ASN 2021: Emerging Research from Days 1 & 2 of the Annual Meeting

The 2021 American Society of Nephrology (ASN) Annual Meeting began with a diverse selection of sessions and posters exploring the latest research in the field. Below are some of the updates from days 1 and 2 of the conference.

ASN President’s Address

Kicking off the 2021 conference was an address given by Dr. Susan Quaggin, the President of ASN. She began by noting that amid the onset of the COVID-19 pandemic, kidney disease has been overlooked as a global public health crisis. But since kidney disease affects 850 million people worldwide—many of whom don’t know they have it—Dr. Quaggin argued that kidney disease can no longer be ignored.

In fact, she urged attending nephrologists that now is the time to take the lessons learned from the COVID-19 pandemic and apply them to kidney disease. Over the past year, medicine and science have come together to collaborate on a public health crisis, which is why Dr. Quaggin believes the same can be done for kidney disease so that advancements and innovations can continue to be uncovered to help improve the lives of patients.

But since that collaboration and other various efforts to promote kidney health don’t come without their own unique set of challenges, Dr. Quaggin gave the following three calls to action:

• Move innovation to implementation: According to Dr. Quaggin, clinical trials are irrelevant if the treatments they uncover aren’t given to patients. That’s why she encouraged attending nephrologists to prescribe new treatments and encourage patients to enroll in trials so even more can be uncovered.
• Resolve health injustice: Regardless of what advancements are uncovered, Dr. Quaggin argued that they will fail unless all patients have equal access to them. While the COVID-19 pandemic shed a light on health disparities, a spotlight needs to remain on social justice, especially since Black patients have a four-fold higher risk of kidney failure.
• Remember who the kidney community is: Dr. Quaggin asked her colleagues to recall the fact that nephrology as a specialty was built on innovation. Nephrologists, for instance, were the first to successfully transplant an organ, and now they can continue to transform the field and give hope to patients living with kidney disease.

To conclude, Dr. Quaggin noted that despite all the challenges that may be encountered, it’s up to all nephrologists to make it known that kidney disease matters and to encourage collaboration with researchers, societies, organizations, and patients so that the field can continue to evolve and improve patients’ lives.

Psychosocial Aspects of Chronic Kidney Disease

Psychosocial issues are often overlooked when treating patients with advanced or chronic kidney disease (CKD), but this is an important concern when it comes to the overall health and well-being of these patients. The “Psychosocial Aspects of CKD” session brought these issues to the forefront.

Moderated by Dr. Scott Cohen from George Washington University and Dr. Jennifer Scherer from the NYU Grossman School of Medicine, this session featured a panel of experts who all spoke about this important topic. Here’s a quick recap of a few presentations.

Psychological Aspects of Kidney Disease

First up was Dr. Daniel Cukor from the Rogosin Institute in NYC. According to recent data, there’s a high prevalence of psychological disorders among patients with kidney disease. To gain a better understanding of why that is, Dr. Cukor cited four models and strategies nephrologists can use to support these patients:

1. Coping: This refers to how patients interpret whether they have the power, ability, or resources to respond or adjust to a particular event or challenge. The greater the threat or challenge is, the larger the coping response must be, and patients with kidney disease have many challenges to cope with, such as illness/treatment changes, roles/relationship changes, lifestyle changes, and future plan changes. To help these patients, Dr. Cukor recommended various resources like patient-centered team meetings, support groups, and family counseling sessions.

1. Cognitive-Behavioral Model: According to Dr. Cukor, believing bad things are internal, global, and stable are all hallmarks of depressive thinking, which can then in turn affect a patient’s behaviors and feelings. For these patients, Dr. Cukor discussed the benefits of cognitive restructuring and existential coaching.

1. Learned Helplessness: This refers to the idea that passive behavior is produced by exposure to unavoidable aversive events. For instance, if a dialysis patient’s life primarily consists of waking up, prepping for dialysis, receiving it, and recovering from it, the enjoyable things in life might start to become less rewarding. That’s why patient engagement, motivational interviewing, treatment for depression—whether it’s pharmacological or non-pharmacological—and scheduled activities are recommended by Dr. Cukor.

1. Symptom Burden: According to a recent survey of 162 dialysis patients, symptom burden affects 50 percent of patients, and some of those interconnected burdens include sleep difficulty, depression, pain, sexual dysfunction, and anxiety. Due to this, it’s important to view and target symptoms as clinical entities worth treating and not merely as comorbidities. If that’s done, Dr. Cukor believes that positive cycles can develop.

Pharmacotherapy for Pain Syndromes in Advanced CKD

Up next to focus on pain as one of the most common aspects of symptom burden was Dr. Holly Koncicki from Mount Sinai Hospital. Recent data has shown that chronic pain, which is defined as pain lasting for 3 months or longer, is more prevalent in dialysis patients than in the general population (50 percent compared to 45 percent, respectively).

