Dialysis from the sharp end of the needle

Lufkin police arrest DaVita nurse on asault charge

The Lufkin Daily News reported on Friday that a former employee of the DaVita Lufkin unit was arrested for injecting two DaVita hemodialysis patients with bleach, confirming the tip from my source. RenalWEB has a news summary of events as they have been reported to date (largely by Jessica Savage Lufkin Daily News reporter).

This is not the end of the story. The incidents that police have identified involving bleach are reported to have resulted in hospitalization but not death. On Wednesday DaVita released a statement saying that they believed four deaths were attributable to the arrested nurse; this means at as minimum six patients are involved. It is unclear what evidence DaVita has indicating murder that the Lufkin police does not have, unless murder or manslaughter charges will be forthcoming.

So many questions need to be answered. Where else did Saenz (the arrested nurse) work? How long had she been working as a dialysis nurse? We need a full accounting of her history. I am concerned by a statement in the Wednesday article:

Dr. David Van Wyck, a nephrologist who is vice president of clinical services for DaVita and working with state officials during the investigation of the Lufkin clinic, said on average two to three patients die a month at dialysis centers.

Does he mean "2 or 3 people die during treatment or immediately after treatment and transport to a hospital" or does he mean 'typically in the US, at a 120 patient unit, several patients die each month", the former would not be usual, the later would be all too true - the overall mortality rate among people on dialysis is stuck stubbornly above 20%. What needs to be made clear is how many deaths had there been among Lufkin patients above the typical general mortality rate of 22 to 24%? What were the number of deaths in comparison to the expected? And were the causes what one would expect? For instance an unexpected number of deaths due to hemolysis or extreme dehydration.   

Home

We were off the boat and on the road by noon Friday, right on schedule. It took about an hour and half to fuel, pump out (for the fifth time), clean and pack our stuff (including all the dialysis supplies) off the boat. It was a great trip - I felt completely immersed in the vacation but I wouldn't call it restful.

I finally got home after lunch and picking up the dog (he was working at my friend's school today, soaking in the attention of dozens of kids) and immediately took a nap. First on the coach and then in bed.  Everyone else on the boat was always going down for naps but as the only skipper I was always at the helm when we were under way. Except coming back today.

Grace took the Grand Walt around Blakeley Island and into Rosario Strait, after testing the trawlers maneuverability some tricky wheel work. She used the Rayamarine information system to keep us on course and avoid the several ferries we saw as we made our way back. If Grace and her parents come out next year maybe I will take a nap.

As I type this the chair feels like it is rocking ... as I dialyze in a about an hour I will enjoy the sensation of still being on the boat one last night. At least 'til the next time.

Back to Rosario, then home

On Thursday we had an easy day, leaving Friday Harbor in the mid-morning to head to Jones Island a Washington State marine state park in the San Juan Channel. From there we went through Wasp Passage to Rosario. Another great day in the San Juans.

One last run this morning across Rosario Strait and the trip will be complete. I'm already thinking about my next boating adventure.

Welcome RenalWEB visitors

I see RenalWEB has linked to Peter's post. Welcome.

The idea of this blog is simply that it is from the point of view of those on dialysis. Anna, Peter and Mel have all guest blogged - I hope that as the blog evolves (the first post, about 500 post ago, was on December 26, 2007) we will continue to show that dialysis is not a death sentence. That life continues.

Since starting the blog we've had the news of tainted heparin and the news from Lufkin; both events had a tinge of "Well what do you expect - they're on dialysis". This is extremely frustrating because with a correct dose of dialysis, I know life  can continue and one can live the life they were meant to live.

Gary - RenalWEB's editor - comments that there are many incestuous relationships throughout the renal industry. Once I'm back from this vacation, batteries recharged, I look forward to exploring this issue further - until then I hope you look around and enjoy what you find.

Since Monday

On Tuesday we made the run across Rosario Strait where I changed crew in Anacortes. My Mom, Sally and VJ reported having a great time - there was some talk of doing it again.

My new crew is Steve, Cathy and Grace, from Florida. Steve and I have known each other for 37 years, Cathy is his better half and Grace is their 11 year old. We left Anacortes to spend the night in Friday Harbor with the plan to reprise our whale watching success the previous Saturday. Coming into Friday Harbor we had seen dolphins; on the channel buoy there was a large sea lion sunning to the sound of the bell.

On Wednesday we headed out the San Juan channel and around Cattle Point into 2' to 4' swells, building as we entered Haro Strait. We got up to Eagle Point - the same general location as before and waited. Soon we were joined by a couple whale watching boats. It was a great whale watching day but for the swells coming from the west. The whales put on a great show of breaching and spyhopping but I had no luck getting a photo of the action. By the time my camera took a picture the whales were heading back under. I also tried to shoot some video but again the whales did not cooperate so I ended up with video of the rolling seas.

Grace and Steve were the most affected by the wave action so we cut the viewing short and headed back to Friday Harbor. I had wanted to go to Sucia or Roche Harbor but they were ready for dry land but that did mean I had to go back around Cattle Point against the tide which made for a slow bumpy ride. By then their Dramamine had kicked in and I was the only one awake for the two hour run into port. Today we'll picnic lunch on Jones Island and then go through Wasp Passage for a round of massages at Rosario.

I could happily spend the rest of the summer up here but it'll be back to Seattle on Friday. It will be nice to see the dog but I'll miss being on the water.

Today is webinar day

I think I should be able to join the webinar tonight. This is a repost but I'm getting ready to go look for whales.

Back when I started this blog at the start of the year I blogged about Dr. Agar's two part article on Home Dialysis Central (part 1; part 2)  Fluid and solute removal: how and why. I wrote three posts inspired by the article: Dr. Agar on fluid and solute removal; More on fluid and solute removal; Optimal dialysis - beyond Kt/V; I think Dr. Agar's papers offer a great insight into a key concept.

Dr. Agar's been a champion of nocturnal dialysis, particularly home more frequent hemodialysis for quite some time - he makes his compelling case on his own nocturnaldialysis.org website. Not to mention he's handy with PowerPoint. I've met Dr. Agar but it's not a frequent occurrence - Dr. Agar lives in Geelong, Victoria, Australia.

But now thanks to the internet you can have Dr. Agar present a PowerPoint right in your home, right through the computer. A PowerPoint on the same topic these papers address. If you weren't sure about all the concepts in the papers now is your chance to hear Dr. Agar himself present. Here's how to sign up - from Dori Schatell on the HDC forums:

The session will be held on Wednesday May 28th for those east of Europe (the US) and on Thursday May 29th for those living between England and Hawaii. The Webinar will start at:
2:00am (Thursday) GMT/London
6:00pm (Wednesday) US Pacific time (GMT -08:00)
7:00pm (Wednesday) US Mountain time
8:00pm (Wednesday) US Central time
9:00pm (Wednesday) US Eastern time
7:30am (Thursday) Mumbai, India
11:00am (Thursday) Australia (Geelong) time

This is a web-based session; you don't need a telephone to take part.  To sign up, visit:  http://www.wiziq.com/TutorSession/Se...2Rv1VT7g%3d%3d.

