Quality Improvement Initiative to Increase Modality Education in a Nephrology Clinic During the COVID-19 Pandemic.

Low attendance by patients with advanced chronic kidney disease (CKD stage 4 and 5) to the kidney replacement therapy (KRT) education sessions was noted by our nurse practitioners at a safety net hospital. The main outcome measure was the weekly percentage of patients with advanced CKD seen by the nephrology division weekly that completed KRT education. Process measures were weekly KRT session attendance by scheduled patients and the weekly referral of patients to KRT education sessions.

Behavioral stage of change and dialysis decision-making.

Background And Objectives: Behavioral stage of change (SoC) algorithms classify patients' readiness for medical treatment decision-making. In the precontemplation stage, patients have no intention to take action within 6 months. In the contemplation stage, action is intended within 6 months.

Travel distance and home dialysis rates in the United States.

Introduction: Rural residence is associated with increased peritoneal dialysis (PD) utilization. The influence of travel distance on rates of home dialysis utilization has not been examined in the United States. The purpose of this study was to determine whether travel distances to the closest home and in-center hemodialysis (IHD) facilities are a barrier to home dialysis.

Neighborhood socioeconomic status and barriers to peritoneal dialysis: a mixed methods study.

Background And Objectives: The objective of this study was to evaluate the association between neighborhood socioeconomic status and barriers to peritoneal dialysis eligibility and choice.

Design, Setting, Participants, & Measurements: This study was a mixed methods parallel design study using quantitative and qualitative data from a prospective clinical database of ESRD patients. The eligibility and choice cohorts were assembled from consecutive incident chronic dialysis patients entering one of five renal programs in the province of Ontario, Canada, between January 1, 2004 and December 31, 2010.

An international perspective on peritoneal dialysis among indigenous patients.

Objective: To review utilization rates, outcomes, and barriers to peritoneal dialysis (PD) in indigenous peoples from an international perspective.

Methods: Articles were obtained from Medline and EMBASE and from author name and reference searches. Data from census bureaus and renal registries in Australia, Canada, New Zealand, and the United States were used.

Racial composition of residential areas associates with access to pre-ESRD nephrology care.

Referral to a nephrologist before initiation of chronic dialysis occurs less frequently for blacks than whites, but the reasons for this disparity are incompletely understood. Here, we examined the contribution of racial composition by zip code on access and quality of nephrology care before initiation of renal replacement therapy (RRT). We retrospectively studied a cohort study of 92,000 white and black adults who initiated RRT in the United States between June 1, 2005, and October 5, 2006.

Interaction of aging and chronic kidney disease.

Our goals in this review are to describe what is known about the prevalence and clinical implications of non-dialysis-dependent chronic kidney disease in the elderly and to discuss some of the most common challenges to managing older patients with chronic kidney disease.

Lead poisoning from an Ayurvedic herbal medicine in a patient with chronic kidney disease.

Background: A 60-year-old man with a history of diabetes and hypertension was referred to a nephrology clinic for investigation of his elevated serum creatinine level.

Investigations: Physical examination; laboratory investigations, including measurement of whole-blood lead level, body lead burden and urine albumin:creatinine ratio; history of lead exposure and use of herbal medical products; and renal ultrasonography.

Diagnosis: Stage 3 chronic kidney disease that was probably worsened by consumption of lead in the form of an Ayurvedic herbal remedy.

A case of occult compartment syndrome and nonresolving rhabdomyolysis.

Case Report: A 32-year-old African male presented with 10 hours of severe back pain. Initial computed tomography scan of the back showed no abnormality, and initial laboratory investigations were consistent with rhabdomyolysis. Despite stopping potential causative medications, aggressive intravenous hydration, and urine alkalinization, his creatinine kinase continued to steadily climb.

Regional effects of satellite haemodialysis units on renal replacement therapy in non-urban Ontario, Canada.

Background: To provide better dialysis care to rural communities, the Ministry of Health chose to build satellite haemodialysis (HD) units, which are affiliated with, but are distant to, a main renal centre. We considered whether constructing such units in rural regions of Ontario, Canada, alleviated under-service of rates of renal replacement therapy (RRT) locally, decreased patient travel distance and decreased local peritoneal dialysis (PD) utilization.

Methods: We compared two groups of rural regions at two time points (years 1995 and 2002) in a before and after cross-sectional study.

Midodrine appears to be safe and effective for dialysis-induced hypotension: a systematic review.

Background: Dialysis-induced hypotension is an important complication of haemodialysis. Midodrine is an oral alpha-1 agonist that has been used in several small studies to prevent intradialytic hypotension (IDH).

Methods: The authors searched MEDLINE, EMBASE, ASN conference proceedings, and references of potentially relevant articles, and contacted industry (Shire Pharmaceuticals) for unpublished data.

Hemodynamic and volume changes during hemodialysis.

Background: Volume overload is a factor in the hypertension of hemodialysis (HD) patients. Fluid removal is therefore integral to the hemodialysis treatment. Fluid removal by hemodialysis ultrafiltration (UF) may cause intradialytic hypotension and leg cramps.

Central, peripheral, and other blood volume changes during hemodialysis.

Volume overload is a factor in development of hypertension in hemodialysis patients. Fluid removal by hemodialysis (HD), however, may cause intradialytic hypotension and associated symptoms. A better understanding of the relationships between blood pressure volume status and the pathophysiology of fluid removal during HD are, therefore, necessary to control blood pressure and to eliminate intradialytic hypotension.

Lactic acidosis in asthma: report of two cases and review of the literature.

Lactic acidosis is commonly associated with states of hypoxia and decreased tissue perfusion. Elevated lactic acid levels have also been observed in individuals who are not septic and who are normotensive, but who have received systemic adrenergic agonist therapy. This report presents two patients with acute asthma treated with very large doses of aerosolized and systemic salbutamol, who developed lactic acidosis despite normal systemic hemodynamics and adequate oxygenation.