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…
Amazing Dialysis Biker
Wow. In case you hadn’t heard the news, Shad Ireland, a 37 year-old dialysis patient, recently completed a cross-country bike trip which involved cycling from California to Washington, DC. Mr. Ireland has been on dialysis for 27 years,…
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…
GI Bleeding in ESRD Patients
While the GI & renal systems are not typically linked together, there are a few aspects to managing a GI Bleed in patients with CKD/ESRD which are somewhat unique. For instance, angiodysplasias in the stomach, duodenum and…
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…
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…
3 Key Facts Regarding Catheter-Related Bacteremia
The following “3 Key Facts Regarding Catheter-Related Bacteremia” are taken from Eliot Heher’s “MGH Nephrology Handbook” distributed to nephrology fellows every year which I find very helpful: Fact #1: Fever and chills are highly predictive of positive blood…