The PPI Paradox

Millions of people take long-term proton pump inhibitors for acid-related GI complaints. These agents are very effective and appear to have an excellent safety profile. However, they may also have interesting effects on calcium and phosphate balance that…

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Board question of the week: PD-1

A 55-year-old woman with ESRD secondary to lupus nephritis presents to the PD clinic with volume overload. She reports decreased UF volume, despite the use of 4.25% dextrose exchanges over the last few weeks. She has been on…

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Follow the patient, not the number

As a nephrology fellow, I find it somewhat challenging to follow a patient with advanced CKD (eGFR, MDRD 8-10). However, I do find this process rewarding as it truly allows for the establishment of a substantial relationship with…

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Cisplatin induced hyponatremia; looking deeper

Cisplatin based therapy for the treatment of solid organ tumors is commonly associated with several renal abnormalities including; *hypokalemia*hypomagnesemia*hypocalcemia*hypophosphatemia*fanconi-like syndrome*acute kidney injury We have all seen these complications on the renal consult service at least once. However, less…

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ACE inhibitors and PD

Back to the subject of ACE inhibitors again. There are a number of reasons why ACEi might be particularly beneficial for patients on PD and two recent editorials in KI and CJASN laid these out very well. 1….

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Achilles heel of dialysis

Vascular access is the Achilles tendon of hemodialysis. Just yesterday, I saw a patient with one of those lumbar catheters… Examining his arm revealed that he had failed 4 attempts of access creation (2 fistulas and 2 grafts)….

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