1. If you are new to the WiZiQ site, click "Not a member? Register." Fill in your name, email address, and choose a password, and click "Join Now." When the session time rolls around, click "LAUNCH" and you're in!

2.  If you have signed up for WiZiQ,  Log in.  When the session time rolls around, click "LAUNCH" and you're in!

This is a fantastic opportunity to hear from an international hemodialysis expert. This is the first of what I hope will be many Webinars from HDC - I made a Webinar category so I hope to see one at least once a month.

Our friends in India will have to attend the Webinar while eating breakfast and those in Europe will need to set an alarm clock but before you lose sleep over this I have good news - the Webinar will be available on WizIQ for viewing at your convenience after the event. 

Back when I started this blog at the start of the year I blogged about Dr. Agar's two part article on Home Dialysis Central (part 1; part 2)  Fluid and solute removal: how and why. I wrote three posts inspired by the article: Dr. Agar on fluid and solute removal; More on fluid and solute removal; Optimal dialysis - beyond Kt/V; I think Dr. Agar's papers offer a great insight into a key concept.

Dr. Agar's been a champion of nocturnal dialysis, particularly home more frequent hemodialysis for quite some time - he makes his compelling case on his own nocturnaldialysis.org website. Not to mention he's handy with PowerPoint. I've met Dr. Agar but it's not a frequent occurrence - Dr. Agar lives in Geelong, Victoria, Australia.

But now thanks to the internet you can have Dr. Agar present a PowerPoint right in your home, right through the computer. A PowerPoint on the same topic these papers address. If you weren't sure about all the concepts in the papers now is your chance to hear Dr. Agar himself present. Here's how to sign up - from Dori Schatell on the HDC forums:

The session will be held on Wednesday May 28th for those east of Europe (the US) and on Thursday May 29th for those living between England and Hawaii. The Webinar will start at:
2:00am (Thursday) GMT/London
6:00pm (Wednesday) US Pacific time (GMT -08:00)
7:00pm (Wednesday) US Mountain time
8:00pm (Wednesday) US Central time
9:00pm (Wednesday) US Eastern time
7:30am (Thursday) Mumbai, India
11:00am (Thursday) Australia (Geelong) time

This is a web-based session; you don't need a telephone to take part.  To sign up, visit:  http://www.wiziq.com/TutorSession/Se...2Rv1VT7g%3d%3d.

1. If you are new to the WiZiQ site, click "Not a member? Register." Fill in your name, email address, and choose a password, and click "Join Now." When the session time rolls around, click "LAUNCH" and you're in!

2.  If you have signed up for WiZiQ,  Log in.  When the session time rolls around, click "LAUNCH" and you're in!

This is a fantastic opportunity to hear from an international hemodialysis expert. This is the first of what I hope will be many Webinars from HDC - I made a Webinar category so I hope to see one at least once a month.

Our friends in India will have to attend the Webinar while eating breakfast and those in Europe will need to set an alarm clock but before you lose sleep over this I have good news - the Webinar will be available on WizIQ for viewing at your convenience after the event. 

The Battle Begins (Again)

The battle for optimal dialysis here in the US is not one due to lack of evidence, but instead, the government's focus on money and not on outcomes.  Home dialysis was actually started back in the 1960's here in America for cost containment purposes in the days before Medicare funding.  Dr. Charra, who was recently honored by ISHD,  showed that nocturnal dialysis saves lives nearly thirty years ago, yet today it is talked about as a "new" way of doing dialysis. For instance, take a look at the recent article on nocturnal dialysis from news-press.com.

Nevertheless, Japan, Europe and Australia have shown that daily dialysis saves lives for decades.  Yet, here in America, the government funded program sought the minimal effective dose of dialysis and that was where the funding stopped, at three days a week with the length of dialysis so shamefully low that many over the years died for lack of effective dialysis which could have easily been provided as it was in so many other nations.  Critics of daily dialysis often cite the fact that no large randomized and controlled studies have show daily dialysis more effective than conventional, at the same time ignoring the multitude of observational studies that have shown exactly that as well as many smaller trials.  They further are completely unaware of the fact that conventional dialysis has likewise never been shown to be the most effective dosage by randomized trials as well.  All that they have are observational studies which show a horrific death rate compared to many other nations with Japan having the highest rate of survival and the lowest rate of transplant.  Is transplant really the answer for ALL CKD 5 patients?

Yet, for those that do know the benefits of this very simple treatment modality, the battle has been uphill in my opinion due in part to the relatively small numbers of people needing renal replacement therapies.  Yes, CKD affects millions, yet at any given time, most sources place the number with CKD 5 at ~350,000.  Yes, in politics, the numbers of people affected may be the most important denominator for action at the level of Washington D.C. 

Thus, in the end, even though articles such as the one above are completely in error calling nocturnal dialysis a "new" treatment, it is part of the battle for the popular press and the general public to begin a grass roots movement and then perhaps the internists and nephrologists in this nation may actually learn about the benefits of daily/nocturnal dialysis from the newspapers, their patients or the popular press.  It is clear that they are not learning it from their peers or from their training programs.  Yes, we need to educate not only the politicians in America, yet again, we need to educate the physicians who take care of all of us CKD 5 patients.  We must remember that there is not any politician that ever orders a prescription for dialysis, it is all done by physicians.  Perhaps it is time for a well educated physcian population to take back control of dialysis here in America and start treating with proven methods used by other physicians in these other nations that are not hampered by short sighted political oversight from the politicians.

Yes, the battle begins (AGAIN).

May God bless,

Peter blogging for Bill, the dialysis explorer.

Roche Harbor to Rosario Resort

We had an easy day going from Roche Harbor to Rosario Resort on Memorial Day. The seas were calm the only rocking was due to the large number of boats returning from the weekend.

When we got in to Rosario we had lunch which in my case included a daiquiri or two, then we checked out the spa to find that there were openings for a massage. I signed up for eighty minutes of relaxation to get the kinks out; it was wonderful. I usually dialyze in a chair overnight but on the boat I've been in a bed which I find to be less comfortable. I hold my arm still and I think because I don't move around it ends up giving me achy shoulder and back muscles. That and the beds on board aren't the most comfortable. After the massage all kinks were gone.

I had planned on dialyzing Monday night - my fourth treatment but a couple glasses of wine with dinner and simply going to bed was very appealing. On Sunday night I had to call NxStage tech support during set up. I was getting a #38 alarm. After trying a couple things I ended up discarding the whole set up and starting over. This solved the problem and I had an alarm free run.

In preparing for the trip I brought 6 treatments worth of dialysate and 8 treatments of all the other supplies so discarding a cartridge is not an issue. I think I'll end up with 5 treatments but I may dialyze the next three nights so that I don't need to dialyze when I get home Friday. I know that on Friday I'll just want to crawl into bed but if we end up at Sucia Wednesday night I'll take that off. There are plenty of options.

