Bundling
It’s a hot topic amongst dialysis centers around the country: bundling. Here’s my attempt to explain it in a brief manner. If anybody has corrections or comments about this explanation, feel free to make them known. With the…
The Four Types of Immune Sensitivity Reactions & Renal Examples for Each
Basic Clinical Immunology: there are four types of hypersensitivity reactions. Below is a listing of all four types and, since this is a Nephrology Blog, renal examples for each one. Type I Immune Reaction (anaphylactic): Type I hypersensitivity…
When To Refer For Dialysis Access?
Despite the knowledge that AV fistulas and grafts give superior outcomes when compared to dialysis catheters, there remain a large chunk of patients who begin dialysis without a fistula or graft. Conversely, there are also examples of “unnecessary…
Prophylactic Hemodialysis for IV Contrast Exposure?
The issue comes up all the time: you try and set up one of your ESRD patients for a procedure requiring iv contrast, such as a cardiac catheterization or a PE-protocol CT scan. You get a call from…
Sudden cardiac death rates in ESRD patients
The case against Sunday As A Day Of Rest For the Dialysis Unit: this older study (Bleyer et al, Kidney International 1999) looked at sudden death amongst ESRD patients according to days of the week using data from…
Why Do U.S. ESRD Patients Do So Poorly?
The Dialysis Outcomes and Practice Patterns Study (DOPPS) is an important longitudinal study of ESRD patients in multiple countries, and is the source of much respected epidemiologic data on dialysis patients worldwide. Interestingly, the DOPPS estimated the crude…
AAMI…What You Wanna Do?
For a while, maybe longer if I do…. No, I’m not talking about the one-hit wonder song “Amy” by Pure Prairie League…I’m talking about AAMI (the Association for the Advancement of Medical Instrumentation), the organization which regulates water…
Why doesn’t this catheter work?
Dialysis catheters: the bane of the renal fellow’s existence. I’m sure there are some of you who actually like putting in catheters and are quite good at it, and while I will admit that an efficient line placement…
Aggrenox for Maintaining AV Graft Patency?
A very significant percentages of ESRD patient admissions derive from clotted dialysis access–the “lifeline” dialysis patients require in order to survive on dialysis. Any maneuver or treatment which is successful in preventing, or even delaying, access thrombosis would…
Dialysis in the Elderly
The rate of patients >75 years of age initiating dialysis has grown substantially in the U.S. over the past two decades. This has to do with several factors, including improvements in medical technology enabling people to live long…