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Erickson RL, Kamath N, Iyengar A, Ademola A, Esezobor C, Lalji R, Hedin E, Arruebo S, Caskey FJ, Damster S, Donner JA, Jha V, Levin A, Nangaku M, Saad S, Tonelli M, Ye F, Okpechi IG, Bello AK, Johnson DW. Disparities in kidney care in vulnerable populations: A multinational study from the ISN-GKHA. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0004086. [PMID: 39705218 DOI: 10.1371/journal.pgph.0004086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 11/27/2024] [Indexed: 12/22/2024]
Abstract
Vulnerable populations, such as the elderly, children, displaced people, and refugees, often encounter challenges in accessing healthcare. In this study, we used data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to describe kidney care access and delivery to vulnerable populations across countries and regions. Using data from an international survey of clinicians, policymakers, and patient advocates, we assessed the funding and coverage of vulnerable populations on all aspects of kidney replacement therapies (KRT). Overall, 167 countries or jurisdictions participated in the survey, representing 97.4% of the world's population. Children had less access than adults to KRT: hemodialysis (HD) in 74% of countries, peritoneal dialysis (PD) in 53% of countries, and kidney transplantation (KT) in 80% of countries. Available nephrologist workforce for pediatric kidney care was much lower than for adults (0.69 per million population [pmp] vs 10.08 pmp). Refugees or displaced people with kidney failure did not have access to HD, PD, or KT in 21%, 33%, and 37% of the participating countries, respectively. Low-income countries (LICs) were less likely to provide KRT access to refugees compared to high-income countries (HICs): HD: 13% vs 22%; PD: 19% vs 61%; KT: 30% vs 44%. Testing for kidney disease was routinely offered to elderly people in only 61% of countries: LICs (45%), lower-middle-income countries (56%), upper-middle-income countries (54%), and HICs (75%). Equitable access to kidney care for vulnerable people, particularly for children and displaced people, remains an area of unmet need. Strategies are needed to address this issue.
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Affiliation(s)
- Robin L Erickson
- Paediatric Kidney Service, Starship Children's Hospital, University of Auckland, Auckland, New Zealand
| | - Nivedita Kamath
- Department of Pediatric Nephrology, St. John's Medical College Hospital, Bangalore, India
| | - Arpana Iyengar
- Department of Paediatric Nephrology, St.John's National Academy of Health Sciences, Bangalore, India
| | - Adebowale Ademola
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Ibadan / University College Hospital Ibadan, Ibadan, Oyo State, Nigeria
| | - Christopher Esezobor
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Rowena Lalji
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Queensland, Australia
- Department of Nephrology, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Metro South and Integrated Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Erin Hedin
- Division of Pediatric Nephrology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
- School of Public Health, Imperial College, London, United Kingdom
- Manipal Academy of Higher Education, Manipal, India
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Syed Saad
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization's Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ikechi G Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Aminu K Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - David W Johnson
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Queensland, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia
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2
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Soranno DE, Amaral S, Ashoor I, Atkinson MA, Barletta GM, Braun MC, Carlson J, Carter C, Chua A, Dharnidharka VR, Drake K, Erkan E, Feig D, Goldstein SL, Hains D, Harshman LA, Ingulli E, Kula AJ, Leonard M, Mannemuddhu S, Menon S, Modi ZJ, Moxey-Mims M, Nada A, Norwood V, Starr MC, Verghese PS, Weidemann D, Weinstein A, Smith J. Responding to the workforce crisis: consensus recommendations from the Second Workforce Summit of the American Society of Pediatric Nephrology. Pediatr Nephrol 2024; 39:3609-3619. [PMID: 38976042 PMCID: PMC11511730 DOI: 10.1007/s00467-024-06410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/23/2024] [Accepted: 05/11/2024] [Indexed: 07/09/2024]
Abstract
IMPORTANCE Pediatric patients with complex medical problems benefit from pediatric sub-specialty care; however, a significant proportion of children live greater than 80 mi. away from pediatric sub-specialty care. OBJECTIVE To identify current knowledge gaps and outline concrete next steps to make progress on issues that have persistently challenged the pediatric nephrology workforce. EVIDENCE REVIEW Workforce Summit 2.0 employed the round table format and methodology for consensus building using adapted Delphi principles. Content domains were identified via input from the ASPN Workforce Committee, the ASPN's 2023 Strategic Plan survey, the ASPN's Pediatric Nephrology Division Directors survey, and ongoing feedback from ASPN members. Working groups met prior to the Summit to conduct an organized literature review and establish key questions to be addressed. The Summit was held in-person in November 2023. During the Summit, work groups presented their preliminary findings, and the at-large group developed the key action statements and future directions. FINDINGS A holistic appraisal of the effort required to cover inpatient and outpatient sub-specialty care will help define faculty effort and time distribution. Most pediatric nephrologists practice in academic settings, so work beyond clinical care including education, research, advocacy, and administrative/service tasks may form a substantial amount of a faculty member's time and effort. An academic relative value unit (RVU) may assist in creating a more inclusive assessment of their contributions to their academic practice. Pediatric sub-specialties, such as nephrology, contribute to the clinical mission and care of their institutions beyond their direct billable RVUs. Advocacy throughout the field of pediatrics is necessary in order for reimbursement of pediatric sub-specialist care to accurately reflect the time and effort required to address complex care needs. Flexible, individualized training pathways may improve recruitment into sub-specialty fields such as nephrology. CONCLUSIONS AND RELEVANCE The workforce crisis facing the pediatric nephrology field is echoed throughout many pediatric sub-specialties. Efforts to improve recruitment, retention, and reimbursement are necessary to improve the care delivered to pediatric patients.
