Dialysis from the sharp end of the needle

Glenn Chertow, MD to give ADC 2011 Keynote Address

By Peter Laird, MD

The Annual Dialysis Conference is the best place to watch and learn about optimal dialysis trends not only in America but from around the globe. The tone of the conference is often highlighted in the key note address by one of many leading researchers and dialysis advocates. Past key note addresses in prior conferences still resonate in the lecture halls as data and information is not only presented but at times debated with great passion. Carl Kjellstrand spoke with great conviction two years ago in his keynote address against randomized controlled dialysis trials (RCT) and how they were not needed nor ethical in dialysis patients with over 40 years of solid evidence from observational studies showing great benefit of longer and more frequent dialysis schedules.

The legacy of Dr. Belding Scribner's dedication to bringing about optimal dialysis in America is often the subtext of the keynote address. Perhaps no where else is optimal dialysis championed as eloquently than at the Annual Dialysis Conference put on by the University of Missouri for over 30 years. I recently reviewed the upcoming program for the ADC meeting in February 2011 in Phoenix and found that the keynote address will come from Dr. Glenn Chertow. Dr. Chertow is a renowned nephrologist now at Stanford University and researcher involved in many of the dominant studies of the last two decades.

The HEMO study is a randomized, controlled trial that showed no benefit to high flux, high intensity hemodialysis maximizing Kt/V in conventional hemodialysis regimens. The result of this study and it's negative outcome led to questioning of the entire optimal dialysis strategy that was just gaining ground at that time with the the results of the Toronto group's nocturnal dialysis program. Dr. Chertow vocally championed the cause of further randomized and controlled trials to prove all aspects of optimal dialysis before adopting more frequent and longer duration sessions in America. In fact, DSEN has written several posts (here, here and here) in opposition to his dependence on randomized and controlled trials before going forward with the same type of programs that are already used with great success in Japan, Europe, Australia and New Zealand.

Dr. Chertow's upcoming keynote address is based on another study published in Kidney International earlier this year titled: Shorter dialysis times are associated with higher mortality among incident hemodialysis patients. The interesting aspect of this study is not only the astounding conclusion that shortened dialysis times less than 4 hours/session resulted in over 42% increased mortality, but that the conclusions were obtained not from a RCT, but from an observational trial. The simple fact that the Keynote address is by Dr. Chertow using an observational trial and not waiting for confirmation from a RCT is in my opinion big news for the dialysis industry.

Are the winds of time changing in the American dialysis community? Is this also prognostication of the results of the soon to be released Frequent Hemodialysis Network studies on short daily hemodialysis as well as daily nocturnal dialysis in which Dr. Chertow is a principle investigator? Perhaps my optimism for implementing optimal dialysis is overwhelming me with hope, or perhaps we are about to experience the paradigm shift that Mel Hodge wrote about so eloquently earlier this year. The path to a paradigm shift in hemodialysis:

About 1 out of 4 American conventional dialysis patients die in the first year and 3 out of 5 die within 5 years with no favorable trend in sight. Largely ignored in practice is the evidence accumulated over decades that longer, more frequent dialysis can immediately slash this grim result in half or more. Pierratos has called for a paradigm shift—a disruptive change—in dialysis practice from conventional treatment to daily nocturnal dialysis, performed at home, to realize this dramatic improvement. We examine here how such a paradigm shift might be brought about and suggest that changes in 3 perspectives must occur. First, new dialysis guidelines must be recast from the old goal of minimally adequate to a new goal of best possible. Second, the body of dialysis research must be interpreted through the lens of best possible patient survival and well being, and the near-impossibility of demonstrating dialysis survival advantage through randomized clinical trials must be acknowledged. Finally, dialysis modality must be seen as, most importantly, a survival and well-being choice, not merely a “Lifestyle” choice; hence, it must be the nondelegatable responsibility of the physician, not dialysis center personnel, to advise and prescribe. Many old perspectives, which might stand in the way of this sorely needed paradigm shift are also examined. These old perspectives make up a fabric of excuses that has delayed—and, if not discarded, will continue to delay—progress toward a survival and well-being outlook for dialysis patients just as favorable as might be achieved through kidney transplant.

