“The single biggest problem in communication is the illusion that it has taken place.” –George Bernard Shaw (1856-1950) Advancing American Kidney Health While the Executive Order set forth bold goals to increase home dialysis utilization amongst patients with end stage renal disease (ESRD),1 the COVID-19 pandemic has served as an even greater impetus to allow… Read More
Opinion article International Practice Considerations After COVID-19 As England moves into the recovery phase from COVID-19, it is worth reflecting on newly enacted changes in clinical practice that should be sustained going forward. This could be particularly helpful to my colleagues in the United States, still in the midst of the pandemic. In the United… Read More
Opinion article Clinical Practice Learnings with Potential Post-Pandemic Application The world is amidst a public health crisis related to the COVID-19 pandemic. COVID-19 will remain a primary healthcare concern until a vaccine and effective medications are discovered, which may take many more months.1 End Stage Renal Disease (ESRD) patients are at particularly high risk of… Read More
Opinion article Physician and Physician Extender Clinical Practice Considerations Caring for Dialysis Patients During the COVID-19 Epidemic On March 13, 2020, the US administration instituted a national emergency, as nearly 200,000 COVID-19 cases presented worldwide.1 This a novel disease and a rapidly evolving situation in the U.S., with the number of newly confirmed cases increasing… Read More
In the March issue of Nephrology News & Issues, I described the challenge of managing volume during and between hemodialysis sessions. The root of the challenge is the intermittent nature of hemodialysis. In the dominant schedule, intermittency is marked by 3 hemodialysis sessions per week, either on Monday-Wednesday-Friday or Tuesday-Thursday-Saturday, for 210 to 230 minutes… Read More
During the past decade, the use of peritoneal dialysis (PD) in the United States has grown substantially.1 In 2009, 7.5% of dialysis patients were treated with PD; by 2016, the statistic had increased to 10.0%.1 And according to the United States Renal Data System (USRDS), 10.5% of dialysis patients with new Medical Evidence Report (“2728”)… Read More
Total Medicare expenditures on the health care of patients with permanent kidney failure have steadily risen to more than $35 billion per year, although per capita expenditures on the care of dialysis patients have been relatively stable in recent years.1 This conflict in trends can be readily explained by the seemingly unstoppable increase in the… Read More
In 2017, Medicare Administrative Contractors (MACs) began to promulgate draft local coverage determinations that include restrictive language regarding Medicare reimbursement for additional hemodialysis sessions. An important element of the draft determinations is medical justification, or the clinical conditions that constitute evidence-based rationale for the prescription of more frequent hemodialysis. Suri and Kliger, who were both… Read More
Many studies represent incremental gains in our understanding of human pathophysiology. Some studies, especially large randomized clinical trials, can singlehandedly change the standard of care. Other studies, at the most unexpected times, flash a signal that raises the question of whether the widely accepted standard of care is simply inadequate. In the April 2018 issue… Read More
Many dialysis patients, including patients on frequent home hemodialysis, have been diagnosed with heart failure. In one large study, 31% of patients who initiated home hemodialysis already had heart failure.1 One of the cornerstones of pharmacologic therapy for heart failure is renin-angiotensin system blockade, which may be achieved with either angiotensin-converting enzyme (ACE) inhibitors or angiotensin… Read More