Roche Harbor to Sucia Island and back

It was a very relaxing day Sunday with a cruise from Roche Harbor up President Straight - between Waldron and Orcas Island to Sucia Island a Washington State Marine State Park. It is a very special place, one of my favorite places in the world that I always enjoy sharing with people. We found a buoy and motored in on the skiff to spend some time walking around.

After a short hike we headed back to Roche Harbor for a dinner of stew that I made last Sunday. I froze eight portions - four for tonight and four for my next crew who are boarding on Tuesday. I made the stew with a no salt broth and did not add salt but there was plenty of garlic. My crew added a bit of salt but over all it received raves and all bowls were cleaned.

Monday it is off to Rosario resort for the last stop on this leg of the trip. If the weather is as nice as the last two days, I am sure there will be swimming and daiquiris.

The Crew

Here's a shot of the me and the crew. I'm in back. In the center row from left to right is my Mom in front of me, Sally next (Mom and Sally have been friends since freshman year in college - 57 years ago) and next to Sally's is her husband VJ. In the front row is Carol and my brother Charley. This was taken at Bell Harbor in Downtown Seattle right after the Breakfast of Hope. From here we left Charley and Carol in Seattle and headed up to Port Townsend.

Video of my NxStage extended nocturnal dialysis set up

This video shows my nocturnal set up aboard the Grand Waltz.

 

This is aboard a bare boat charter from ABC Yachts in Anacortes, Washington on Memorial Day weekend 2008. The video was shot on Saturday May 24th and shows the System One as it is getting ready for treatment.

Friday Harbor to Roche Harbor

Saturday was a perfect day. As we walked to breakfast in Friday Harbor we may have felt a drop or two of rain but there was a bit of blue to the west. By the time we were walking back to the boat the sun was out with just a slight breeze - it looked like a fine day was shaping up.

I had a choice to make - go up the east side or west side of San Juan Island. A true toss of the coin. The east side - San Juan channel - is more protected but the west side - Harro Straight - is where the Orcas often frequent on their patrol of the islands. I picked the west side and Harro Straight and ordered the crew to think happy thoughts.

We had just passed around Cattle Point and crossed Salmon Bank when the Victoria Clipper - a large passenger only ferry - passed us heading north? Odd. It runs between Seattle and Friday Harbor - why would it be heading up Harro Straight? It came to a stop off Eagle Point and then I saw the first spout. It was the Orcas!

I cut the engines and waited - you are not to approach the whales but if they approach you it's their choice. Slowly about 20 whales made their way past us, complete with babies and full breaching. I don't know how you ever get a picture of a breach, even getting them coming up for air seemed to be a matter of complete luck - of about 30 pictures three show more than a dorsal fin.

For the next forty five minute to an hour we sat in awe under clear blue skies trying to get that award winning photo of a breach. I finally stopped trying and just enjoyed the show. What a great day. From there we continued across calm seas to Mosquito Pass between Henry and San Juan Islands and into Roche Harbor for the night.

Not a typical Sunday

Usually  on Sundays I post the listserv and discussion board reports along with a jump page to my CKD links page highlighting whatever new links I've added. Thanks to Anna I do have a whole new category but it'll have to wait 'til next week. I'm going to continue with trip blogging and rest and relaxation.

Happy Birthday Dr. Arthur Arnold Osman!

By Anna Bennett

This is Anna posting, Bill is on the boat somewhere around here, enjoying some R&R - but I'm not jealous because it is Arthur Arnold Osman's Birthday! (well, maybe I am a little envious.)

Now back to the birthday wishes. Dr. Osman (May 24,1893 - April 26,1972) was the first physician specialize entirely in the management of renal disorders, he was the world's first Nephrologist. 

During the 1930s Osman developed first, the idea that the study of renal diseases required a team of specialist nurses and doctors, and second the concept of charting in detail a visual picture of the patients’ signs, symptoms, and chemical findings. His charts could be used today, 60 years later. (from http://ndt.oxfordjournals.org/cgi/reprint/12/7/1526)

In these days of media obsessed culture, it is nice to take a moment and recognize a medical hero who was a pathfinder in a profession that works to keep us alive.

Legislative update from NN&I

Nephrology News & Issues' editor Mark Neumann at NephrOnline has the latest news from DC about changing Medicare's dialysis program. I can't believe that legislation passed and signed this year would improve the provision of dialysis better than legislation passed and signed next year. I have to believe that someone in Congress is making that same calculation.

Port Townsend to Friday Harbor

We crossed the Straight of Juan de Fuca today after first motoring out of Port Townsend and up Admiralty Inlet. When thinking about the trip this was where I thought the potential for weather related impact was greatest but in the event it was fine. There was still a small craft advisory in effect and because we had a leisurely breakfast we left at the peak of the tide change - from low to high.

Puget Sound tide-wise is like a bath tub forever filling and draining with the the Straight of Juan de Fuca acting as spigot and drain in turn. Today at midmorning the spigot was on as the high tide filled Puget Sound. This caused a variety of currents, mostly slowing us down to 6 or so knots over ground and at one point a bit of 2' to 4' chop but it was short lived. Mostly there was a steady headwind and 1' to 2' swell.

We had our eyes peeled for whales - they're up here somewhere - but as of yet no luck. We hit San Juan channel exactly at the slack tide and had no problems docking in beautiful Friday Harbor. What a scenic spot. A late lunch on board after hitting the grocery store and I was ready for a nice long nap. I've been sleep deprived fort he last few days particularly but back the last couple weeks generally. A nap never felt better.

Thursday night I dialyzed for 8 hours but had the temperature of the boat wrong and woke up a couple of times feeling very cold. Tonight I'll plug a space heater in to have a ready option at hand. I was worried about the NxStage disrupting my Mom's sleep - she's in my cabin's second berth - but she reports she thought the cycler was very quiet and other than that damn heparin pump alarming an hour prior to the end of treatment the process didn't disturb her at all.

Back in '89, '90 when I had a transplant and was running boats for a living the plan was to move into sail boats and take a summer to run up the Inside Passage. I'm not ready to do that tomorrow but the dream is back in my head. I think you could get a couple of those clam shell luggage carriers lashed down on deck which would allow you to carry at least three weeks of NxStage dialysis supplies. Maybe by the time they come out with a System Three I'll be able to get three months of supplies on board. That would get me to Sitka and points north.

I just want to get back to Elfin Cove.

Seattle to Port Townsend

What a difference a day makes. We left Seattle at noon after attending the Northwest Kidney Centers Breakfast of Hope. What a fantastic event - 800 people came to breakfast at the Seattle Westin and heard a fantastic program headlined by the Galloping Gourmet but all the speakers were great. It was the sixth Breakfast of Hope and I'm saying it was the best ever.

It took us about five hours to get to Port Townsend across much calmer seas, though it was much slower without the 30 knot tail wind - 6 to 7 knots and hour instead of 9 to 10. We spent the last three hours under blue skies and the promise of even nicer weather for the weekend. We saw dolphins and seals but no whales ... yet. J Pod and L Pod are in the waters around the San Juans so we'll be watching for spouts tomorrow.

