Dialysis & CKD Report 10/25

By Miriam Lippel Blum

The clock is ticking everyone! Comments on the Proposed Rule are due to CMS by end of business on November 16. Submit them here. If you don't understand how this rule might impact your dialysis care then go to the Renal Support Network's Kidney Public Policy 101 and learn. If we don't stand up for ourselves, who will?

Here are the CKD related blogs updated since my last report on 10/22. If you have or know of a blog that should be on the list let Bill know. Comments in parentheses are my reactions or opinions.

• Dialysis from the sharp end of the needle Bill posted the comments he made at the CMS Town Hall meeting on the ESRD Prospective Payment System Proposed Rule; Bill notes that the audio recording of the CMS Town Hall meeting will only be available for four days and thinks that it should be available until the end of the open comment  (It was excellent, definitely worth hearing. I think they are only having it available for four days to limit patient exposure to it. Less exposure means fewer complaints.);  Rich Berkowitz also spoke at the Town Hall meeting and shares his comments, as well as urging us all to submit our written comments for CMS's consideration; Bill posts Dori Schatell's testimony from the CMS Town Hall meeting and applauds her for bringing the 2-day killer gap to the attention of both CMS and the entire renal community.
• Kamal Shah's Blog Kamal reports that the Andhra Pradesh state government in India is extending a program for dialysis with 111 new clinics where patients can obtain dialysis three times a week - free of cost. a revolutionary step.  He also doen't understand people who think less dialysis is acceptable treatment.
• Kaply, Inc. Tracy lists things she loves, including a cashmere sweater, is having fistula surgery yet again and might have to have sinus surgery. (Tracy, you would look gorgeous in that sweater and if you have to put up with all the health stuff you do, darn it, Girl, I think you deserve some cashmere!)
• Toastiest shares a photo of his cat.
• Birdman Sparrow's wife has a cold, a neighbor brings soup, Sparrow needs a keyboard for music and for his transplant pager to go off.
• The Life of a 20-Something With Lupus Flo looks forward to her week off, finds it difficult to juggle nocturnal dialysis and early morning appointments to which she must travel by public bus, she also yearns for her kidney pager to ring.
• Becky Perry Becky's boys have colds, she does lots of laundry, and is addicted to crunching Ice Breaker mints which she thinks is a dialysis thing. (People do all sorts of things to combat thirst and dry mouth.)
• Life on dialysis ... and now life after my transplant! Holly's brother gets "Live Life Then Give Life" tattooed on his back for her which delighted her; Holly celebrates the day she got "the call" for her kidney with some photos and reminisces about it and how her life has changed, she expresses gratitude to the donor and their family for the amazing gift they gave her.
• The Daily Dialysis Bonni is amused to find out that Mark's nephrologist discovered her blog when he googled himself, he noted that she likes to write and uses it to vent, she now has a following of dialyzors, caregivers, dialysis staff...and at least one doctor.
• I Am. Are you? has an interview with Donate Life Illinois’ hard-working Volunteer Coordinator, Jane Lee-Zimmer.
• Transplant Alliance A young woman, member of a donor family, shares thoughts about eye donation.
• The Ins and Outs of Dialysis Gayle describes clinic visits and how she and John lighten the mood.
• Chronic Chick Talk urges supporting the Lupus Foundation of America in America's Giving Challenge to help them win $50,000; some tips for traveling when you have a chronic illness; her Friday Fill-ins feature; a link to a bed cover to keep the bedbugs away from you; a photo of her dog, Mason, hiding under a chair; is surprised at how furniture styles change from year to year.
• Precious Bodily Fluids Joel manages to revive the files from his first book Fluid, Electrolyte and Acid Base Companion and shares the first chapter. He will be editing and revising it to provide a modern, comprehensive tutorial about fluids and electrolytes aimed at medical students and residents.
• Renal Fellow Network A review shows that renal biopsy complications occur in 7.4% to 19.5% of patients. These mostly consist of self-limiting macroscopic hematuria or a peri-renal, or subcapsular, hematoma.
• Uremic Frost has a photo of a thoracic kidney, an extraordinarily rare congenital anomaly. It is more common in men and usually found in the left thorax. It is also completely benign and does not require any intervention; a clever video called "Assault by Salt" about avoiding excess sodium intake; a study showed that higher intensity CRRT (continuous renal replacement therapy) prescription in the ICU resulted in a lot more hypophosphatemia, but unfortunately, no reduction on the mortality rate; a nice video about the NKF Kidney Walk; the testimony given at the CMS Town Hall meeting by LaVarne Burton,  President of the American Kidney Fund; the FDA has just approved APP Pharmaceutical’s Chlorothiazide Sodium (Diuril) for injection. The drug is approved for use in the treatment of high blood pressure , as well as fluid retention in people with congestive heart failure, cirrhosis of the liver, kidney disorders, or edema caused by taking steroids or estrogen;  a study in the New England Journal of Medicine  showed that nursing home residents requiring renal replacement therapy with hemodialysis suffered "substantial and sustained" declines in functional status after the initiation of therapy.
• Renal tsar's blog The UK's Dept. of Health is introducing a new capacity planning software model called MORRIS (the model for optimizing renal replacement investment and services).  MORRIS has been constructed to support policy making and commissioning of renal replacement therapy services for adults in England and is now available for anyone who wishes to use it. NHS Kidney Care will be interested in hearing comments and views of all stakeholders.
• pkdmom2five Amy posts pictures from a family visit to the pumpkin patch; quotations regarding religious revival; photos from the birth of her son, Isaiah.
• Dialysis and Me Barry has been busy making model soldiers and proves it with photos; a video of him and Laura organizing his Warhammer stuff; a picture of another model he will make called the Fortress of Redemption; a video of his participation in the American Heart Association's Heart Walk.
• Kidney Notes - Exploring the Intersection of Medicine and Technology posts a very clever animation from NPR about how a virus does its thing in your body. (After you watch this, you'll go get your flu shot.)
• Lemonade and Kidneys Ruth will be at the Swarthmore Co-op's Food Festival come rain or shine.
• The inner game of PKD  If you sense that you, the PKD patient, could use an injection of fortitude, Coach Richie invites you to contact him to discover how to tap into your natural store of fortitude.
• Kidney Diet Tips has low potassium diet tips and recipes.
• Team Teddy Bear Bob's grandson receives Confirmation at his church.

Comments

[christmas gift ideas]

We saw a case of this during my 1st year of nephrology fellowship--we were consulted on a 58 yo M with a history of stage 3 CKD--who developed altered mental status requiring intubation. We were consulted to rule out "uremia" as a cause of his delta MS, though his BUN was only in the 50s and not that off from his baseline. It turns out the patient had been on a cruise during which he had consumed some starfruit at a buffet. His altered mental status improved rapidly following 2-3 sessions of dialysis.

[Miriam Lippel Blum]

Interesting case. Thanks for sharing. Starfruit can be deadly for those with advanced CKD and it turns up in fruit salads and other places sometimes so it is worth asking what is in things before one eats them.