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The perils of Gabapentin

One of the things that I always highlight when teaching fellows and residents is the importance of appropriate drug dosing for patients on dialysis and one of the drugs that is most often inappropriately dosed in my experience…

ESRD Quality Incentive Program

Quality Incentives for ESRD Care Reimbursing physicians based on the quality of care they provide is not a new idea. In the 1700s B.C. in ancient Babylon, Hammurabi’s Code stated “If a physician operates on a man for…

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Hyponatremia and ESRD

Hyponatremia can be seen in patients with end-stage renal disease (ESRD), often as a consequence of a patient’s increase in free water intake in the setting of the kidneys’ diminished ability to regulate sodium and water homeostasis. I…

Spironolactone Revisited

As a renal fellow, I have found myself reaching for spironolactone more and more. It is very helpful when treating the patient with resistant hypertension, but it continues to be under-utilized. Aside from the renal-centric effects of aldosterone,…

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Live Kidney Donation: What’s the risk?

As ESRD prevalence continues to increase, the kidney transplant list continues to grow meaning longer waiting times for deceased donor transplantation. Living donation (LD) provides the best outcomes for patients with ESRD and is considered safe for the…

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The Brave New World of Renal ACOs

This past week CMS announced the formation of a new form of payment and service delivery for patients with ESRD – the ESRD Seamless Care Organization (ESCO) – essentially an ACO specifically and exclusively for individuals with ESRD….

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Bundling Redux

Here’s an update on the recent financial upheaval in the world of dialysis reimbursement. The expanded bundling payment system was officially implemented in January 2011, and most dialysis units have now switched over to this new billing practice….

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