I have the machine all set up and I am ready to cannulate so I don't think I've forgotten anything. I'm planning a nice, eight hour overnight treatment. Pictures to follow, along with a full account of tomorrows run to Friday Harbor on San Juan Island.

Hey what do you know, plan A worked

It was pretty crazy but we made it to Seattle. The wind turned around to the north and pushed us down the Sound. The thing about a trawler is that they make a pretty good sail, which is usually only noted when one crashes the dock or another boat, but the cool new data system on the Grand Waltz told us we were doing 9 to 10 knots over ground for a couple hours with following waves. Sails can be good things. By this point as we got to the south end of Whidbey Island (Whidbey is a monumentally long island) the tide should have turned against us and we'd have been lucky to get 7 knots over ground, with calm seas, and no wind.

We pushed on to the downtown Seattle  marina Bell Harbor, where a friend, my Mom and my Mom's friend met us. Towards the end of our run the wind dropped, as did our speed, but even with a nap the trip left my crew frazzled. This is the second time my sister-in-law has thought she was going to die on the Grand Waltz: last year we went around San Juan Island and had side chop along the whole west side. I didn't even know she was white knuckling it during this 3 hour stretch until last Thanksgiving, when I heard her tell the story.

Last year I just thought we had some uncomfortable moments; after this run I can totally understand the "we are going to die" perspective.

Plan B

I've never had a wave go over the top of a trawler's fly bridge. We had two a couple hours ago. The fly bridge must be 15 feet or more above the water; my sister-in-law was sitting up there because she feels better outside when the boat is rocking. The chop we found ourselves in must have resulted from a confluence of wind and tide (the wind came up suddenly, there is now a small craft advisory), to avoid the side to side motion I went straight into them taking them on head on.

At first it was fun. Water over the bow, splashing up on the windshield. But they kept getting bigger, more frequently washing over the bow. I saw a large pair of waves coming towards us; all I could do is get the boat perpendicular to the two eight foot rollers. We crashed through the first one, plunged into the trough and then the second one came right over the top of us. Carol was wet and cold but otherwise alright and the Grand Waltz took the chop much better than we did.

It's been a grind coming down the east side of Whidbey Island, at this point I have been following swells but we're about 45 minutes from the south end of the island where the seas are likely to change. The outside of the Island must be real bad because the hydroplane that goes up to Victoria - the Victoria Clipper - has been using the inside route.

Hopefully we can push on to Edmonds but I can't see getting to Seattle tonight. If it is too bad off the end of Whidbey we'll backtrack to Everett. This causes logistical challenges but my options are diminishing with the daylight.

Dialysis in Acute Kidney Injury -€” More Is Not Better

Howdy once again from Peter.  Bill is off on another great adventure and he sent the following article to me on acute renal failure for comment.  (Can someone on dialysis really have as much fun as Bill does?)

The NEJM has published a large, randomized and controlled study on the effects of intensive dialysis vs. usual dialysis strategies in acute kidney injury patients in the ICU.  In this study with 1124 patients, the findings between the two dialysis strategies was essentially the same: "The rate of death from any cause by day 60 was 53.6% with intensive therapy and 51.5% with less-intensive therapy." Prior studies had shown promise with reduction of mortality in intensive, six days a week dialysis strategies.  However, none had a high enough "power" to prove whether the mortality differences were due to random patient selection or to a true treatment effect.

(Power in a statistical study is the number of patients needed to show a specific result or lack thereof that excludes the effect of random patient factors.)

The conclusion of this study is that intensive or daily dialysis is not any more effective than usual three times a week dialysis.  However, this study must be understood in context of the patient population it was studying. In the ICU, acute renal failure is often the result of severe underlying disease states such as uncompensated congestive heart failure with low cardiac output, acute myocardial infarction (heart attack),sepsis from severe systemic infections, blood loss, severe hypotension (low blood pressure) and other disease states which all result in inadequate perfusion or blood flow to the kidneys.  This results often in a specific condition called ATN (Acute Tubular Necrosis) which occurs when the renal blood flow is severely reduced or from a nephrotoxic agent.

It is well understood in the medical community that the development of secondary renal failure in this ICU patient population is an omen of adverse outcomes with mortality at the 50% level of any patient that develops this conditions secondary to the original underlying severe illness. 

Nevertheless, with the multitude of observational outcomes on daily dialysis in the chronic renal disease population, we should be careful not to generalize the results of this negative study to our own population.  What was proven in this very large and well done study is that the ICU population with acute renal failure is unique and does not benefit from a proven therapy shown in the chronic renal disease population. 

The underlying pathophysiology of the acute renal failure state in the ICU population is still in itself a marker of poor outcomes for secondary renal failure that occurs due to severe single or multiple organ failures.  The same injury that leads to renal failure also effects in similar manner the other organs as well.  The entire inflammatory cascade associated with ICU acute renal failure patients is apparently not improved in the least with aggressive renal replacement modalities vs usual dialysis therapy.  Thus, for the ICU population with acute renal failure, the frequency of dialysis does not address the underlying inflammatory cascade that leads to the acute renal failure in the first place.  Unfortunately, to date, very few effective therapies have been found for patients in this situation.

However, the hemodialysis community on chronic renal replacement therapy should not in any manner consider this a negative study for quotidian dialysis.  They are quite simply very different patient populations with the same therapy equally effective in mortality reduction to cadaveric transplant in the chronic renal disease population, yet in the other population in the ICU where acute renal failure is still a marker of adverse outcomes and death, there was no treatment effect with intensive vs. usual dialysis care.  We should be careful to understand the limitations of applying the results of this study to a different CKD patient population and optimal renal replacement therapies which is long, slow and daily dialysis.

So it begins

It's 10:30 Tuesday night, I just got on dialysis for a 6.5 hour run - the NxStage is my alarm clock - so I can be on the road tomorrow by 6AM. The plan is to start my checkout/paper work duties by 8:30 to get underway by 11.

Tomorrow I'm making a long slow run from Anacortes to Seattle via LaConner with my brother and sister in law on the Grand Waltz. Then after the NKC Breakfast of Hope Thursday me, my Mom and her college roommate plus roommate's spouse, will leave from downtown Seattle for Port Townsend; from there I'll have a week in the San Juan Islands and the vacation can begin in earnest.

Peter and Anna will be pitching in with posts, while I expect to be travel blogging on occasion. I'm hoping to report whale sightings.

22 out of 22 patients on wrong bath at DaVita Lufkin unit during 2007 Texas State survey

RenalWEB links to another disturbing article in the Lufkin Daily News concerning DaVita dialysis operations in the city of Lufkin Texas.  RenalWEB's news summary of events gives a chronology of what we know to date. Reading through the now 25 pages of comments to Jessica Savage's reporting, is very worrying when read in the context of the State of Texas surveyor's 2007 report.

