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The study examines the effect of limiting the intake of phosphorus-containing food additives on serum phosphorus levels among patients with end-stage renal disease. Findings suggest educating patients to avoid phosphorus-containing food additives leads to modest improvements in hyperphosphatemia.

A study aims to determine the impact of informing resource-poor rural populations about entitled health and social services in India. The results concluded that informing the population enhanced delivery of health and social care services.

Quality improvement efforts may eliminate some disparities in medical care among different ethnic groups but not others. In a study of 58,700 patients with kidney failure who received dialysis, 87% of white patients and 84% of black patients received an adequate dose in 2000. In 1993, those figures were 46% and 36%, respectively. However, blacks and women were less likely to be treated for anemia than white men in both time periods.

It may not be a good idea to pay people to donate an organ such as a kidney while they are still alive. A survey of 305 people who had sold a kidney in India found that most experienced a decline in their health after the surgery and the money they received in exchange did not improve their standard of living. Seventy-nine percent said they would not recommend selling a kidney.

Doctors may be able to lower mortality rates in US dialysis patients by using a fistula or graft rather than a catheter, treating the patient more often, and increasing the duration of dialysis. US dialysis patients have the highest mortality rates in the industrialized world., Context Mortality rates among US hemodialysis patients are the highest in the industrialized world at 23% per year. Measures of dialysis dose (Kt/V) correspond strongly with survival and are inadequate in one sixth of patients. Inadequate dialysis is also associated with increased hospitalizations and high inpatient costs. Our previous work identified 3 barriers to adequate hemodialysis: dialysis underprescription, catheter use, and shortened treatment time. Objective To determine the effect of a tailored intervention on adequacy of hemodialysis. Design and Setting Community-based randomized controlled trial with recruitment from April 1999 to June 2000 at 29 hemodialysis facilities in northeast Ohio. Participants Forty-four nephrologists and their 169 randomly selected adult patients receiving inadequate hemodialysis. Intervention Nephrologists were randomly assigned to an intervention (n=21) or control (n=23) group. For patients in the intervention group (n=85), depending on the barrier(s) present, a study coordinator gave nephrologists recommendations about optimizing dialysis prescriptions, expedited conversion of catheters to surgically created grafts or fistulas, and educated patients about the importance of compliance with treatment time. Patients in the control group (n=84) continued to receive usual care. Main Outcome Measures Changes in Kt/V and specific barriers after 6 months. Results At baseline, intervention and control patients had similar Kt/V measurements, specific barriers, and demographic and medical characteristics. After 6 months, intervention patients had 2-fold larger increases in Kt/V compared with control patients (+0.20 vs +0.10; P Conclusions An intervention tailored to patient-specific barriers resulted in increased hemodialysis dose. Extending this approach to the 33000 persons in the United States receiving inadequate hemodialysis may substantially enhance patient survival, diminish hospitalizations, and decrease inpatient expenditures.

Dialysis patients in Germany and Japan are much less likely to have advance directives than American dialysis patients. Researchers surveyed 72 American nephrologists, 87 German nephrologists and 73 Japanese nephrologists. The American nephrologists had stopped dialysis for 5% of their patients, while the German nephrologists had withdrawn only 1.6% of their patients and the Japanese nephrologists only 0.7% of their patients. Only 0.3% of Japanese and German patients had advance directives compared to 30% of the American dialysis patients.

African Americans, the poor, and women with chronic kidney disease are less likely to enter and progress through the kidney transplant process than white people, men, and those in higher socioeconomic classes. Researchers compared 7,125 patients undergoing long-term kidney dialysis, most of whom would have benefited from transplantation of a cadaver organ. Blacks and the poor were significantly less likely to show clear interest in a transplant, receive a medical work, join the organ waiting list, or undergo transplantation. Only about 3% of patients not evaluated for surgery were medically ineligible for the procedure. The transplant system needs to address these barriers to increase transplantations among less-privileged groups.

Objective: To evaluate the association of community health indicators with outcomes for kidney transplant recipients. Design: Retrospective observational cohort study using multivariable Cox proportional hazards models. Setting: Transplant recipients in the United States from the Scientific Registry of Transplant Recipients merged with health indicators compiled from several national databases and the Centers for Disease Control and Prevention, including the National Center for Health Statistics, the Behavioral Risk Factor Surveillance System, and the National Center for Chronic Disease Prevention and Health Promotion. Patients: A total of 100 164 living and deceased donor adult (aged⩾18 years) kidney transplant recipients who underwent a transplant between January 1, 2004, and December 31, 2010. Main OutcomeMeasures: Risk-adjusted time to posttransplant mortality and graft loss. Results: Multiple health indicators from recipients' residence were independently associated with outcomes, including low birth weight, preventable hospitalizations, inactivity rate, and smoking and obesity prevalence. Recipients in the highest-risk counties were more likely to be African American (adjusted odds ratio, 1.59, 95% CI, 1.51-1.68), to be younger (aged 18-39 years; 1.46; 1.32-1.60), to have lower educational attainment (

A response by Ashwini R. Sehgal, Catherine Sullivan, and Srilekha S. Sayre to a letter to the editor about their article "Effect of Food Additives on Hyperphosphatemia Among Patients With End-Stage Renal Disease: A Randomized Controlled Trial" in the 2009 issue is presented.