Whatever the outcome of Dr. Chertow's keynote address, I believe that a true paradigm shift is in the making. The standard of dialysis care can no longer be that of minimum standards but instead that of maximizing patient survival and rehabilitation which are precisely the goals of therapy long advocated by Dr. Scribner. It is time to come full circle and realize that the pioneers of dialysis did it right by focusing on patient rehabilitation as the objective measure of dialysis adequacy instead of reliance on the laboratory based Kt/V. Dr. Chertow's keynote address on length of dialysis sessions is a welcome addition to the Annual Dialysis Conference not only for the data and evidence that he shall present, but more importantly because of the underlying message that he will send loud and clear in presenting evidence from an observational study as the basis of the 2011 ADC keynote address.

Notes From Transplantation in the USA: Part Two Using Incentives in Organ Donation

By Anna Bennett

This is Part Two (part one) of a three post series on Transplantation in the USA a program given in NYC on April 19th 2010 by the Kidney and Urology Foundation of America.

Paying for organs has been discussed before on DSEN. I have firmly taken a stance that opposes creating an organ market here in the United States. That being said, the discussion is on the table and both sides have the mic.

The second speaker of the evening was Alex Tabarrock, Ph.D.: Bartley J. Madden Chair in Economics at the Mercatus Center and Associate Professor of Economics , George Mason University, Fairfax VA; Director of Research, The Independent Institute, Oakland, CA.

Dr. Tabarrock presented his studies showing that economic incentive is the way to cure the organ shortage. He even quoted Adam Smith (pretty safe bet for an economist). It was when Dr. Tabarrock started extolling the virtues of the Iranian system that he raised my ire. Seriously? He was using Iran as an example of a robust and functional organ market? He did. Really.

My favorite moment though was when he said that other medical/organ donations were already being compensated. His example: When you donate your body to science, they give you a free cremation after they are done. I almost laughed out loud on that one. What are these centers going to do? Ship the body parts back home? Of course the donated body would be cremated (hint Dr. Tabarrock, unclaimed bodies in NYC are cremated for free as well).

Obviously, I do not agree with Dr. Tabarock or the whole school of thought "Why can't I buy a kidney if I can afford it? It's the American way." There have been posts here on DSEN and all over the internet about the subject, it is polarizing and controversial. I cannot write unbiasedly about it. There seems to be two schools of thought, one of individual rights (Dr. Tabarrock's camp) and Society (my position). Dr. Tabarrock cited Israel and their compensation for deceased donors. I would agree that is a program worth watching closely. Deceased donors cannot be coerced or manipulated, they are not desperate.  He also cited the State of Pennsylvania creating a trust to compensate deceased donor families. He stated that the fund was established, but never used for fear of public backlash.

This is such a polarizing subject, and debate can easily devolve, and has.  My suggestion is that we watch and wait, and while we are doing that, let's fix the holes in the current system.  Because, before we create a whole new administrative and ethical nightmare with any form of compensation for donors (other than medical expenses) we have a lot of work to do. There is so much room for improvement in our system right now.  It is my opinion that Dr. Tabarrock's time, education and energy could be of use to the CKD community in a much more advantageous and practical way, rather than pick a morally gray area and try to grandstand upon it.

Notes From Transplantation in the USA: Part One Successes and Challenges

By Anna Bennett

The Kidney and Urology Foundation of America hosted a program last Monday: Transplantation in the USA: The Shortage of Available Organs and Public Health Policy:

There are over 100,000 people on the national transplant wait list, and most wait for kidneys. The organ shortage crisis and recent events surrounding the underground market for organs begs us to explore current practices in organ allocation, incentives for organ donation, and how health care policies evolve.

See NephrOnline coverage here.

It was my intention to attend this program and write a simple recap for DSEN. As I sat in the audience at the Paley Center for Media, all hope for an unbiased recap was lost. Instead, what I found was a diverse group of presenters who challenged my thoughts and opinions, and in two cases, reassured me that there are amazing professionals working in the field today. I am writing these as a series of posts.  This is the first: Successes and Challenges in Transplantation 2010.

