How California Prepared for Implementation of Physician-Assisted Death: A Primer.

Physician-assisted death is now legal in California, and similar laws are being considered in many other states. The California law includes safeguards, yet health care providers will face practical and ethical issues while implementing physician-assisted death that are not addressed by the law. To help providers and health care facilities in California prepare to provide optimal care to patients who inquire about physician-assisted death, we brought together experts from California, Oregon, and Washington.

Creating A Nationwide Nonpartisan Initiative for Family Caregivers in Political Party Platforms.

Policymakers have been slow to support family caregivers, and political agendas mostly fail to address the cost burdens, impact on employment and productivity, and other challenges in taking on long-term care tasks. This project set out to raise policymakers' awareness of family caregivers through proposals to Republican and Democratic party platforms during the 2016 political season. The Family Caregiver Platform Project (FCPP) reviewed the state party platform submission process for Democratic and Republican parties in all 50 states and the District of Columbia.

Blood pressure control in dialysis patients.

Hypertension is present in most patients on hemodialysis, and evidence suggests that it is not well controlled. In this review we discuss the pathogenesis of hypertension in these patients and the reasons that short-duration, intermittent hemodialysis makes blood pressure treatment especially difficult. We provide suggestions for targeting volume management as a basis for optimal hypertension treatment.

The Middle Molecule Hypothesis Revisited. Should Short, Three Times Weekly Hemodialysis Be Abandoned?

When the middle molecule (MM) hypothesis was formulated in 1975, no MM had yet been identified as a uremic toxin. Meanwhile, the birth and implementation of the Kt/V concept gained wide acceptance and has remained the world standard for assessing dialysis adequacy. However, over the past 20 years, accumulating evidence has made it clear that MM's are important uremic toxins, and that the dose of dialysis based on removal of small molecular substances does not protect against excessive hemodialysis mortality, morbidity, or the presence of uremic signs and symptoms.

The Case for Every-Other-Day Dialysis.

Until daily dialysis becomes widely available, we believe that hemodialysis patients would benefit enormously from every-other-day dialysis (EODD), which may be implemented both by home patients and in centers. Benefits of EODD over the routine, three-times-weekly schedule would include decreased mortality after the weekend interval without dialysis; increased weekly dose of dialysis, resulting in better rehabilitation; and improved blood pressure control.

Blood pressure control in dialysis patients: importance of the lag phenomenon.

Failure by the world dialysis community to understand and use the dry-weight method of blood pressure (BP) control has resulted in an increasing incidence of treatment-resistant hypertension, which remains the principal cause of cardiovascular morbidity and mortality. This failure may in part be because the relationship between the extracellular volume (ECV) and BP is not simple and linear, but complex, because of a lag of several weeks between the normalization of the time-averaged ECV and the decrease in BP. Another cause for this failure may be the unwillingness to taper and stop all antihypertensive medications during the transition from hypertension to normotension.