RPA and ESRD networks launch kidney patient safety initiative, including a new website.

Kidney Patients Safety: he web site aims to provide information and best practices to prevent the occurrence of the Five Adverse Patient Safety Events identified through patient and professional surveys that form the core of the site. Keeping Kidney Patients Safe also assists nephrology professionals in meeting the quality assessment and performance improvement (QAPI) portion of the Centers for Medicare and Medicaid Services (CMS) Conditions for Coverage for End Stage Renal Disease Facilities. Links to other patient safety resources, a patient safety improvement program toolkit and articles spotlighting various safety improvement programs and other resources are also offered to nephrology professionals.

The Declaration of Istanbul on Organ Trafficking and Transplant Tourism

Organ commercialism, which targets vulnerable populations (such as illiterate and impoverished persons, undocumented immigrants, prisoners, and political or economic refugees) in resource-poor countries, has been condemned by international bodies such as the World Health Organization for decades. Yet in recent years, as a consequence of the increasing ease of Internet communication and the willingness of patients in rich countries to travel and purchase organs, organ trafficking and transplant tourism have grown into global problems. For example, as of 2006, foreigners received two-thirds of the 2000 kidney transplants performed annually in Pakistan.

The Istanbul Declaration proclaims that the poor who sell their organs are being exploited, whether by richer people within their own countries or by transplant tourists from abroad. Moreover, transplant tourists risk physical harm by unregulated and illegal transplantation. Participants in the Istanbul Summit concluded that transplant commercialism, which targets the vulnerable, transplant tourism, and organ trafficking should be prohibited. And they also urged their fellow transplant professionals, individually and through their organizations, to put an end to these unethical activities and foster safe, accountable practices that meet the needs of transplant recipients while protecting donors.

Countries from which transplant tourists originate, as well as those to which they travel to obtain transplants, are just beginning to address their respective responsibilities to protect their people from exploitation and to develop national self-sufficiency in organ donation. The Declaration should reinforce the resolve of governments and international organizations to develop laws and guidelines to bring an end to wrongful practices. "The legacy of transplantation is threatened by organ trafficking and transplant tourism. The Declaration of Istanbul aims to combat these activities and to preserve the nobility of organ donation. The success of transplantation as a life-saving treatment does not require—nor justify—victimizing the world's poor as the source of organs for the rich" (Steering Committee of the Istanbul Summit).

Consistent Control of Mineral and Bone Disorder in Incident Hemodialysis Patients

Background and objectives: In 2003, the National Kidney Foundation introduced guidelines for the control of parathyroid hormone, calcium, and phosphorus in hemodialysis patients.

Design, setting, participants, & measurements: A cohort study was conducted of 22,937 incident hemodialysis patients who were identified from a large national provider between July 1, 2000, and June 30, 2002, and followed through June 30, 2004. Consistent achievement was determined (1) as the simultaneous control of multiple markers over time and (2) as the time in target for each marker during the first year of dialysis. Mortality risk was assessed with Cox proportional hazards models.

Results: In the simultaneous control analysis, patients who achieved target for none of the markers had a 51% greater risk for death than those who achieved target for all three markers (reference group). Patients who achieved any target for any single marker had a 35 to 39% higher risk for death, and patients who achieved target for any two of the three markers had a 15 to 21% higher risk for death compared with the reference group. In the time in target analysis, patients with parathyroid hormone in target for 4 quarters had a 25% lower risk for death compared with those who did so for ≤1 quarter (reference group). Patients with calcium in target for 4 quarters had a 14% lower risk, and patients with phosphorus in target for 4 quarters had a 38% lower risk.

Conclusions: Consistent control of the markers of bone metabolism and disease within published targets is a strong predictor of survival in hemodialysis patients.

Genetic data stored at NIH temporarily withdrawn due to privacy concerns raised by new method of forensic SNP analysis

New Scientist: Participants in such "genome-wide association" studies have been told that it was impossible to gain any information about individuals from these summary statistics. So after being informed about Craig's method, the NIH last week decided to remove summary data from its genome-wide association studies from the web (see the NIH statement, pdf format). Britain's Wellcome Trust, and the Broad Institute in Cambridge, Massachusetts, also took steps to remove their summary data from public view. "NIH did the right thing in applying the precautionary principle," says Kathy Hudson, director of the Genetics and Public Policy Center in Washington DC.

Cause-specific Mortality of Dialysis Patients After Coronary Revascularization: Why Don't Dialysis Patients Have Better Survival After Coronary Intervention?

Why is mortality risk after coronary intervention significantly higher for dialysis patients? Authors of this retrospective review share study results and suggest strategies to improve the problem.
Nephrology Dialysis Transplantation