Gary at RenalWEB offers the following commentary:

Answers definitely need to be provided to the ESRD community about this fundamental aspect of dialysis patient care:

• Were patients being dialyzed on the wrong potassium baths?
• How large were the discrepancies?
• Were the discrepancies noted on the patients' charts?
• Were post-treatment K+ blood levels checked?
• Were patients counseled on dietary adjustments?
• When and/or was the physician notified of the administrator's decision?
• Why wasn't there an adequate supply of dialysis concentrate for all 22 patients dialyzing that day?
• Why was dialyzing any patient on the wrong dialysate bath an accepted practice by anyone in the facility? (In my thirteen years of direct patient care, I never saw a patient intentionally dialyzed on the wrong potassium bath.)
• What clinic procedures were and/or are in place in the event a patient must be dialyzed on the wrong dialysate bath?

I would add two thoughts: the wrong calcium concentration can also have severe impacts and that the State of Texas must also answer questions about what follow up they instituted after these findings. My initial thought is that the State should have made certain, completely certain, that each and every patient knew their proper dialysate prescription and how to read the labels of the concentrate. If mislabeled dialysate was being used the unit should have been immediately closed.

                              

HDC Webinars - the future of dialysis learning

Home Dialysis Central tested out this Webinar idea after it was suggested by Rich Berkowitz. The initial presentation that Dr. Agar gave was on needle orientation. Here is my cannulation video where I show how I put my dialysis needles in every night using the buttonhole method (this was filmed in April/May 2006)

I had always placed the arterial needle (the needle that takes blood from the body to the machine) retrograde, meaning the needle pointed into the flow of blood. This is the first needle that I insert in the video. The second needle, the venous needle (which returns blood to the body) I've always placed antegrade, with the flow of blood. Dr. Agar's presentation made a strong case for placing both needles antegrade. I now place both my needles antegrade. It was seeing his Webinar that persuaded me to make the switch.

I had seen the presentation - Dr. Agar sent me the file - and I thought it was a good argument but it wasn't until he presented the data that I was moved to switch. There is real value to have the data presented and being able to interact with the presenter in real time. Try it for yourself a week from tomorrow, Wednesday May 28th. Sign up at WizIQ and then register for Dr. Agar's presentation. To get an email reminder before the session, send an email with "WEBINAR" in the subject heading to: info@homedialysis.org.  Everyone who sends an email to be reminded will be entered to win a pair of headphones.

I think once you sign up at WizIQ you can go back and view the practice sessions where Dr. Agar presents his case for antegrade/antegrade dialysis needle placement. Even as we practiced using the technology the data shone through; and now my video is out of date, for the last two weeks I have been placing both of my needles antegrade.

DaVita Lufkin rumors - criminal act involving bleach?

The Lufkin Daily News Reported over the weekend that a former employee is suspected of "criminal acts" in connection to the cluster of deaths at a DaVita dialysis unit in Lufkin Texas. RenalWEB has a news summary of events as they have been reported to date (largely by Jessica Savage Lufkin Daily News reporter).

My source is suggesting that this has to do with the misuse of bleach. Bleach is used to clean surfaces in diluted form throughout a dialysis clinic; it should have no contact with an individual's blood. When I heard bleach might be involved I thought I remembered a case of someone who killed using bleach who worked at a nursing home or hospice but I couldn't Google up a reference.

Whatever happened in Lufkin I hope they can sort it out and give the community a full accounting.

Free knowledge now available in cool new Webinar format

Back when I started this blog at the start of the year I blogged about Dr. Agar's two part article on Home Dialysis Central (part 1; part 2)  Fluid and solute removal: how and why. I wrote three posts inspired by the article: Dr. Agar on fluid and solute removal; More on fluid and solute removal; Optimal dialysis - beyond Kt/V; I think Dr. Agar's papers offer a great insight into a key concept.

Dr. Agar's been a champion of nocturnal dialysis, particularly home more frequent hemodialysis for quite some time - he makes his compelling case on his own nocturnaldialysis.org website. Not to mention he's handy with PowerPoint. I've met Dr. Agar but it's not a frequent occurrence - Dr. Agar lives in Geelong, Victoria, Australia.

But now thanks to the internet you can have Dr. Agar present a PowerPoint right in your home, right through the computer. A PowerPoint on the same topic these papers address. If you weren't sure about all the concepts in the papers now is your chance to hear Dr. Agar himself present. Here's how to sign up - from Dori Schatell on the HDC forums:

The session will be held on Wednesday May 28th for those east of Europe (the US) and on Thursday May 29th for those living between England and Hawaii. The Webinar will start at:
2:00am (Thursday) GMT/London
6:00pm (Wednesday) US Pacific time (GMT -08:00)
7:00pm (Wednesday) US Mountain time
8:00pm (Wednesday) US Central time
9:00pm (Wednesday) US Eastern time
7:30am (Thursday) Mumbai, India
11:00am (Thursday) Australia (Geelong) time

This is a web-based session; you don't need a telephone to take part.  To sign up, visit:  http://www.wiziq.com/TutorSession/Se...2Rv1VT7g%3d%3d.

1. If you are new to the WiZiQ site, click "Not a member? Register." Fill in your name, email address, and choose a password, and click "Join Now." When the session time rolls around, click "LAUNCH" and you're in!

2.  If you have signed up for WiZiQ,  Log in.  When the session time rolls around, click "LAUNCH" and you're in!

*To sign up for a PRIZE drawing and get an email reminder before the session, please send an email with "WEBINAR" in the subject heading to: info@homedialysis.org.  Win a pair of headphones donated by Genesis Worldwide Enterprises!

This is a fantastic opportunity to hear from an international hemodialysis expert. This is the first of what I hope will be many Webinars from HDC - I made a Webinar category so I hope to see one at least once a month.

Our friends in India will have to attend the Webinar while eating breakfast and those in Europe will need to set an alarm clock but before you lose sleep over this I have good news - the Webinar will be available on WizIQ for viewing at your convenience after the event. 

Dialysis & CKD discussion board report for 5/18

Dialysis & CKD discussion boards activity this week from 5/12 to 5/18. It's a six day week this week, but averaging the last two reports together and IHD had over 2,700 posts a week. There is a new Board  on the list - Chronic Chick Talk - which looks like it will be a go to site for those with Lupus. Online discussions are a great way to connect with those with CKD and the people that love them, join the discussion today.

1. I Hate Dialysis 1,769 new posts; 70 new threads; 1,950(+26) members
2. Kidney Fun 893 new posts; n/a; 403(+7) members
3. Angie's Kidney Community 322 new posts; 35 new threads; 39(+2) members
4. Kidney Space 127 new posts; 7 new threads; 374(+7) members
5. Kidney Friends 156 new posts; 24 new threads; 240(+3) members
6. The Kidney Patient Guide 61 new posts; 9 new threads; 1,510(+2) members
7. Davita 70 new posts; 10 new threads; 6,116(+16) members
8. Home Dialysis Central Forums 23 new posts; 6 new threads; 458(+5) members
9. Renal Romance 10 new posts; 0 new threads; 194() members
10. Care Giver Talk 47 new posts; 0 new threads; 219(+1) members
11. Global Dialysis 7 new posts; 4 new threads; 406(+6) members
12. Life Options 1 new post; 0 new threads; 255() members

Chronic Chick Talk New URL/Data

• Other dialysis/CKD discussion boards (data not published)
  
  • JENY ESRD Network Community
  • Nephrology Now registration required
  • Kidney Research UK
  • RenalWeb
  • Talkline
  • Dialysis & Transplant City
  • Lupus Foundation of America

If you know of an active discussion board covering CKD related subjects leave a comment or send an email with the URL and I'll add it to the discussion board report.