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Affiliation(s)
- Danielle E Soranno
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
- Department of Bioengineering, Purdue University Weldon School of Engineering, 1044 W. Walnut Street, West Lafayette, IN, R4-42146202, USA.
| | - Sandra Amaral
- Departments of Pediatrics and Biostatistics, Epidemiology and Informatics, Children's Hospital of Philadelphia and University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Isa Ashoor
- Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Meredith A Atkinson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gina-Marie Barletta
- Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR, USA
| | - Michael C Braun
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Joann Carlson
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Caitlin Carter
- Rady Children's Hospital, University of California San Diego, San Diego, CA, USA
| | - Annabelle Chua
- Duke Children's Hospital and Health Center, Durham, NC, USA
| | | | - Keri Drake
- University of Texas Southwestern Medical Center, St. Louis, MO, USA
| | - Elif Erkan
- Department of Pediatrics, University of Cincinnati College of Medicine, Indianapolis, IN, USA
| | - Dan Feig
- Department of Pediatrics, University of Alabama, Heersink School of Medicine, Birmingham, AL, USA
| | - Stuart L Goldstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Indianapolis, IN, USA
| | - David Hains
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lyndsay A Harshman
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Elizabeth Ingulli
- Rady Children's Hospital, University of California San Diego, San Diego, CA, USA
| | | | - Mary Leonard
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | | | - Shina Menon
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Zubin J Modi
- Department of Pediatrics and Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI, USA
| | - Marva Moxey-Mims
- Department of Pediatrics, Children's National Hospital/George Washington University SOM, Washington, D.C, USA
| | - Arwa Nada
- Department of Pediatrics, Le Bonheur Children's Hospital, UTHSC, Memphis, TN, USA
| | - Victoria Norwood
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Michelle C Starr
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Darcy Weidemann
- Department of Pediatrics, Division of Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Adam Weinstein
- Department of Medical Sciences and Pediatrics, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Jodi Smith
- Department of Pediatrics, University of Washington, Seattle, WA, USA
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Bacchetta J, Boyer O, Hogan J, Nobili F, Faudeux C, Lapeyraque AL, Fort E. French pediatric nephrologists are in crisis: the consequences of paradoxical injunctions and a plea for action. Pediatr Nephrol 2024; 39:3131-3135. [PMID: 38630295 DOI: 10.1007/s00467-024-06337-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 09/20/2024]
Affiliation(s)
- Justine Bacchetta
- French Society of Pediatric Nephrology, Lyon, France.
- Service de Néphrologie, Rhumatologie, Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Boulevard Pinel, 69677, Bron Cedex, France.
- INSERM 1033, Lyon, France.
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France.
| | - Olivia Boyer
- French Society of Pediatric Nephrology, Lyon, France
- Service de Néphrologie Pédiatrique, Hypertension Artérielle, Dialyse, Et Transplantation, Hôpital Necker - Enfants Malades, Institut Imagine, Université Paris-Cité, Paris, France
| | - Julien Hogan
- French Society of Pediatric Nephrology, Lyon, France
- Service de Néphrologie Pédiatrique, Hôpital Robert Debré, Université Paris-Cité, Paris, France
| | - François Nobili
- French Society of Pediatric Nephrology, Lyon, France
- Service de Pédiatrie, CHU Besançon, Besançon, France
| | - Camille Faudeux
- French Society of Pediatric Nephrology, Lyon, France
- Service d'Hémodialyse Pédiatrique, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Anne Laure Lapeyraque
- French Society of Pediatric Nephrology, Lyon, France
- Département de Pédiatrie, Hôpital Sainte Justine, Montréal, Canada
| | - Emmanuel Fort
- UMRESTTE UMR T 9405, Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, 69622, Lyon, France
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Cho Y, Cullis B, Ethier I, Htay H, Jha V, Arruebo S, Caskey FJ, Damster S, Donner JA, Levin A, Nangaku M, Saad S, Tonelli M, Ye F, Okpechi IG, Bello AK, Johnson DW. Global structures, practices, and tools for provision of chronic peritoneal dialysis. Nephrol Dial Transplant 2024; 39:ii18-ii25. [PMID: 39235200 DOI: 10.1093/ndt/gfae130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Worldwide, the uptake of peritoneal dialysis (PD) compared with hemodialysis remains limited. This study assessed organizational structures, availability, accessibility, affordability and quality of PD worldwide. METHODS This cross-sectional study relied on data from kidney registries as well as survey data from stakeholders (clinicians, policymakers and advocates for people living with kidney disease) from countries affiliated with the International Society of Nephrology (ISN) from July to September 2022. RESULTS Overall, 167 countries participated in the survey. PD was available in 79% of countries with a median global prevalence of 21.0 [interquartile range (IQR) 1.5-62.4] per million population (pmp). High-income countries (HICs) had an 80-fold higher prevalence of PD than low-income countries (LICs) (56.2 pmp vs 0.7 pmp). In 53% of countries, adults had greater PD access than children. Only 29% of countries used public funding (and free) reimbursement for PD with Oceania and South East Asia (6%), Africa (10%) and South Asia (14%) having the lowest proportions of countries in this category. Overall, the annual median cost of PD was US$18 959.2 (IQR US$10 891.4-US$31 013.8) with full private out-of-pocket payment in 4% of countries and the highest median cost in LICs (US$30 064.4) compared with other country income levels (e.g. HICs US$27 206.0). CONCLUSIONS Ongoing large gaps and variability in the availability, access and affordability of PD across countries and world regions were observed. Of note, there is significant inequity in access to PD by children and for people in LICs.
