Author Archives: Kerri Fitzgerald

From the Field: New Bill Cuts Facility Certification Delays and Expands Telehealth Options

Rick Collins Ridiculously lengthy delays in getting new dialysis facilities certified might finally be going away. H.R. 3178, sponsored by ten members of the House of Representatives, would allow new facilities to be certified by government-approved agencies other than Medicare. In this age of few agreements between political parties, this bill appears to have great appeal to both parties as ... Read More »

Education Program Helps Patients Make Modality Decisions

Orlando—In the United States, end-stage renal disease (ESRD) represents a burden to public health and increases pressure on healthcare costs. Data from 2014 identified approximately 680,000 prevalent cases of ESRD in the United States; up to 38% of incident patients did not receive care from a nephrologist prior to renal replacement therapy initiation. Percentages of treatment modalities in the United ... Read More »

Facilitating Transition of Care from Hospital Discharge to Outpatient Dialysis Unit

Orlando—The transition from hospital discharge to return to the dialysis unit is a vulnerable time for patients on maintenance hemodialysis. Unsafe transitions put patients at risk for adverse outcomes, visits to the emergency department (ED), and hospital readmission. At the University of Pennsylvania Hospital, 44% of dialysis patients discharged from the hospital had at least one ED visit within 30 ... Read More »

From the Chair: The New Mineral and Bone Disorder Guideline Update: Osteoporosis and Fracture Risk

Ajay K. Singh, MBBS, FRCP, MBA Brigham and Women’s Hospital and Harvard Medical School Boston, Massachusetts Fractures in chronic kidney disease (CKD) patients, particularly those that are elderly, have substantial morbidity and mortality. The Kidney Disease Improving Global Outcomes 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (KDIGO CKD-MBD)1, ... Read More »

Endovascular AVF May Be Viable Option for Vascular Access in Hemodialysis Patients

The recommended method of vascular access is the surgical creation of an arteriovenous fistula (AVF), a technique developed in 1966. At present, only 14% of patients with end-stage renal disease in the United States initiate hemodialysis with an AVF; in addition, prevalent use of AVFs is low in many regions worldwide. Factors contributing to underuse of AVF include long cumulative ... Read More »

Associated Costs Lower for Endovascular AVF Creation

Arteriovenous fistula (AVF) is the preferred access type, offering longer access survival, lower risk of mortality, and reductions in rate of infection. AVF also requires fewer interventions following successful maturation and use. Recent studies have suggested that maturation and maintenance of function may require two or more additional procedures following the initial AVF creation. Additional procedures notwithstanding, a proportion of ... Read More »

Initial Dialysis Session Duration Associated with Patient Outcomes

Following expansion of Medicare coverage to patients with end-stage renal disease (ESRD) 40 years ago, the average number of hours per hemodialysis session has decreased from 6 hours in 1973 to 3.5 to 4 hours in 2010. The decline is explained in part by the improved efficiency of dialyzers; however, there are few data on the clinical consequences of shorter ... Read More »

Risk of Hip Fracture and PPI Use in Kidney Transplant Recipients

Increased mortality, decreased mobility, and loss of independence are all associated with hip fracture. For patients with end-stage renal disease (ESRD), the risk of hip fracture is considerably elevated compared with that of the general population. The time immediately following kidney transplantation is particularly high-risk for hip fracture due to pre-existing chronic kidney disease and the associated mineral bone disease, ... Read More »