Infectious metastases (e.g., infective endocarditis, epidural abscess, liver & lung abscesses, etc) are unfortunately not uncommon in the ESRD population, particularly in those with in-dwelling catheters. I have personally seen several cases of epidural abscesses as a fellow,…
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…
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…
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,…
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…
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…
The DCOR Trial was a Genzyme-funded randomized control trial–somebody recently told me the largest ever conducted in a dialysis population–designed to compare the phosphate binder sevelamer (Renagel) with Ca-containing phosphate binders (calcium acetate a.k.a. Phoslo or calcium carbonate)….
We are all familiar with “uremic pericarditis” as one of the standard indications for initiating dialysis, and the number of physical exams with a negative cardiac rub I have documented this year is truly impressive. Which is why,…
The man on the left is Victor Gura, one of the authors on a 2007 Lancet paper demonstrating the efficacy of the wearable artificial kidney (WAK). The machine (which can perhaps be likened to deluxe version of Batman’s…
The situation: a 53 year old ESRD patient shows up with vomiting. She is normally dialyzed Monday, Wednesday and Friday and now [ Her Na level is 111. What to do? There are several reports of central pontine…
