines U.S. pregnancy rates over 9 years By Tracy Hampton Because there is limited information on current pregnan- study uses data from the largest retrospective cohort of cy rates in women on dialysis, a recent study examined dialysis patients in the United States.” pregnancy data in the United States by age, race, dialysis The analysis included 47,555 women who were aged 15 modality, time on dialysis, socioeconomic status, rurality, to 44 years and were on peritoneal or hemodialysis at any and cause of kidney failure, along with factors associated time between January 1, 2005, and December 31, 2013. with pregnancy. The investigators identified 2352 pregnancies and “Pregnancy in a woman with end stage kidney disease showed that for every 1000 women on dialysis each year, is not common, and many questions still remain unan- pregnancies occurred in 18 women. Rates were highest in swered. I was curious to know the nationwide incidence women aged 20 to 24 years. of conceptions and pregnancies among women undergo- In adjusted analyses, white women had a lower likeli- ing dialysis and whether it was associated with differences hood of becoming pregnant than other groups. Compared in race/ethnicity,” said lead author Silvi Shah, MD, of the with white women, the likelihood of becoming pregnant University of Cincinnati Medical Center. was 77% higher in Native American women, 51% higher In the JASN analysis conducted by Shah and her col- in Hispanic women, and 33% higher in black women. leagues, the team analyzed national registry information Kidney failure as a result of diabetes appeared to lessen from the United States Renal Data System, as well as the likelihood of pregnancy. The likelihood of becoming Medicare Part A institutional claims and Medicare Part B pregnant was 64%, 38%, 32%, and 18% higher when physician/supplier claims. women’s kidney failure was due to cancer, glomerulone- “Previous research has mostly been conducted on vol- phritis, hypertension, or vasculitis, respectively, compared ertility diminishes with declining kidney function, untary registries and single center studies and therefore with diabetes. and it is challenging for women with kidney failure accurate estimation of rate of pregnancy in women with Women on peritoneal dialysis had a 53% lower likeli- Fwho are undergoing dialysis to become pregnant. end stage kidney disease was difficult,” Shah said. “Our Continued on page 3 > Kidney Week Scientific Sessions Inside THURSDAY Diagnostic Exome Sequencing in Chronic Advancing Kidney Health Kidney Disease Rewriting the Code of Life: The Future of Genome Editing Spurring innovation and reenergizing State-of-the-Art Lecture: Jennifer A. Doudna Robert W. Schrier Endowed Lectureship: Ali G. Gharavi nephrology, helping shape new FGF23 and Risks of Cardiovascular Prospects for NAD+ Based Therapies in Acute payment models, and seeking and Noncardiovascular Diseases Kidney Injury congressional support for the kidney Jack W. Coburn Endowed Lectureship: Sharon M. Moe Donald W. Seldin Young Investigator Award: community’s priorities, all in this issue Samir M. Parikh Diabetic Kidney Disease: Structural–Functional Relationships and the Possibilities of Cure SATURDAY Findings Barry M. Brenner Endowed Lectureship: Michael Mauer Perspectives on Innovation and Transformation Early prediciton of AKI through in Kidney Care artificial intelligence FRIDAY State-of-the-Art Lecture: Dean Kamen Genes Controlling Sleep and Circadian Rhythms State-of-the-Art Lecture: Bruce Culleton Human Factors State-of-the-Art Lecture: Michael Young Person-Centered Dialysis Care: and Dialysis The Future of Value-Based Care and Nephrology A Patient’s Perspective Small workforce adjustments can Christopher R. Blagg Lectureship in Kidney Diseases Celeste Castillo Lee Memorial Lectureship: and Public Policy: Adam Boehler Derek L. Forfrang yield improvements in care Genome-Wide Association Study (GWAS)–Derived Targets for Glomerular Diseases SUNDAY Detective Nephron What Patients Say; What Doctors Hear Michelle P. Winn Endowed Lectureship: Rasheed A. Gbadegesin A case of acute kidney injury with State-of-the-Art Lecture: Danielle Ofri Educating Patients and Practitioners About the Benefits unknown cause of Transplantation Presentation of Inaugural ASN Midcareer Award Winners Burton D. Rose Endowed Lectureship: Bertram L. Kasiske NOW 510(k) CLEARED you could experience the next generation in CRRT? Experience the innovation behind the new PRISMAX System, including: • Intelligent fluid management with an auto-effluent drain option • Integrated THERMAX blood warmer • Powerful data tracking with TRUEVUE Analytics FOR MORE INFORMATION renalacute.com/prismax 