Fistula First Controversy
In 2003, the Fistula First Initiative was enacted, in which an attempt is actively being made to get as many dialysis patients as possible to get dialyzed via an AV fistula. As AV fistulas have been perceived to…
Measuring Adequacy
Dialysis adequacy is traditionally measured as either Kt/V (most popular in outpatient dialysis units) or urea reduction ratio (URR, most popular with acute dialysis/inpatient dialysis units). Both methods use the degree to which urea is cleared–by comparing the…
First Use Syndrome
I have never seen “First Use Syndrome” firsthand, but it usually comes up as a topic when discussing “Complications of Dialysis.” It refers to a severe IgE-mediated anaphylactoid reaction which occurs during the first use of a dialyzer,…
Lithium as a dialyzable toxin
Lithium is one of the classic dialyzable toxins, as it is very small (atomic # of 3) and elevated Li levels (>2.5 meq/L) may result in tremor, ataxia, vomiting, seizures, or even coma. However it is somewhat unique…
High Flux versus Hemofiltration
There has been a lot of attention these days regarding increasing “middle molecule clearance”, a topic already covered previously here. Certainly it is well-established that buildup of beta-2-microglobulin can lead to a dialysis-derived form of amyloidosis, and it…
The Latest on FGF23
There has been a lot of buzz surrounding the recent NEJM article by Gutiérrez (a recently graduated fellow from my program!) et al regarding the potential role of measuring FGF23 levels as an important biomarker in patients with…
Beta-2 Microglobulin Amyloidosis
The two major forms of amyloidosis are AL amyloidosis (in which light chains form the amyloid deposits) and AA amyloidosis (in which a variety of inflammatory molecules may adopt a beta-pleated structure to deposit as amyloid. A specific…
The Hemodialysis Prescription
This is probably fairly basic to many renal fellows already, but the Hemodialysis Prescription is an integral part of any nephrologist’s routine. The hemodialysis prescription should specify the following: 1. The dialyzer being used. These days, most dialysis…
Starfruit Toxicity
Starfruit (Averrhoa carambola) is a popular tropical fruit in numerous countries of Asia and South America, and is increasing found in Western countries as well. Why am I writing about this on the Renal Fellow Network? It turns…
Hemolysis-with-Dialysis
Hey, it rhymes! One of the rare but potentially severe complications seen with hemodialysis is intravascular hemolysis. There is an interesting differential diagnosis of what might cause dialysis-associated hemolysis, many of which have to do with contamination of…