After a warm welcome by Jonathan A. Winston, M.D., Program Chair and Moderator. There were greetings and mutual respect for an audience full of transplant professionals, transplant families and State Health Workers.

The first speaker was David J. Cohen, M.D. Professor of Clinical Medicine; Medical Director, Renal Transplantation, Columbia University Medical Center, New York, NY; Member, Board of Directors and Chair, Public Policy Committee, American Society of Transplantation.

Dr. Cohen's presentation Kidney Transplantation in the US 2010: Successes and Challenges, was direct, full of current statistics, and had plenty of suggestions to improve the current system. Dr. Cohen talked about problems in the system that laypeople usually never hear about. The disparity in practice between transplant centers. There is no uniform protocol, there is government mandated uniform reporting, but centers can pick and choose how aggressive they are when it comes to procedures. Do they push for extended criteria kidneys? Do they push for paired donation? Or do they strictly stick to the UNOS and living related donors? Dr Cohen really highlighted the under-tapped resource of paired donations, and he stressed that this is solely in the purview of the individual center. There is no national or regional system. In his center, they do the matching by hand and they assess the cases on an individual basis. My question, wouldn't a regional registry help? But Dr. Cohen notes that then, you would be asking people to wait.

Dr. Cohen also spoke about the reality of transplant being rationed medical care. The fact that only 20% of people in CKD5 are listed for a transplant. He posited that there were possibly 100,000 dialyzors (which would be about 25%) who could be listed, but for some reason are not. Dr. Cohen also stated that 30% of those on the UNOS list have significant levels of antibodies, extending their anticipated wait time. (My take: and thus, skewing the wait time average)

Dr. Cohen also used another phrase that I would like to point out: A transplant center's "Discard Rate": organs that go unused, for whatever reason. After listening to Dr. Cohen, seeing his slides and numbers, it's clear that there are gaping holes in the current system. These can be fixed, numbers can be brought up dramatically by simply fixing what already exists. With better organization, better communication and more informed patients.

He concluded on a hopeful note - by discussing some of the cutting edge protocols that are on the horizon for lowering PRA.

2010 is indeed a time of great success for renal transplant, and it is also a time of great challenge, because as long as inroads are made, the demand will rise for those who are eligible and desiring a kidney transplant.

2010 Annual Dialysis Conference is in Seattle March 6 - 9

By Bill Peckham

The Annual Dialysis Conference is in Seattle this year. Last year I attended the Saturday program which is presented each year in cooperation with the International Society for Hemodialysis. I live blogged the day, right up until it was my turn to talk, this year I'm going to live blog all four days of the conference. There's a lot going on simultaneously so I'll have to pick what to attend.

NephrOnline has a 2010 conference preview. I think the toughest choice, as to which program to attend, will be on Monday from 2 to 4 but I don't want to miss Challenges to and Defenses of Kjellstrand’s Keynote Address at the 2009 ADC: Clinical Observations vs. Randomized Controlled Trials (RCTs) in Dialysis Research:

• 2:00 RCT Is Redundant if Observational Studies Consistently Show that Daily HD Is Superior
  Zbylut Twardowski, MD
• 2:25 Observational Studies Are Not Always Reliable Due to Lack of Randomization and Biases
  Marcelo Tonelli, MD
• 2:50 There Is Not Enough Observational Evidence to Support Funding and Widespread Application of Daily HD
  James Sloand, MD
• 3:15 The Waste of Life, Time, and Money Waiting for the Results of RCT in Daily HD
  Carl Kjellstrand, MD
• 3:40 Discussion
• 4:00 Adjourn

I have pretty strong opinions about this but I'll try to fairly present both sides of the discussion. It should be very good.

How should the provision of dialysis change when the dialyzor has multimorbidity?

By Bill Peckham

Kevin MD has a post up on a New York Times article, Treating an Illness Is One Thing. What About a Patient With Many? that points to the lack of practice guidelines for those with multiple health problems - those with multimorbidity. The article and the 2005 paper it links to do not include chronic kidney disease among the conditions studied but the conclusions are just as applicable to people with CKD.