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Affiliation(s)
- Yeoungjee Cho
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Brett Cullis
- Department of Nephrology and Child Health, University of Cape Town, Cape Town, South Africa
| | - Isabelle Ethier
- Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales (UNSW), New Delhi, India
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Fergus J Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Syed Saad
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ikechi G Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Aminu K Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - David W Johnson
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Kamath N, Erickson RL, Hingorani S, Bresolin N, Duzova A, Lungu A, Bjornstad EC, Prasetyo R, Antwi S, Safouh H, Montini G, Bonilla-Félix M. Structures, Organization, and Delivery of Kidney Care to Children Living in Low-Resource Settings. Kidney Int Rep 2024; 9:2084-2095. [PMID: 39081753 PMCID: PMC11284437 DOI: 10.1016/j.ekir.2024.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction There is a disparity in the availability of health care for children in resource-constrained countries. The International Pediatric Nephrology Association (IPNA) commissioned an initiative exploring the challenges in the care of children with kidney disease in low- or middle-income countries (LMICs) with a focus on human, diagnostic, and therapeutic resources. Methods A survey was sent by e-mail to all members of IPNA and its affiliated regional or national societies residing in LMICs. Data were extracted from individual responses after merging duplicate data. Descriptive analysis was done using Microsoft Excel. Results Responses were obtained from 245 centers across 62 countries representing 88% of the LMIC pediatric population. Regional disparity in the availability of basic diagnostic and therapeutic resources was noted. Even when resources were available, they were not accessible or affordable in 15% to 20% of centers. Acute and chronic dialysis were available in 85% and 75% of centers respectively. Lack of trained nurses, pediatric-specific supplies, and high costs were barriers to providing dialysis in these regions. Kidney transplantation was available in 32% of centers, with the cost of transplantation and lack of surgical expertise reported as barriers. About 65% of centers reported that families with chronic disease opted to discontinue care, with financial burden as the most common reason cited. Conclusion The survey highlights the existing gaps in workforce, diagnostic, and therapeutic resources for pediatric kidney care in resource-constrained regions. We need to strengthen the health care workforce, address disparities in health care resources and funding, and advocate for equitable access to medications, and kidney replacement therapy (KRT).
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Affiliation(s)
- Nivedita Kamath
- Pediatric Nephrology Department, St John’s Medical College Hospital, Bengaluru, India
| | - Robin L. Erickson
- Department of Paediatric Nephrology, Starship Children’s Hospital-Te Whatu Ora, University of Auckland, Auckland, New Zealand
| | - Sangeeta Hingorani
- Division of Nephrology, University of Washington Department of Pediatrics and Seattle Children’s Hospital, Seattle, Washington, USA
| | - Nilzete Bresolin
- Faculty of Medicine of Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Ali Duzova
- Division of Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | | | - Erica C. Bjornstad
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Risky Prasetyo
- Division of Nephrology, Department of Child Health, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - Sampson Antwi
- Department of Child Health and Pediatric Nephrology, Kwame Nkrumah University of Science and Technology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Hesham Safouh
- Pediatric Nephrology Unit, Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Giovanni Montini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Nephrology, Dialysis and Transplant Unit, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Melvin Bonilla-Félix
- Department of Pediatrics, University of Puerto Rico-Medical Sciences Campus, San Juan, Puerto Rico, USA
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Swanson MB, Weidemann DK, Harshman LA. The impact of rural status on pediatric chronic kidney disease. Pediatr Nephrol 2024; 39:435-446. [PMID: 37178207 PMCID: PMC10182542 DOI: 10.1007/s00467-023-06001-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023]
Abstract
Children and adolescents in rural areas with chronic kidney disease (CKD) face unique challenges related to accessing pediatric nephrology care. Challenges to obtaining care begin with living increased distances from pediatric health care centers. Recent trends of increasing centralization of pediatric care mean fewer locations have pediatric nephrology, inpatient, and intensive care services. In addition, access to care for rural populations expands beyond distance and encompasses domains of approachability, acceptability, availability and accommodation, affordability, and appropriateness. Furthermore, the current literature identifies additional barriers to care for rural patients that include limited resources, including finances, education, and community/neighborhood social resources. Rural pediatric kidney failure patients have barriers to kidney replacement therapy options that may be even more limited for rural pediatric kidney failure patients when compared to rural adults with kidney failure. This educational review identifies possible strategies to improve health systems for rural CKD patients and their families: (1) increasing rural patient and hospital/clinic representation and focus in research, (2) understanding and mediating gaps in the geographic distribution of the pediatric nephrology workforce, (3) introducing regionalization models for delivering pediatric nephrology care to geographic areas, and (4) employing telehealth to expand the geographic reach of services and reduce family time and travel burden.
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Affiliation(s)
- Morgan Bobb Swanson
- Department of Epidemiology, College of Medicine and College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Darcy K Weidemann
- Department of Pediatrics, Section of Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Lyndsay A Harshman
- Department of Pediatrics, Division of Nephrology, Dialysis and Transplantation, University of Iowa, 425 General Hospital, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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Teixeira A, Topaloglu R, Cochat P, Coppo R, Levtchenko E, Haffner D, Mahan JD, Oh J. IPNA-ESPN Junior Master Class-a decade of successful continuing education and training in pediatric nephrology. Pediatr Nephrol 2023; 38:3201-3205. [PMID: 37014529 PMCID: PMC10071458 DOI: 10.1007/s00467-023-05940-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 04/05/2023]
Affiliation(s)
- Ana Teixeira
- Pediatric Nephrology Unit, Pediatrics Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
| | - Rezan Topaloglu
- Department of Pediatric Nephrology, Hacettepe University School of Medicine, Ankara, Turkey.
| | | | - Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Elena Levtchenko
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - John D Mahan
- Division of Pediatric Nephrology, The Ohio State University College of Medicine, Columbus, OH, 43209, USA
| | - Jun Oh
- Department of Pediatric Nephrology, University Medical Center Hamburg/Eppendorf, Hamburg, Germany
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Wu J, Li Q, Bao C, Yang C, Li P, Zhang L. Nephrology workforce in China: describing current status and evaluating the optimal capacity based on real-world data. HUMAN RESOURCES FOR HEALTH 2023; 21:62. [PMID: 37553692 PMCID: PMC10410773 DOI: 10.1186/s12960-023-00851-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/03/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE This study aims to characterize the current status of the nephrology workforce in China and evaluate its optimal capacity based on real-world patient mobility data. METHODS Data on nephrologists in China were collected from two prominent online healthcare platforms using web crawlers and natural language processing techniques. Hospitalization records of patients with chronic kidney disease (CKD) from January 2014 to December 2018 were extracted from a national administrative database in China. City-level paths of patient mobility were identified. Effects of nephrology workforce on patient mobility were analyzed using multivariate Poisson regression models. RESULTS Altogether 9.13 nephrologists per million population (pmp) were in practice, with substantial city-level variations ranging from 0.16 to 88.79. The ratio of nephrologists to the estimated CKD population was 84.57 pmp. Among 6 415 559 hospitalizations of patients with CKD, 21.3% were cross-city hospitalizations and 7441 city-level paths of patient mobility with more than five hospitalizations were identified. After making adjustment for healthcare capacity, healthcare insurance, economic status, and travel characteristics, the Poisson regression models revealed that the number of nephrologists in both the source city (incidence rate ratio [IRR] 0.99, per 1 pmp increase) and destination city (IRR 1.07, per 1 pmp increase) were independently associated with patient mobility. An IRR plateau was observed when the number of nephrologists exceeded 12 pmp in the source city, while a rapidly increasing IRR was observed beyond 20 pmp in the destination city. CONCLUSIONS The nephrology workforce in China exhibits significant geographic variations. Based on local healthcare needs, an optimal range of 12-20 nephrologists pmp is suggested.
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Affiliation(s)
- Jingyi Wu
- Advanced Institute of Information Technology, Peking University, No.233 Yonghui Road, Xiaoshan District, Hangzhou, 311215, Zhejiang, China
| | - Qing Li
- Advanced Institute of Information Technology, Peking University, No.233 Yonghui Road, Xiaoshan District, Hangzhou, 311215, Zhejiang, China
| | - Chenlu Bao
- Advanced Institute of Information Technology, Peking University, No.233 Yonghui Road, Xiaoshan District, Hangzhou, 311215, Zhejiang, China
| | - Chao Yang
- Advanced Institute of Information Technology, Peking University, No.233 Yonghui Road, Xiaoshan District, Hangzhou, 311215, Zhejiang, China
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, 100034, China
| | - Pengfei Li
- Advanced Institute of Information Technology, Peking University, No.233 Yonghui Road, Xiaoshan District, Hangzhou, 311215, Zhejiang, China.
- National Institute of Health Data Science, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Luxia Zhang
- Advanced Institute of Information Technology, Peking University, No.233 Yonghui Road, Xiaoshan District, Hangzhou, 311215, Zhejiang, China.
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, 100034, China.
- National Institute of Health Data Science, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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Trautmann A, Boyer O, Hodson E, Bagga A, Gipson DS, Samuel S, Wetzels J, Alhasan K, Banerjee S, Bhimma R, Bonilla-Felix M, Cano F, Christian M, Hahn D, Kang HG, Nakanishi K, Safouh H, Trachtman H, Xu H, Cook W, Vivarelli M, Haffner D. IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome. Pediatr Nephrol 2023; 38:877-919. [PMID: 36269406 PMCID: PMC9589698 DOI: 10.1007/s00467-022-05739-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/03/2022] [Accepted: 08/22/2022] [Indexed: 01/19/2023]
Abstract
Idiopathic nephrotic syndrome is the most frequent pediatric glomerular disease, affecting from 1.15 to 16.9 per 100,000 children per year globally. It is characterized by massive proteinuria, hypoalbuminemia, and/or concomitant edema. Approximately 85-90% of patients attain complete remission of proteinuria within 4-6 weeks of treatment with glucocorticoids, and therefore, have steroid-sensitive nephrotic syndrome (SSNS). Among those patients who are steroid sensitive, 70-80% will have at least one relapse during follow-up, and up to 50% of these patients will experience frequent relapses or become dependent on glucocorticoids to maintain remission. The dose and duration of steroid treatment to prolong time between relapses remains a subject of much debate, and patients continue to experience a high prevalence of steroid-related morbidity. Various steroid-sparing immunosuppressive drugs have been used in clinical practice; however, there is marked practice variation in the selection of these drugs and timing of their introduction during the course of the disease. Therefore, international evidence-based clinical practice recommendations (CPRs) are needed to guide clinical practice and reduce practice variation. The International Pediatric Nephrology Association (IPNA) convened a team of experts including pediatric nephrologists, an adult nephrologist, and a patient representative to develop comprehensive CPRs on the diagnosis and management of SSNS in children. After performing a systematic literature review on 12 clinically relevant PICO (Patient or Population covered, Intervention, Comparator, Outcome) questions, recommendations were formulated and formally graded at several virtual consensus meetings. New definitions for treatment outcomes to help guide change of therapy and recommendations for important research questions are given.
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Affiliation(s)
- Agnes Trautmann
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Olivia Boyer
- Department of Pediatric Nephrology, Reference Center for Idiopathic Nephrotic Syndrome in Children and Adults, Imagine Institute, Paris University, Necker Children's Hospital, APHP, Paris, France
| | - Elisabeth Hodson
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Debbie S Gipson
- Department of Pediatrics, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Susan Samuel
- Section of Pediatric Nephrology, Department of Pediatrics, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Jack Wetzels
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Khalid Alhasan
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sushmita Banerjee
- Department of Pediatric Nephrology, Institute of Child Health, Kolkata, India
| | | | - Melvin Bonilla-Felix
- Department of Pediatrics, University of Puerto Rico-Medical Sciences Campus, San Juan, Puerto Rico
| | - Francisco Cano
- Department of Pediatric Nephrology, Luis Calvo Mackenna Children's Hospital, University of Chile, Santiago, Chile
| | - Martin Christian
- Children's Kidney Unit, Nottingham Children's Hospital, Nottingham, UK
| | - Deirdre Hahn
- Division of Pediatric Nephrology, Department of Paediatrics, The Children's Hospital at Westmead, Sydney, Australia
| | - Hee Gyung Kang
- Division of Pediatric Nephrology, Department of Pediatrics, Seoul National University Children's Hospital & Seoul National University College of Medicine, Seoul, Korea
| | - Koichi Nakanishi
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hesham Safouh
- Pediatric Nephrology Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Howard Trachtman
- Department of Pediatrics, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Hong Xu
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Wendy Cook
- Nephrotic Syndrome Trust (NeST), Somerset, UK
| | - Marina Vivarelli
- Division of Nephrology and Dialysis, Department of Pediatric Subspecialties, Bambino Gesù Pediatric Hospital IRCCS, Rome, Italy
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School Children's Hospital, Hannover and Center for Rare Diseases, Hannover Medical School, Hannover, Germany.
