Category Archives: NKF 2013
Depressive Symptoms & Hospitalization Risk in Incident Hemodialysis Patients
Hemodialysis.com eInterview with:
Eduardo Lacson, Jr., MD, MPH, FACP, FASN
Vice President
Clinical Science, Epidemiology, and Research
Fresenius Medical Care, North America
Written Interview conducted with author by Editor Marie Benz, MD
Hemodialysis.com: What are the main findings of the study?
Dr. Lacson: Based on retrospective study of the cohort of 9,417 adult incident dialysis patients (i.e. new to dialysis, within 120 days of first ever chronic dialysis) treated in Fresenius Medical Care North America (FMCNA) facilities, we found that self-reported depressive symptoms based on 2 questions indicating frequency of feeling “down in the dumps” or “downhearted and blue” reported on average by the 45th day of chronic dialysis, were associated with shorter time to first hospitalization, greater number of hospitalization events, and more hospital days during the yearlong period immediately following the survey.
Marie Benz, MD on Google+The Smartphone in Nephrology: Preliminary Survey on Current Trends and Perceived Needs
Hemodialysis.com eInterview with Dr. Ritu Soni
Renal-Electrolyte Division
Fellow, Renal-electrolyte division
University of Pittsburgh Medical Center
Hemodialysis.com: What are the main findings of the study?
Dr. Soni: The study was a cross-sectional survey, which was administered to the health-care providers in the division of nephrology at the University of Pittsburgh. The respondents included nephrology attending physicians (57.1%), fellows (31.4%) and physician assistants (11.4%). The response rate was 78.2%, with a 100% response rate from fellows and physician assistants.
The results showed that over 55% of the respondents used digital applications on their mobile devices for clinical decision-making either frequently, or sometimes. The most popular application types were medical calculators (62.9%), reference databases like Epocrates etc. (57.1%) and medical journal applications (28.6%). When asked about the nephrology-related clinical problems that they desired more applications on, the most requested topic was sodium and water metabolism (58.1%) followed by calcium, phosphate and magnesium metabolism (54.8%), acid-base disorders (41.9%) and secondary hypertension (41.9%).
Do ESRD patients really want to know prognosis
Hemodialysis.com eInterview with Krishna Manda, MD
Berkshire Medical Center in Pittsfield, Mass.
Hemodialysis.com: What are the main findings of the study?
Dr. Manda:
• Our small study shows that dialysis patients are at risk of “optimistic bias”.
• Despite the extremely high mortality associated with ESRD, most of our patients do not believe their health will deteriorate in future and a large number do not know the meaning of the word, prognosis, and/or are hesitant to have discussions on this subject with their nephrologist.
Withdrawal from dialysis and palliative care for severely ill dialysis patients in terms of patient-centered medicine
Hemodialysis.com Author Interview: M.D. Hideaki Ishikawa
Tokai Central Hospital of Japan Mutual Aid Association of Public School Teachers
Hemodialysis.com: What are the main findings of the study?
Answer: In daily works for our dialysis patients, we occasionally have some difficulty in diagnosis of severely ill patients. Although dialysis is life-sustaining therapy, however, it can no longer be helpful to improve their life expectancy in that situation.
Moreover, we feel that dialysis itself may be burdensome for these seriously ill patients such as terminal phase of cancer, severe heart failure, sepsis due to infectious diseases and so on.
So, in our hospital, we sometimes recommend or propose “withdrawal from dialysis (WD) ” for them as an optional treatment. As a result, we believe that the patients can die with peace and dignity.
Disease Progression and Surgical Parathyroidectomy in the EVOLVE Trial
Hemodialysis.com eInterview with:
Patrick Parfrey, MD, FRCPC, FACP on behalf of the EVOLVE investigators
University Research Professor at Memorial University
St. John’s, Newfoundland and a staff nephrologist.
Dr. Parfrey is Associate Dean for Clinical Research, Research Chief of Eastern Health
Hemodialysis.com: What are the main findings of the study?
Dr. Parfrey: The EVOLVE trail enrolled 3883 patients with secondary hyperparathyroidism from 22 countries , randomly allocated them to the calcimimetic, cinacalcet ,or placebo, and followed them for up to 64 months. Parathyroidectomy was undertaken in patients with severe unremitting hyperparathyroidism: PTH level prior to surgery 2143 mg/dl in the cinacalcet group and 1873 in the placebo group.
Pilot Study of a Physician-Delivered Education Tool to Increase Patient Knowledge About CKD
Hemodialysis.com Authors’ eInterview
J.A. Wright Nunes, MD MPH
Assistant Professor
University of Michigan Health System
Department of Internal Medicine, Division of Nephrology
Kerri Cavanaugh, MD MHS
Assistant Professor of Medicine
Vanderbilt University Medical Center
Division of Nephrology
Center for Health Services Research Nashville, TN 37232-2372
Hemodialysis.com: What are the main findings of the study?
Answer: The main finding of the study was that a simple, efficient educational worksheet designed to facilitate patient-provider communication about kidney disease, increased patient knowledge in fundamental areas related to their kidney health.
We are also encouraged by the very positive response in patients who received the educational worksheet, as well as the providers who delivered the tool in practice.
The PICC Epidemic and the Kidney Patient
Hemodialysis.com eInterview: Rita McGill MD
Allegheny General Hospital
Pittsburgh, PA USA
The major finding of this study is that more than 20% of hospital inpatients have PICC lines. Compared to hospital patients in general, PICC patients are sicker and have more chronic kidney disease. This is particularly unfortunate, since national ASDIN guidelines advise against PICC placement in kidney patients. Despite this recommendation, CKD patients actually bear a disproportionate brunt of the PICC ‘epidemic, with a PICC rate of 30%, which is higher than other patients.