Dialysis & CKD discussion boards activity this week from 5/12 to 5/18. It's a six day week this week, but averaging the last two reports together and IHD had over 2,700 posts a week. There is a new Board  on the list - Chronic Chick Talk - which looks like it will be a go to site for those with Lupus. Online discussions are a great way to connect with those with CKD and the people that love them, join the discussion today.

1. I Hate Dialysis 1,769 new posts; 70 new threads; 1,950(+26) members
2. Kidney Fun 893 new posts; n/a; 403(+7) members
3. Angie's Kidney Community 322 new posts; 35 new threads; 39(+2) members
4. Kidney Space 127 new posts; 7 new threads; 374(+7) members
5. Kidney Friends 156 new posts; 24 new threads; 240(+3) members
6. The Kidney Patient Guide 61 new posts; 9 new threads; 1,510(+2) members
7. Davita 70 new posts; 10 new threads; 6,116(+16) members
8. Home Dialysis Central Forums 23 new posts; 6 new threads; 458(+5) members
9. Renal Romance 10 new posts; 0 new threads; 194() members
10. Care Giver Talk 47 new posts; 0 new threads; 219(+1) members
11. Global Dialysis 7 new posts; 4 new threads; 406(+6) members
12. Life Options 1 new post; 0 new threads; 255() members

Chronic Chick Talk New URL/Data

• Other dialysis/CKD discussion boards (data not published)
  
  • JENY ESRD Network Community
  • Nephrology Now registration required
  • Kidney Research UK
  • RenalWeb
  • Talkline
  • Dialysis & Transplant City
  • Lupus Foundation of America

If you know of an active discussion board covering CKD related subjects leave a comment or send an email with the URL and I'll add it to the discussion board report.

Dialysis & CKD discussion boards activity this week from 5/12 to 5/18. It's a six day week this week, but averaging the last two reports together and IHD had over 2,700 posts a week. There is a new Board  on the list - Chronic Chick Talk - which looks like it will be a go to site for those with Lupus. Online discussions are a great way to connect with those with CKD and the people that love them, join the discussion today.

1. I Hate Dialysis 1,769 new posts; 70 new threads; 1,950(+26) members
2. Kidney Fun 893 new posts; n/a; 403(+7) members
3. Angie's Kidney Community 322 new posts; 35 new threads; 39(+2) members
4. Kidney Space 127 new posts; 7 new threads; 374(+7) members
5. Kidney Friends 156 new posts; 24 new threads; 240(+3) members
6. The Kidney Patient Guide 61 new posts; 9 new threads; 1,510(+2) members
7. Davita 70 new posts; 10 new threads; 6,116(+16) members
8. Home Dialysis Central Forums 23 new posts; 6 new threads; 458(+5) members
9. Renal Romance 10 new posts; 0 new threads; 194() members
10. Care Giver Talk 47 new posts; 0 new threads; 219(+1) members
11. Global Dialysis 7 new posts; 4 new threads; 406(+6) members
12. Life Options 1 new post; 0 new threads; 255() members

Chronic Chick Talk New URL/Data

• Other dialysis/CKD discussion boards (data not published)
  
  • JENY ESRD Network Community
  • Nephrology Now registration required
  • Kidney Research UK
  • RenalWeb
  • Talkline
  • Dialysis & Transplant City
  • Lupus Foundation of America

If you know of an active discussion board covering CKD related subjects leave a comment or send an email with the URL and I'll add it to the discussion board report.

Dialysis & CKD discussion boards activity this week from 5/12 to 5/18. It's a six day week this week, but averaging the last two reports together and IHD had over 2,700 posts a week. There is a new Board  on the list - Chronic Chick Talk - which looks like it will be a go to site for those with Lupus. Online discussions are a great way to connect with those with CKD and the people that love them, join the discussion today.

1. I Hate Dialysis 1,769 new posts; 70 new threads; 1,950(+26) members
2. Kidney Fun 893 new posts; n/a; 403(+7) members
3. Angie's Kidney Community 322 new posts; 35 new threads; 39(+2) members
4. Kidney Space 127 new posts; 7 new threads; 374(+7) members
5. Kidney Friends 156 new posts; 24 new threads; 240(+3) members
6. The Kidney Patient Guide 61 new posts; 9 new threads; 1,510(+2) members
7. Davita 70 new posts; 10 new threads; 6,116(+16) members
8. Home Dialysis Central Forums 23 new posts; 6 new threads; 458(+5) members
9. Renal Romance 10 new posts; 0 new threads; 194() members
10. Care Giver Talk 47 new posts; 0 new threads; 219(+1) members
11. Global Dialysis 7 new posts; 4 new threads; 406(+6) members
12. Life Options 1 new post; 0 new threads; 255() members

Chronic Chick Talk New URL/Data

• Other dialysis/CKD discussion boards (data not published)
  
  • JENY ESRD Network Community
  • Nephrology Now registration required
  • Kidney Research UK
  • RenalWeb
  • Talkline
  • Dialysis & Transplant City
  • Lupus Foundation of America

If you know of an active discussion board covering CKD related subjects leave a comment or send an email with the URL and I'll add it to the discussion board report.

Dialysis & CKD discussion boards activity this week from 5/12 to 5/18. It's a six day week this week, but averaging the last two reports together and IHD had over 2,700 posts a week. There is a new Board  on the list - Chronic Chick Talk - which looks like it will be a go to site for those with Lupus. Online discussions are a great way to connect with those with CKD and the people that love them, join the discussion today.

1. I Hate Dialysis 1,769 new posts; 70 new threads; 1,950(+26) members
2. Kidney Fun 893 new posts; n/a; 403(+7) members
3. Angie's Kidney Community 322 new posts; 35 new threads; 39(+2) members
4. Kidney Space 127 new posts; 7 new threads; 374(+7) members
5. Kidney Friends 156 new posts; 24 new threads; 240(+3) members
6. The Kidney Patient Guide 61 new posts; 9 new threads; 1,510(+2) members
7. Davita 70 new posts; 10 new threads; 6,116(+16) members
8. Home Dialysis Central Forums 23 new posts; 6 new threads; 458(+5) members
9. Renal Romance 10 new posts; 0 new threads; 194() members
10. Care Giver Talk 47 new posts; 0 new threads; 219(+1) members
11. Global Dialysis 7 new posts; 4 new threads; 406(+6) members
12. Life Options 1 new post; 0 new threads; 255() members

Chronic Chick Talk New URL/Data

• Other dialysis/CKD discussion boards (data not published)
  
  • JENY ESRD Network Community
  • Nephrology Now registration required
  • Kidney Research UK
  • RenalWeb
  • Talkline
  • Dialysis & Transplant City
  • Lupus Foundation of America

If you know of an active discussion board covering CKD related subjects leave a comment or send an email with the URL and I'll add it to the discussion board report.