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Kalyesubula R, Conroy AL, Calice-Silva V, Kumar V, Onu U, Batte A, Kaze FF, Fabian J, Ulasi I. Screening for Kidney Disease in Low- and Middle-Income Countries. Semin Nephrol 2022; 42:151315. [DOI: 10.1016/j.semnephrol.2023.151315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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11
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Banerjee S, Kamath N, Antwi S, Bonilla-Felix M. Paediatric nephrology in under-resourced areas. Pediatr Nephrol 2022; 37:959-972. [PMID: 33839937 DOI: 10.1007/s00467-021-05059-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Nearly 50% of the world population and 60% of children aged 0 to 14 years live in low- or lower-middle-income countries. Paediatric nephrology (PN) in these countries is not a priority for allocation of limited health resources. This article explores advancements made and persisting limitations in providing optimal PN services to children in such under-resourced areas (URA). METHODS Medline, PubMed and Google Scholar online databases were searched for articles pertaining to PN disease epidemiology, outcome, availability of services and infrastructure in URA. The ISN and IPNA offices were contacted for data, and two online questionnaire surveys of IPNA membership performed. Regional IPNA members were contacted for further detailed information. RESULTS There is a scarcity of published data from URA; where available, prevalence of PN diseases, managements and outcomes are often reported to be different from high income regions. Deficiencies in human resources, fluoroscopy, nuclear imaging, immunofluorescence, electron microscopy and genetic studies were identified. Several drugs and maintenance kidney replacement therapy are inaccessible to the majority of patients. Despite these issues, regional efforts with support from international bodies have led to significant advances in PN services and infrastructure in many URA. CONCLUSIONS Equitable distribution and affordability of PN services remain major challenges in URA. The drive towards acquisition of regional data, advocacy to local government and non-government agencies and partnership with international support bodies needs to be continued. The aim is to optimise and achieve global parity in PN training, investigations and treatments, initially focusing on preventable and reversible conditions.
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Affiliation(s)
| | | | - Sampson Antwi
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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12
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Pawłowicz-Szlarska E, Skrzypczyk P, Stańczyk M, Pańczyk-Tomaszewska M, Nowicki M. Burnout Syndrome among Pediatric Nephrologists—Report on Its Prevalence, Severity, and Predisposing Factors. Medicina (B Aires) 2022; 58:medicina58030446. [PMID: 35334623 PMCID: PMC8950474 DOI: 10.3390/medicina58030446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Burnout is an occupation-related syndrome comprising emotional exhaustion, depersonalization, and reduced feelings of work-related personal accomplishments. There are reports on burnout among adult nephrologists and general pediatricians, but little is known about burnout among pediatric nephrologists. The aim of our study was to assess the prevalence and severity of burnout syndrome among Polish pediatric nephrologists. Materials and Methods: A 25-item study survey consisting of abbreviated Maslach Burnout Inventory and additional self-created questions about work-related factors was completed by 97 physicians affiliated with the Polish Society of Pediatric Nephrology. Women comprised 75.3%, with median time of professional experience in the study group was 15 years. Results: A high level of emotional exhaustion, depersonalization, and reduced feeling of personal accomplishments were observed in 39.2%, 38.1%, and 21.6% of the participants, respectively. At least a medium level of burnout in all three dimensions were observed in 26.8% of the participants and 8.2% of them presented high three-dimensional burnout. About 41.2% of the participants stated that they would like to take part in burnout prevention and support programs. According to the study participants, excessive bureaucracy in healthcare systems, rush at work, and overtime work were the main job-related problems that could influence burnout intensity. Conclusions: Burnout is an important factor in the professional landscape of pediatric nephrology. Actions aimed at reducing the risk of occupational burnout among pediatric nephrologists should be applied, both at the personal and institutional levels.
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Affiliation(s)
- Ewa Pawłowicz-Szlarska
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, 92-213 Lodz, Poland;
- Young Nephrologists’ Club, Polish Society of Nephrology, 02-006 Warsaw, Poland
| | - Piotr Skrzypczyk
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.S.); (M.P.-T.)
- Young Nephrologists’ Forum, Polish Society of Pediatric Nephrology, 93-338 Lodz, Poland;
| | - Małgorzata Stańczyk
- Young Nephrologists’ Forum, Polish Society of Pediatric Nephrology, 93-338 Lodz, Poland;
- Department of Pediatrics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland
| | | | - Michał Nowicki
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, 92-213 Lodz, Poland;
- Correspondence: ; Tel.: +48-42-201-44-00
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Weidemann DK, Ashoor IA, Soranno DE, Sheth R, Carter C, Brophy PD. Moving the Needle Toward Fair Compensation in Pediatric Nephrology. Front Pediatr 2022; 10:849826. [PMID: 35359890 PMCID: PMC8960267 DOI: 10.3389/fped.2022.849826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
Remuneration issues are a substantial threat to the long-term stability of the pediatric nephrology workforce. It is uncertain whether the pediatric nephrology workforce will meet the growing needs of children with kidney disease without a substantial overhaul of the current reimbursement policies. In contrast to adult nephrology, the majority of pediatric nephrologists practice in an academic setting affiliated with a university and/or children's hospital. The pediatric nephrology service line is crucial to maintaining the financial health and wellness of a comprehensive children's hospital. However, in the current fee-for-service system, the clinical care for children with kidney disease is neither sufficiently valued, nor appropriately compensated. Current compensation models derived from the relative value unit (RVU) system contribute to the structural biases inherent in the current inequitable payment system. The perceived negative financial compensation is a significant driver of waning trainee interest in the field which is one of the least attractive specialties for students, with a significant proportion of training spots going unfilled each year and relatively stagnant growth rate as compared to the other pediatric subspecialties. This article reviews the current state of financial compensation issues plaguing the pediatric nephrology subspecialty. We further outline strategies for pediatric nephrologists, hospital administrators, and policy-makers to improve the landscape of financial reimbursement to pediatric subspecialists. A physician compensation model is proposed which aligns clinical activity with alternate metrics for current non-RVU producing activities that harmonizes hospital and personal mission statements.