800-525-2623 DESIGNED FOR ACCURACY AND SIMPLICITY. CRRT BUILT FOR YOUR ICU. The PRISMAX control unit is intended for: Continuous Renal Replacement Therapy (CRRT) for patients weighing 20 kilograms or more with acute renal failure and/or fluid overload. Therapeutic Plasma Exchange Therapy (TPE) for patients with diseases where removal of plasma components is indicated. Rx Only. For the safe and proper use of the devices mentioned herein, please refer to the appropriate Operator’s Manual. Baxter, Prismax, Prismaflex, Thermax, and TrueVue are trademarks of Baxter International Inc. or its subsidiaries. USMP/MG207/18-0015 02/19 October/November 2019 | ASN Kidney News | 3 THE KIDNEY MOONSHOT By Ryan Murray and Molly O’Neill he United States was built on bold, audacious July 10, 2019. The EO calls for a fundamental shift toward The Executive Order on Advancing American Kidney plans in which the public and private sectors a system of value-based care by incentivizing earlier clinical Health is “a major win in the battle against kidney disease. collaborate to solve complex problems. Our interventions to delay the progression, or prevent, kidney They have thought about the entire spectrum of kidney dis- healthcare system is no exception, and the can- disease and kidney failure. ease from better detection to better dialysis therapies and Tcer community wrote the book on how to advance the field For decades, the American Society of Nephrology better access to transplantation.” – Holly Kramer, MD, on behalf of patients. (ASN) has advocated tirelessly for the priorities highlighted MPH, President of the National Kidney Foundation. When President Richard M. Nixon signed the National in AAKH, which has three overarching goals: Advancing innovation and reenergizing the nephrology Cancer Act of 1971, he shared “that a total national com- ■ Reduce the risk of kidney failure field is a core component of the EO. This is also the over- mitment means more than government.” Nearly 45 years ■ Improve access to and quality of person-centered treat- arching mission behind KidneyX, a public-private partner- later, Vice President Joseph R. Biden, Jr., described a Cancer ment options ship between ASN and the Department of Health and Hu- Moonshot to cure cancer through a collaborative, multi- ■ Increase access to kidney transplants man Services. KidneyX is taking a cutting-edge approach to disciplinary coalition of public and private resources. Fol- address the lack of funding and ingenuity, and the stagna- lowing the former vice president’s call to action, Congress As with the Cancer Moonshot, the kidney community tion in kidney care by accelerating innovation in the devel- passed the 21st Century Cures Act in 2016 and allocated can leverage AAKH to create a variety of opportunities opment of drugs, devices, biologics, and other therapies. It is $1.8 billion to the National Institutes of Health (NIH) over benefiting both patients and kidney health professionals. also specifically highlighted in the EO as an opportunity to seven years dedicated to cancer research in what is referred While at press time Congress was finalizing its appropria- develop an artificial kidney and is actively working on this to as the Beau Biden Cancer Moonshot. tions for FY 2020, the House bill provided a substantial goal through a series of staged prize competitions. As a direct result of the Obama administration making increase in funding for the NIH at $41.1 billion and for The initial prize competition sponsored by KidneyX, cancer research a priority, the National Cancer Institute the National Institute of Diabetes and Digestive and Kid- Redesign Dialysis Phase I, encouraged innovators to con- received an additional $300 million in appropriations for ney Diseases (NIDDK) at $2.1 billion. Appropriations ceptualize next-generation dialysis products. Participants fiscal year (FY) 2017 designated specifically for the Cancer increases will support NIDDK initiatives including the were asked to design possible solutions that can replicate Moonshot, an additional $300 million for FY 2018, and pioneering work that is being conducted by the APOL1 normal kidney function and improve patient quality of an additional $400 million for FY 2019. This three-year $1 Long-term Kidney Transplantation Outcomes Network life. Phase I ignited enthusiasm throughout the nephrology billion was on top of the average annual appropriation for (APOLLO) and Kidney Precision Medicine Project community and received more than double the number of the National Cancer Institute, which during the time was (KPMP). expected submissions. The winning submissions included $5.9 billion. By better educating patients