Dialysis & CKD discussion boards activity this week from 5/12 to 5/18. It's a six day week this week, but averaging the last two reports together and IHD had over 2,700 posts a week. There is a new Board  on the list - Chronic Chick Talk - which looks like it will be a go to site for those with Lupus. Online discussions are a great way to connect with those with CKD and the people that love them, join the discussion today.

1. I Hate Dialysis 1,769 new posts; 70 new threads; 1,950(+26) members
2. Kidney Fun 893 new posts; n/a; 403(+7) members
3. Angie's Kidney Community 322 new posts; 35 new threads; 39(+2) members
4. Kidney Space 127 new posts; 7 new threads; 374(+7) members
5. Kidney Friends 156 new posts; 24 new threads; 240(+3) members
6. The Kidney Patient Guide 61 new posts; 9 new threads; 1,510(+2) members
7. Davita 70 new posts; 10 new threads; 6,116(+16) members
8. Home Dialysis Central Forums 23 new posts; 6 new threads; 458(+5) members
9. Renal Romance 10 new posts; 0 new threads; 194() members
10. Care Giver Talk 47 new posts; 0 new threads; 219(+1) members
11. Global Dialysis 7 new posts; 4 new threads; 406(+6) members
12. Life Options 1 new post; 0 new threads; 255() members

Chronic Chick Talk New URL/Data

• Other dialysis/CKD discussion boards (data not published)
  
  • JENY ESRD Network Community
  • Nephrology Now registration required
  • Kidney Research UK
  • RenalWeb
  • Talkline
  • Dialysis & Transplant City
  • Lupus Foundation of America

If you know of an active discussion board covering CKD related subjects leave a comment or send an email with the URL and I'll add it to the discussion board report.

Dialysis & CKD discussion boards activity this week from 5/12 to 5/18. It's a six day week this week, but averaging the last two reports together and IHD had over 2,700 posts a week. There is a new Board  on the list - Chronic Chick Talk - which looks like it will be a go to site for those with Lupus. Online discussions are a great way to connect with those with CKD and the people that love them, join the discussion today.

1. I Hate Dialysis 1,769 new posts; 70 new threads; 1,950(+26) members
2. Kidney Fun 893 new posts; n/a; 403(+7) members
3. Angie's Kidney Community 322 new posts; 35 new threads; 39(+2) members
4. Kidney Space 127 new posts; 7 new threads; 374(+7) members
5. Kidney Friends 156 new posts; 24 new threads; 240(+3) members
6. The Kidney Patient Guide 61 new posts; 9 new threads; 1,510(+2) members
7. Davita 70 new posts; 10 new threads; 6,116(+16) members
8. Home Dialysis Central Forums 23 new posts; 6 new threads; 458(+5) members
9. Renal Romance 10 new posts; 0 new threads; 194() members
10. Care Giver Talk 47 new posts; 0 new threads; 219(+1) members
11. Global Dialysis 7 new posts; 4 new threads; 406(+6) members
12. Life Options 1 new post; 0 new threads; 255() members

Chronic Chick Talk New URL/Data

• Other dialysis/CKD discussion boards (data not published)
  
  • JENY ESRD Network Community
  • Nephrology Now registration required
  • Kidney Research UK
  • RenalWeb
  • Talkline
  • Dialysis & Transplant City
  • Lupus Foundation of America

If you know of an active discussion board covering CKD related subjects leave a comment or send an email with the URL and I'll add it to the discussion board report.

Dialysis & CKD discussion boards activity this week from 5/12 to 5/18. It's a six day week this week, but averaging the last two reports together and IHD had over 2,700 posts a week. There is a new Board  on the list - Chronic Chick Talk - which looks like it will be a go to site for those with Lupus. Online discussions are a great way to connect with those with CKD and the people that love them, join the discussion today.

1. I Hate Dialysis 1,769 new posts; 70 new threads; 1,950(+26) members
2. Kidney Fun 893 new posts; n/a; 403(+7) members
3. Angie's Kidney Community 322 new posts; 35 new threads; 39(+2) members
4. Kidney Space 127 new posts; 7 new threads; 374(+7) members
5. Kidney Friends 156 new posts; 24 new threads; 240(+3) members
6. The Kidney Patient Guide 61 new posts; 9 new threads; 1,510(+2) members
7. Davita 70 new posts; 10 new threads; 6,116(+16) members
8. Home Dialysis Central Forums 23 new posts; 6 new threads; 458(+5) members
9. Renal Romance 10 new posts; 0 new threads; 194() members
10. Care Giver Talk 47 new posts; 0 new threads; 219(+1) members
11. Global Dialysis 7 new posts; 4 new threads; 406(+6) members
12. Life Options 1 new post; 0 new threads; 255() members

Chronic Chick Talk New URL/Data

• Other dialysis/CKD discussion boards (data not published)
  
  • JENY ESRD Network Community
  • Nephrology Now registration required
  • Kidney Research UK
  • RenalWeb
  • Talkline
  • Dialysis & Transplant City
  • Lupus Foundation of America

If you know of an active discussion board covering CKD related subjects leave a comment or send an email with the URL and I'll add it to the discussion board report.

Dialysis & CKD discussion boards activity this week from 5/12 to 5/18. It's a six day week this week, but averaging the last two reports together and IHD had over 2,700 posts a week. There is a new Board  on the list - Chronic Chick Talk - which looks like it will be a go to site for those with Lupus. Online discussions are a great way to connect with those with CKD and the people that love them, join the discussion today.

1. I Hate Dialysis 1,769 new posts; 70 new threads; 1,950(+26) members
2. Kidney Fun 893 new posts; n/a; 403(+7) members
3. Angie's Kidney Community 322 new posts; 35 new threads; 39(+2) members
4. Kidney Space 127 new posts; 7 new threads; 374(+7) members
5. Kidney Friends 156 new posts; 24 new threads; 240(+3) members
6. The Kidney Patient Guide 61 new posts; 9 new threads; 1,510(+2) members
7. Davita 70 new posts; 10 new threads; 6,116(+16) members
8. Home Dialysis Central Forums 23 new posts; 6 new threads; 458(+5) members
9. Renal Romance 10 new posts; 0 new threads; 194() members
10. Care Giver Talk 47 new posts; 0 new threads; 219(+1) members
11. Global Dialysis 7 new posts; 4 new threads; 406(+6) members
12. Life Options 1 new post; 0 new threads; 255() members

Chronic Chick Talk New URL/Data

• Other dialysis/CKD discussion boards (data not published)
  
  • JENY ESRD Network Community
  • Nephrology Now registration required
  • Kidney Research UK
  • RenalWeb
  • Talkline
  • Dialysis & Transplant City
  • Lupus Foundation of America

If you know of an active discussion board covering CKD related subjects leave a comment or send an email with the URL and I'll add it to the discussion board report.

