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1. Acute kidney injury not associated with worsening kidney function in persons with CKD
Findings suggest kidney disease observed after AKI often present before injury
Abstract: https://www.acpjournals.org/doi/10.7326/M22-3617
URL goes live when the embargo lifts
A study of hospitalized persons with chronic kidney disease (CKD) fournd that acute kidney injury (AKI) did not predict worsening of kidney function trajectory once difference in pre-hospitalization characteristically were fully accounted for. Instead, the authors suggest that much of determinants of faster kidney disease decline observed after AKI may already be present before AKI. The findings are published in Annals of Internal Medicine.
Many now believe that AKI is an independent risk factor for accelerated loss of kidney function. This has led to changes in research focus, practice patterns, and public health targets. However, prior studies associating AKI with more rapid subsequent loss of kidney function had methodological limitations, including inadequate control for differences between patients who had AKI and those who did not.
Researchers from the University of California, San Francisco and colleagues in the Chronic Renal Insufficiency Cohort (CRIC study) analyzed data from 3,150 persons with CKD to determine whether AKI is independently associated with subsequent kidney function trajectory. The data showed 612 AKIs in 433 persons with CKD over a median follow-up of 3.9 years. After adjusting for patient characteristics, such as prehospitalization estimated glomerular filtration rate (eGFR) slope and level of proteinuria, AKI did not predict worsening of subsequent kidney function trajectory. Instead, the authors highlight that their results show that much of the kidney disease observed after AKI may already be present before AKI. They recommend that clinicians instead focus on flattening the eGFR slope and treating proteinuria. The authors do acknowledge that a diagnosis of AKI does present an opportunity to identify high-risk patients and implement evidence-based interventions to slow CKD progression.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with a corresponding author, please email Suzanne Leigh at Suzanne.Leigh@ucsf.edu.
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2. SCUBA divers with PFO at higher risk for decompression illness than previously thought
High-risk divers should consider refraining from diving or adhering to conservative protocols
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0260
URL goes live when the embargo lifts
A study of a cohort of SCUBA divers has found that the presence of high-risk patent foramen ovale (PFO), or a hole in the heart, was associated with an increased risk of decompression illness (DCI), also commonly known as the bends. The authors recommend that divers with high-risk PFO should consider either refraining from diving or adhering to a conservative diving protocol. The findings are published in Annals of Internal Medicine.
DCI is a disease in which inhaled nitrogen is dissolved in tissues or blood under a high pressure during a diver’s descent and subsequently forms gas bubbles while they rise, mechanically affecting the tissue or inhibiting blood flow. A PFO enables venous nitrogen bubbles to embolize into the arterial system. In previous studies, a higher prevalence of PFO was seen in divers who experienced DCI than in those whodid not. However, the association between PFO and DCI remains uncertain given the very low prevalence of DCI compared with the high prevalence of PFO.
Researchers from Sejong Hospital, Bucheon, South Korea conducted a prospective cohort study of 100 experienced divers who did more than 50 dives per year. Participants had transesophageal echocardiography with a saline bubble test to determine the presence of a PFO and were subsequently divided into high- and low risk groups. They were followed up using a self-reported questionnaire while blinded to their PFO status. The authors report that 12 of 68 divers with PFO (10 of 37 divers with high-risk PFO) experienced DCI. These findings suggest that divers with high-risk PFO are more susceptible to DCI than has been previously reported. According to the authors, their findings also suggest that DCI events with mild symptoms occurred frequently in divers with PFO, and many divers did not recognize them as DCI.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with a corresponding author, please email untouchables00@hanmail.net.
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3. Early COVID-19 pandemic not associated with significant physician turnover
Abstract: https://www.acpjournals.org/doi/10.7326/M22-2504
URL goes live when the embargo lifts
An analysis of Medicare billing has found that physician turnover rates between 2010 and 2020 had both periods of increase and stability, with annual turnover rising from 5.3% to 7.6% (43%), between 2010 and 2018. However, early data covering the first three quarters of 2020 did not show that the early COVID-19 pandemic caused significant physician turnover. The analysis is published in Annals of Internal Medicine.
Medical groups, health systems, and professional associations are concerned about increases in physician turnover. Although physicians may turn over—move to a new practice or stop practicing—for many reasons, increasing turnover rates may suggest growing dissatisfaction with the practice of medicine or with the organization in which a physician practices. There are no national estimates of physician turnover, so it is not known whether turnover has increased, as is sometimes assumed.
Researchers from Weill Cornell Medical College and University of California San Diego analyzed 100% of traditional Medicare billing to create national estimates of physician turnover. Standardized turnover rates were compared by physician, practice, and patient characteristics. The authors found that the annual rate of turnover increased from 5.3 percent to 7.2 percent between 2010 and 2014, was stable through 2017, and increased again in 2018 to 7.6 percent. According to the authors, the main driver of the increase between 2010 and 2014 came from physicians who stopped practicing. The authors also found that in the second and third quarters of 2020, quarterly turnover was slightly lower than in the corresponding quarters of 2019. The authors note that there were higher rates of turnover among rural and female physicians as well as physicians who saw a large portion of dual-eligible-patients.
Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Amelia M. Bond, PhD, please contact Christine Zuang at chz4003@med.cornell.edu.
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Also published in this issue:
Atrial Fibrillation
Sana M. Al-Khatib, MD, MHS
In The Clinic
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0444
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