Dialysis billing

Why do we write notes in the chart day after day? Why does the chart even exist? In my mind, the main function of the medical chart (and progress notes) is communication: charting allows physicians (and other members…

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SGLT Inhibitors

A promising new class of oral hypoglycemic agents for type 2 diabetes, the SGLT inhibitors, are on the horizon. As they work on the kidney, and potentially have renal side effects, it may be helpful to review them….

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Opiates in advanced renal failure

I was taught the rule of 6’s when it came to using opiates in dialysis patients: they’re metabolized by hepatic glucuronidase to 6-glucurinides (e.g. morphine 6 glucuronide or M6G) these metabolites are renally excreted, increasing the half-life to…

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Thiazide Diuretics

There is a good review article in this month’s NEJM entitled “Use of Diuretics in Patients with Hypertension” by Ernst and Moser which focuses predominantly on the thiazide class of diuretics. The thiazides are considered a FUNCTIONAL rather…

Happy Thanksgiving

One of the things I was definitely grateful for at this year’s Thanksgiving table: I’m not on-call and can spend the holiday with my family! Best wishes to those renal fellows working hard on this holiday. Poll Results…

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Transplant Nephrectomy

In my experience, it’s unusual to perform a transplant nephrectomy in a patient who has returned to dialysis in the absence of a ‘hard’ indication such as macroscopic hematuria or severe symptoms suggestive of rejection or infarction. There…

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