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Affiliation(s)
- Darcy K. Weidemann
- Division of Nephrology, Children's Mercy Kansas City, Kansas City, MO, United States
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - I. A. Ashoor
- Division of Nephrology, LSU Health New Orleans and Children's Hospital, New Orleans, LA, United States
| | - D. E. Soranno
- Departments of Pediatrics, University of Colorado, Bioengineering, and Medicine, Anschutz Medical Campus, Aurora, CO, United States
| | - R. Sheth
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, United States
| | - C. Carter
- Division of Pediatric Nephrology, Rady Children's Hospital, University of California, San Diego, San Diego, CA, United States
| | - P. D. Brophy
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, United States
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Morse KE, Brown C, Fleming S, Todd I, Powell A, Russell A, Scheinker D, Sutherland SM, Lu J, Watkins B, Shah NH, Pageler NM, Palma JP. Monitoring Approaches for a Pediatric Chronic Kidney Disease Machine Learning Model. Appl Clin Inform 2022; 13:431-438. [PMID: 35508197 PMCID: PMC9068274 DOI: 10.1055/s-0042-1746168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/01/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The purpose of this study is to evaluate the ability of three metrics to monitor for a reduction in performance of a chronic kidney disease (CKD) model deployed at a pediatric hospital. METHODS The CKD risk model estimates a patient's risk of developing CKD 3 to 12 months following an inpatient admission. The model was developed on a retrospective dataset of 4,879 admissions from 2014 to 2018, then run silently on 1,270 admissions from April to October, 2019. Three metrics were used to monitor its performance during the silent phase: (1) standardized mean differences (SMDs); (2) performance of a "membership model"; and (3) response distribution analysis. Observed patient outcomes for the 1,270 admissions were used to calculate prospective model performance and the ability of the three metrics to detect performance changes. RESULTS The deployed model had an area under the receiver-operator curve (AUROC) of 0.63 in the prospective evaluation, which was a significant decrease from an AUROC of 0.76 on retrospective data (p = 0.033). Among the three metrics, SMDs were significantly different for 66/75 (88%) of the model's input variables (p <0.05) between retrospective and deployment data. The membership model was able to discriminate between the two settings (AUROC = 0.71, p <0.0001) and the response distributions were significantly different (p <0.0001) for the two settings. CONCLUSION This study suggests that the three metrics examined could provide early indication of performance deterioration in deployed models' performance.
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Affiliation(s)
- Keith E. Morse
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - Conner Brown
- Information Services Department, Lucile Packard Children's Hospital, Stanford, Palo Alto, California, United States
| | - Scott Fleming
- Department of Biomedical Data Science, Stanford University, Palo Alto, California, United States
| | - Irene Todd
- Information Services Department, Lucile Packard Children's Hospital, Stanford, Palo Alto, California, United States
| | - Austin Powell
- Information Services Department, Lucile Packard Children's Hospital, Stanford, Palo Alto, California, United States
| | - Alton Russell
- Harvard Medical School, Boston, Massachusetts, United States
| | - David Scheinker
- Information Services Department, Lucile Packard Children's Hospital, Stanford, Palo Alto, California, United States
| | - Scott M. Sutherland
- Division of Nephrology, Department of Pediatrics, Stanford University, Stanford, California, United States
| | - Jonathan Lu
- Department of Biomedical Data Science, Stanford University, Palo Alto, California, United States
| | - Brendan Watkins
- Information Services Department, Lucile Packard Children's Hospital, Stanford, Palo Alto, California, United States
| | - Nigam H. Shah
- Department of Biomedical Data Science, Stanford University, Palo Alto, California, United States
| | - Natalie M. Pageler
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
- Division of Systems Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - Jonathan P. Palma
- Division of Neonatology, Department of Pediatrics, Orlando Health, Orlando, Florida, United States
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15
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Policy in pediatric nephrology: successes, failures, and the impact on disparities. Pediatr Nephrol 2021; 36:2177-2188. [PMID: 32968856 DOI: 10.1007/s00467-020-04755-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/10/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
Pediatric nephrology has a history rooted in pediatric advocacy and has made numerous contributions to child health policy affecting pediatric kidney diseases. Despite this progress, profound social disparities remain for marginalized and socially vulnerable children with kidney disease. Different risk factors, such as genetic predisposition, environmental factors, social risk factors, or health care access influence the emergence and progression of pediatric kidney disease, as well as access to life-saving interventions, leading to disparate outcomes. This review will summarize the breadth of literature on social determinants of health in children with kidney disease worldwide and highlight policy-based initiatives that mitigate the adverse social factors to generate greater equity in pediatric kidney disease.
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16
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Impact of training nephrologists from developing nations and strategies for sustaining a training program in its fourth decade. Kidney Int 2021; 99:1073-1076. [PMID: 33711332 DOI: 10.1016/j.kint.2021.02.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 01/13/2023]
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17
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Moura-Neto JA. "To Be, or Not to Be" a Nephrologist: Students' Dilemma and a Strategy for the Field. Blood Purif 2021; 50:696-701. [PMID: 33503624 DOI: 10.1159/000513155] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022]
Abstract
The attractiveness of a career in nephrology has diminished over the past decades, leading to global concerns about the future of the specialty's workforce. The reasons physicians choose (and do not choose) a career in the field must be identified in order to boost recruitment of new nephrologists. In this article, a multilevel strategy is proposed to deal with the declining interest in the specialty: (1) increasing contact and providing early exposure to nephrology; (2) promoting mentoring and role models in medical schools; (3) improving the experience of trainees and medical students; (4) incorporating procedural skills and combined fellowship training with critical care in nephrology; (5) facilitating exchanges between trainees and young and senior nephrologists; (6) adopting an active approach to identify reasons for dissatisfaction, reduce burnout, and encourage a suitable work-life balance among nephrologists; (7) increasing remuneration; and (8) incentivizing advances in the field. Finally, a positive perspective for nephrology is presented to the next generation.