Dialysis & CKD discussion boards activity this week from 5/12 to 5/18. It's a six day week this week, but averaging the last two reports together and IHD had over 2,700 posts a week. There is a new Board  on the list - Chronic Chick Talk - which looks like it will be a go to site for those with Lupus. Online discussions are a great way to connect with those with CKD and the people that love them, join the discussion today.

1. I Hate Dialysis 1,769 new posts; 70 new threads; 1,950(+26) members
2. Kidney Fun 893 new posts; n/a; 403(+7) members
3. Angie's Kidney Community 322 new posts; 35 new threads; 39(+2) members
4. Kidney Space 127 new posts; 7 new threads; 374(+7) members
5. Kidney Friends 156 new posts; 24 new threads; 240(+3) members
6. The Kidney Patient Guide 61 new posts; 9 new threads; 1,510(+2) members
7. Davita 70 new posts; 10 new threads; 6,116(+16) members
8. Home Dialysis Central Forums 23 new posts; 6 new threads; 458(+5) members
9. Renal Romance 10 new posts; 0 new threads; 194() members
10. Care Giver Talk 47 new posts; 0 new threads; 219(+1) members
11. Global Dialysis 7 new posts; 4 new threads; 406(+6) members
12. Life Options 1 new post; 0 new threads; 255() members

Chronic Chick Talk New URL/Data

• Other dialysis/CKD discussion boards (data not published)
  
  • JENY ESRD Network Community
  • Nephrology Now registration required
  • Kidney Research UK
  • RenalWeb
  • Talkline
  • Dialysis & Transplant City
  • Lupus Foundation of America

If you know of an active discussion board covering CKD related subjects leave a comment or send an email with the URL and I'll add it to the discussion board report.

Dialysis & CKD listserv report 5/18

If you need information or support about: dialysis (hemodialysis and peritoneal dialysis; incenter hemodialysis or home dialysis); or kidney transplant; or how to slow kidney disease - look into joining a listserv. Not only is the day to day conversation helpful the archives are a wealth of information - join the conversations (these are all listservs hosted by Yahoo Groups see the Yahoo groups help page for any who, how or when questions about listservs).

After last week's count it seems quiet this week. This was a short week because I was a day behind last week.

1. kidney_transplants 130 messages to 1,067(+1) members
   
2. iga-nephropathy 127 messages to 2,964(+8) members
3. Kidney/Pancreas Transplant Recipients 70 messages to 284() members
   
4. dialysis-support MM 66 messages to 148(+4) members 
5. NxStage_Users M 57 messages to 47(+2) members
6. PKDCARE 8 messages to 671(+3) members
7. kidneykidneydisease 49 messages to 314(-1) members
8. EndStageRenalDisease 10 new messages to 401() members
9. Autosomal Recessive Polycystic Kidney Disease 10 messages to 320(+1) members
10. Australian_Dialysis_Buddies 5 Messages to 60(+1) member
11. renalrelating 4 messages to 157() members
12. NxStageUsersGroup M 4 Message to 80() members
13. A_dialysis_and_support_group 4 message to 35() members

(An 'M' indicates I am a member; 'MM' indicates I am a member and a moderator; criteria for membership is set by list owner; posts in the last seven days; members change in the last seven days; let me know if you have an active group not on the list.

If you need information or support about: dialysis (hemodialysis and peritoneal dialysis; incenter hemodialysis or home dialysis); or kidney transplant; or how to slow kidney disease - look into joining a listserv. Not only is the day to day conversation helpful the archives are a wealth of information - join the conversations (these are all listservs hosted by Yahoo Groups see the Yahoo groups help page for any who, how or when questions about listservs).

After last week's count it seems quiet this week. This was a short week because I was a day behind last week.

1. kidney_transplants 130 messages to 1,067(+1) members
   
2. iga-nephropathy 127 messages to 2,964(+8) members
3. Kidney/Pancreas Transplant Recipients 70 messages to 284() members
   
4. dialysis-support MM 66 messages to 148(+4) members 
5. NxStage_Users M 57 messages to 47(+2) members
6. PKDCARE 8 messages to 671(+3) members
7. kidneykidneydisease 49 messages to 314(-1) members
8. EndStageRenalDisease 10 new messages to 401() members
9. Autosomal Recessive Polycystic Kidney Disease 10 messages to 320(+1) members
10. Australian_Dialysis_Buddies 5 Messages to 60(+1) member
11. renalrelating 4 messages to 157() members
12. NxStageUsersGroup M 4 Message to 80() members
13. A_dialysis_and_support_group 4 message to 35() members

(An 'M' indicates I am a member; 'MM' indicates I am a member and a moderator; criteria for membership is set by list owner; posts in the last seven days; members change in the last seven days; let me know if you have an active group not on the list.

CKD links and resources

• Main Link Page
• Dialysis and CKD Blogs
• Dialysis and CKD Discussion Boards
• Dialysis and CKD Listservs

CKD Knowledge Advocacy Groups CKD Shopping Information/News Knowledge Resources Medical Journals Recipes and Nutrition Information Renal Industry Blogs

The CKD Players Professional Organizations Research Dialysis Equipment Manufacturers ESRD Networks For profit Dialysis Providers Nonprofit Dialysis Providers US Government

Lite blogging

I'm experiencing computer issues - right now I am using a neighbors unsecured wi-fi that seems to come and go. Between work and volunteering the next four days were already hopelessly overbooked to try and prepare for a nine night bare boat charter starting on Wednesday, now I'll have to make time to get my internet access working again.

The trip will be from Wednesday the 21st to Friday the 30th. I did this last summer too, there is a report on Home Dialysis Central, and this video where I inexplicably misidentify the boat as a Tollycraft (it is a 36' Grand Banks):

It's the same boat, different crew. There is also this account of last year's trip from my crew's perspective; interesting for me to read about one of my trips through someone else's eyes.

Daily Dialysis Delivers Baby Girl

Howdy, this is Peter with a little report of a brave lady and one more example of a treatment who’s time has come.

Woman on daily dialysis delivers baby girl.

One of the ongoing observations about quotidian dialysis is that securing a family in patients with stage 5 CKD on dialysis was in the past a very rare occurrence.  However, with optimal daily dialysis, all things are once again possible.  Rita Ferrel recently delivered a healthy baby girl while undergoing daily hemodialysis.  Rita not only was able to deliver a healthy baby girl, but because of her daily dialysis, she was able to shed the usual dialysis diet restrictions and eat all of the nutrients she needed for a normal pregnancy.  The unphysiology of three times a week dialysis is the reason that pregnancy while on dialysis has been a rarity.  Normalizing the physiology by daily dialysis has two more premier champions as evidence that its time has come.