However, despite the prevalence of chronic pain, Dr. Pinsinky noted that providers tend to underreport the majority of symptoms. Not only that, but the severity of pain is underestimated in 63 percent of cases, and 74 percent of end-stage kidney disease (ESKD) patients with moderate to severe pain are undertreated.

Given these gaps in care, Dr. Pinsinky discussed the importance of accurately assessing a patient’s pain. This involves not only determining if it’s nociceptive or neuropathic, but also evaluating total pain, which includes physical, psychological, social, and spiritual pain.

Once a patient’s pain is assessed, Dr. Pinsinky recommends taking the following steps: follow the World Health Organization’s Analgesic Ladder, work with patients to set expectations of treatment, follow up with them, and monitor for side effects.

Behavioral Health Approach to Substance Abuse Disorders in Kidney Diseases

A third presentation in this session featured Dr. Teri Browne from the University of South Carolina. Dr. Browne began by showing how the prevalence of substance use disorders (SUDs), overdose deaths, and alcohol consumption have all increased during the COVID-19 pandemic, which is especially concerning for nephrologists.

SUDs can directly and independently lead to acute kidney injury (AKI) and kidney failure, as well as play a role in contributing to CKD. High use of alcohol and alcoholism can also increase the risk for AKI, CKD, and ESKD.

And when it comes to patients who have already been diagnosed with kidney diseases, Dr. Browne noted that as many as 19 percent of hemodialysis patients also have a SUD, and 27.6 percent of hemodialysis patients scored positively for alcoholism.

Considering the high prevalence and impacts of SUDs and alcohol use, Dr. Browne then discussed a behavioral health integration tool called SBIRT, an evidence-based approach to assessing and intervening with SUDs and alcohol use. SBIRT stands for:

• Screening: Universally assess patients’ use and severity of SUDs
• Brief Intervention: Hold an awareness-raising intervention with patients who engage in high-risk behaviors
• Referral to Treatment: Refer those patients with SUDs to specialty care

Together, the presentations in this session stressed the importance of treating all aspects of kidney disease, especially considering the high prevalence of psychological disorders in this patient population.

Predictors of Response to SARS-CoV-2 Vaccines Among Maintenance Dialysis Patients

The efficacy of the SARS CoV-2 vaccines in the general population is proven to be high. But how well does it protect maintenance dialysis patients? And do maintenance dialysis patients respond differently to specific vaccines?

To study the effects of the vaccines on vulnerable maintenance dialysis patients, seroresponse to the vaccine was analyzed in 1,352 subjects. 74 percent of the patients had a serologic response to the vaccine, but the results varied depending on the type of vaccine that was administered.

94 percent of mRNA 1273/Modern recipients had a serologic response, compared to 81 percent of BNT162b2/Pfizer recipients and 22 percent of Ad26.COV.S/Janssen recipients. Patient metrics such as age, lack of hepatitis B immunity, immune-modulation medication, lower serum albumin, and COPD contributed to the vaccine non-response.

Based on the findings, researchers highly recommend the vaccines to the vulnerable population. The outlier results of the Janssen vaccine justify closer study, as does the use of booster vaccines, yet the overall serologic response rate of the COVID-19 vaccines shows significant protection for maintenance dialysis patients.

A New Epidemiological Methodological Approach Using Machine Learning in Prevalence Estimation of CKD

A precise method of predicting chronic kidney disease (CKD) in patients can enhance treatment options and provide a deeper understanding of the disease and the people it affects the most. While pinpointing the exact prevalence of CDK in the general population is challenging, machine learning may provide new insight and more reliable statistics.

To determine if current estimates of CKD prevalence can be fine-tuned and more accurately forecasted by using AI and machine learning, a study was conducted using two sources of data: LDP (Longitudinal Patient Data) and LRx (Lifeline Treatment Dynamics). LDP included 191,905 patients receiving CKD specific medication. 1.9 percent of these patients were diagnosed with CKD, dialysis, or kidney transplant status. A machine learning algorithm analyzed the data, and using gradient boosting, generated a CKD prediction model.

The prediction model was then applied to LRx, a data pool of 40 million subjects based on a representative panel of 45 percent of all French metropolitan retail pharmacies. A rules-based algorithm was used, focused on erythropoietin delivery for renal conditions and keto-analog.

The number of CKD patients was calculated based on the algorithm metrics, resulting in 269,183 CKD patients in LRx. 40.8 percent of the subjects were women, and the mean age was 77.0 years (±11.1).

These results show machine learning has become a helpful tool for distinguishing new, more reliable CKD indicators.