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18
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Okpechi IG, Ekrikpo U, Moloi MW, Noubiap JJ, Okpechi-Samuel US, Bello AK. Prevalence of peritonitis and mortality in patients with ESKD treated with chronic peritoneal dialysis in Africa: a systematic review. BMJ Open 2020; 10:e039970. [PMID: 33361076 PMCID: PMC7768975 DOI: 10.1136/bmjopen-2020-039970] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to report the prevalence of peritonitis and mortality in patients with end-stage kidney disease (ESKD) treated with chronic peritoneal dialysis (PD) in Africa. DESIGN Systematic review. SETTING Africa. PARTICIPANTS Patients with ESKD in Africa. INTERVENTIONS PD in its varied forms. PRIMARY AND SECONDARY OUTCOMES PD-related peritonitis rate (primary outcome), time-to-discontinuation of PD, mortality. DATA SOURCES Four databases, including PubMed, Embase, Web of Science and Africa Journal Online were systematically searched from 1 January 1980 to 31 December 2019. ELIGIBILITY CRITERIA Studies conducted in Africa reporting peritonitis rate and mortality in patients treated with PD. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted and synthesised the data using Microsoft Excel. The quality of included data was also assessed. RESULTS We included 17 studies from seven African countries representing 1894 patients treated with PD. The overall median age was 41.4 years (IQR: 38.2-44.7) with a median time on PD of 18.0 months (17.0-22.6). An overall median peritonitis rate of 0.75 (0.56-2.20) episodes per patient-year (PPY) was observed and had declined with time; peritonitis rate was higher in paediatric studies than adult studies (1.78 (1.26-2.25) vs 0.63 (0.55-1.87) episodes PPY). The overall median proportion of deaths was 21.1% (16.2-25.8). Culture negative peritonitis was common in paediatric studies and studies that reported combined outcomes of continuous ambulatory PD and automated PD. Both 1-year and 2-year technique survival were low in all studies (83.6% and 53.0%, respectively) and were responsible for a high proportion of modality switch. CONCLUSIONS Our study identifies that there is still high but declining peritonitis rates as well as low technique and patient survival in PD studies conducted in Africa. Sustained efforts should continue to mitigate factors associated with peritonitis in patients with ESKD treated with PD in Africa. PROSPERO REGISTRATION NUMBER CRD42017072966.
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Affiliation(s)
- Ikechi G Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, Nigeria
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Udeme Ekrikpo
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Uyo, Uyo, Nigeria
| | - Mothusi W Moloi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Botswana, Gaborone, Botswana
| | - Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Hassen M, Archer E, Pellizzon A, Chikte UME, Davids MR. Human resources for nephrology in South Africa: A mixed-methods study. PLoS One 2020; 15:e0228890. [PMID: 32053647 PMCID: PMC7018074 DOI: 10.1371/journal.pone.0228890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/24/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The global nephrology workforce is shrinking and, in many countries, is unable to meet healthcare needs. Accurate data pertaining to human resources in nephrology in South Africa is lacking. This data is critical for the planning and delivery of renal services and the training of nephrologists in South Africa to meet the challenge of the growing burden of chronic kidney disease. METHODS A cross-sectional study of adult and paediatric nephrologists currently delivering nephrology services in South Africa was conducted. Participants were identified using various data sources, including the register of the Health Professions Council of South Africa. This cohort of doctors was described in terms of their demographics and distribution. A survey was then conducted among these nephrologists to collect additional information on their training, scope of practice, job satisfaction, challenges and future plans. Finally, two focus group interviews were conducted to probe themes identified from the survey data. RESULTS A total of 120 adult nephrologists and 22 paediatric nephrologists were identified (an overall density of 2.5 per million population). There is a male predominance (66%) and the median age is 45 years. The bulk of the workforce (128 nephrologists, 92%) is distributed in three of the nine South African provinces, and two provinces have no nephrologist at all. The survey was completed by 57% of the nephrologists. Most reported positive attitudes to their chosen profession; however, 35 nephrologists (43%) reported an excessive workload, 9 (11%) were planning emigration and 15 (19%) were planning early retirement. A higher frequency of dissatisfaction regarding remuneration (39% vs. 15%) and unsatisfactory work conditions (35% vs. 13%) was observed amongst nephrologists working in the public sector compared to the private sector. A total of 13 nephrologists participated in the focus group interviews. The themes which were identified included that of a rewarding profession, an overall shortage of nephrologists, poor career planning, a need for changes to nephrologists' training, excessive workloads with inadequate remuneration, and challenging work environments. CONCLUSION There are insufficient numbers of nephrologists in South Africa, with a markedly uneven distribution amongst the provinces and healthcare sectors. Qualitative data indicate that South African nephrologists are faced with the challenges of a high workload, obstructive policies and unsatisfactory remuneration. In the public sector, a chronic lack of nephrologist posts and other resources are additional challenges. A substantial proportion of the workforce is contemplating emigration.
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Affiliation(s)
- Muhammed Hassen
- Division of Nephrology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Elize Archer
- Centre for Health Professions Education, Stellenbosch University, Stellenbosch, South Africa
| | - Adriano Pellizzon
- Division of Nephrology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Usuf M. E. Chikte
- Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Mogamat Razeen Davids
- Division of Nephrology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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20
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The European Society for Paediatric Nephrology study of pediatric renal care in Europe: comparative analysis 1998-2017. Pediatr Nephrol 2020; 35:103-111. [PMID: 31664556 DOI: 10.1007/s00467-019-04378-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/24/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In 1998, a survey of the European Society for Paediatric Nephrology (ESPN) revealed substantial disparities in pediatric renal care among European countries. Therefore, ESPN aimed at harmonizing renal care in all European countries in the following 20 years. In 2017, we conducted a survey to evaluate the current status of renal health policies for children in Europe. METHODS A 33-question web-based survey was designed and sent to presidents or representatives of national societies of pediatric nephrology in 44 European countries. RESULTS Data was reported from 42 (95.5%) countries. The number of pediatric nephrologists per million child population increased from 1998 to 2017 in 70% of countries. Pediatric dialysis facilities for acute kidney injury and end-stage kidney disease were available in 95% of countries. The availability of pediatric kidney transplantation increased from 55 to 93% of countries. Considerable variation was found in the current availability of allied health professionals, including psychosocial and nutritional support, high-tech diagnostic methods, and treatment with expensive drugs for children with kidney diseases between different European countries. CONCLUSIONS The 20-year follow-up analysis of pediatric renal care services in European countries revealed that pediatric nephrology has become a well-established subspecialty in pediatrics and nephrology in 2017. The ESPN will continue its efforts to further improve pediatric renal care for European children by harmonizing remaining disparities of renal care services.
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Zhu J, Feldman HA, Eugster EA, Fechner PY, Nahata L, Thornton PS, Chan YM. PRACTICE VARIATION IN THE MANAGEMENT OF GIRLS AND BOYS WITH DELAYED PUBERTY. Endocr Pract 2019; 26:267-284. [PMID: 31859552 DOI: 10.4158/ep-2019-0344] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: Delayed puberty is a common condition, and typical management includes "watchful waiting" and/or sex-steroid therapy. We sought to characterize treatment practices and to assess provider comfort with the management of delayed puberty in girls and boys. Methods: A national survey of pediatric endocrine providers assessed definitions of delayed puberty, practices around sex-steroid therapy, reasons for treatment, and comfort in managing delayed puberty in girls and boys. Results: Of 184 respondents (12% participation rate), 64% and 71% used the traditional age cutoffs for defining delayed puberty of 13 years for girls and 14 years for boys, respectively. Nearly half (45%) of providers would treat boys relatively earlier than girls, compared to 18% who would treat girls relatively earlier (P<.0001). Providers were more likely to cite bone density as a reason to treat girls and alleviating patient and parental distress, accelerating growth, and "jump starting" puberty as reasons to treat boys. Greater experience in endocrine practice was associated with greater comfort managing delayed puberty in both boys and girls. Approximately 80% of providers agreed that clinical guidelines are needed for the management of delayed puberty. Conclusion: There is a high degree of variability in the clinical management of delayed puberty, and our results suggest that providers are more hesitant to treat girls compared to boys and have different reasons for treating each. It remains to be determined if these discrepancies in treatment are justified by biologic differences between girls and boys or represent nonevidence-based disparities in care. Abbreviation: U.S. = United States.
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Vasylyeva TL, Díaz-González de Ferris ME, Hains DS, Ho J, Harshman LA, Reidy KJ, Brady TM, Okamura DM, Samsonov DV, Wenderfer SE, Hartung EA. Developing a Research Mentorship Program: The American Society of Pediatric Nephrology's Experience. Front Pediatr 2019; 7:155. [PMID: 31069203 PMCID: PMC6491803 DOI: 10.3389/fped.2019.00155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/02/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Most pediatric nephrologists work in academia. Mentor-mentee relationships provide support and guidance for successful research career. Mentorship program implementation is valuable in medical fields for providing research opportunities to young faculty. Methods: The American Society of Pediatric Nephrology (ASPN) established a research mentorship program to (a) assist with matching of appropriate mentor-mentee dyads and (b) establish metrics for desirable mentor-mentee outcomes with two independent components: (1) the grants review workshop, a short-term program providing mentor feedback on grant proposals, and (2) the longitudinal program, establishing long-term mentor-mentee relationships. Regular surveys of both mentors and mentees were reviewed to evaluate and refine the program. Results: Twelve mentees and 17 mentors participated in the grant review workshop and 19 mentees were matched to mentors in the longitudinal program. A review of NIH RePORTER data indicated that since 2014, 13 NIH grants have been awarded. Mentees in the longitudinal program reported that the program helped most with identifying an outside mentor, improving grant research content, and with general career development. Mentors perceived themselves to be most helpful in assisting with overall career plans. Email communications were preferred over phone or face-to-face communications. Mentees endorsed strong interest in staying in touch with their mentors and 100% of mentors expressed their willingness to serve in the future. Conclusion: This mentorship program was initiated and supported by a relatively small medical society and has shown early success in cultivating mentoring relationships for a future generation of clinician-scientists.
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Affiliation(s)
- Tetyana L Vasylyeva
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, TX, United States
| | - María E Díaz-González de Ferris
- UNC Transition Program, Manning Drive N.C. Children's Hospital, The University of North Carolina, Chapel Hill, NC, United States
| | - David S Hains
- Division of Pediatric Nephrology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jacqueline Ho
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lyndsay A Harshman
- Division of Pediatric Nephrology, Department of Pediatrics, University of Iowa Stead Family, Iowa City, IA, United States
| | - Kimberly J Reidy
- Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY, United States
| | - Tammy M Brady
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Daryl M Okamura
- Center for Developmental Biology and Regenerative Medicine, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | | | - Scott E Wenderfer
- Renal Section, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Erum A Hartung
- Division of Nephrology, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States
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Primack WA, Glenn DA, Meyers KE. Pediatric Nephrology Training Worldwide 2016: Quantum Educatus?. Kidney Int Rep 2016; 1:144-147. [PMID: 29142923 PMCID: PMC5678658 DOI: 10.1016/j.ekir.2016.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- William A. Primack
- Nephrology Division, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Dorey A. Glenn
- Nephrology Division, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Kevin E.C. Meyers
- Nephrology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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