In the article, Fred Powledge who has multimorbidity says clearly what many dialyzors would say:

“But what’s missing is someone who can look at the big picture and see my health as a whole.  “That falls to me alone, with the help of my very wise wife and frequent visits to reliable Web sites,” he continued. “As our population ages, we need some kind of overseer to juggle all the diagnoses and prescriptions and look for conflicts and duplications. This would also help to counteract the notion in many people’s minds that the doctor knows best - because often the doctor doesn’t.”

Fred sounds like he is pretty far along the learning curve, and I'd say informed self management is ideal, however, many with multimorbidity are not going to be able to learn to self manage (in a timely way) particularly if the onset is sudden. Not to mention the trouble we all have trying to stay up to speed.

As the article notes there is no advocacy group or national institute for those with multimorbidity. In dialysis no one has looked at how dose of dialysis effects the management of those with additional health problems. There are case mix adjusters for reimbursement but where are the "treatment adjusters"?

Live blogging the Successful Home Hemodialysis Program at the Annual Dialysis Conference

By Bill Peckham

The whole agenda is available here, I'm not on until 4:15. I'll see if I can keep up.

I saw Dr. Blagg on the way in, I mentioned I would be live blogging the day; he assigned me PowerPoint tech support.

8:00  Introduction and Overview - Christopher Blagg, MD:
Slow but steady increase in home hemodialysis in the United States. 2008 estimated home hemodialysis census 4,000. FMC and DaVita account for 2/3 of the home hemodialysis census. Illinois and Washington State have the largest percentage of dialysis patients on home hemo - about 2%.  Home hemo increasing the world over. "Like the phoenix hemodialysis is rising from the ashes with renewed vigor."

8:15  Current Home HD Modalities in the US:  A Review of Therapy and Equipment - Michael Kraus, MD:
Incenter hemodialysis is expensive, with poor quality "we can't continue on this course of failure" "NxStage is the only device approved for home; no device is approved for nocturnal" DaVita has about 1.5% of their patients on short daily home hemo" NxStage has 30 in Nocturnal study (IDE) guesses about 100 nationally.

8:35   Effective Patient Screening to Improve Retention - Lisa Koester, MSN, ANP:
First question "What do you know" Many patients think we are sending a nurse home with them. NxStage retention rate about 68% over first year overall; 78% excluding death and transplant - "our program is over 90%" due to screening program". Training for: Nocturnal 6 weeks; Bags 3 weeks; PureFlow 4 weeks. Frequent dialysis reverses "dialysis induced symptoms". Improved clinical outcomes leads to improved quality of life for the whole family

9:00  How do we develop an Independent Home Dialysis Culture? - Robert Lockridge, MD:
The key is work. A successful program is due to the work by all involved. "Side effects occur in 15 to 50% of every (conventional dialysis) treatment" "There is no informed consent for the (dialysis) patient" (again speaking of conventional incenter). "Everyone in this room believes more dialysis is better (there are about 200 people in the room) and home is really the only way can provide it".  "Modality choices with informed consent" means that all involved (e.g. nurses, techs, social workers) have to be taught that more is better and most people can go home. Informed consent means explaining/understanding the mortality outcomes of various dialysis modalities. Many slides showing the poor outcomes associated with conventional dialysis - the day after the dialysis weekend is deadliest by 50%. Lynchberg has 47 on home hemo out of a total hemo census of 224 (I think I caught the numbers) (I asked if they include those who live alone in their home programs. Both Koester and Lockridge have people in their programs who live alone. No additional monitoring)

9:20   How to Prescribe Home HD Therapies - Brent Miller, MD
"What we do now (conventional incenter dialysis) is not adequate" What we need to do is get patients to a point where they have: a normal diet; minimal EPO usage; normotensive; decreased morbidity & mortality; improved quality of life. (Amen Brother) "Play to the patient's strength and that is the way home" "Kt/V should be a tool not the basis for prescribing dialysis" "We have to get out of the urea box" "The only way we can get to optimal dialysis is (treatments) 5, 6 or 7 days a week" "I think phosphorus is a practical marker of optimal dialysis (until something better comes along)" "There is no right prescription. Adjust to the patient, not (to) the labs"

9:50  Optimal Vascular Access - Jack Work, MD 
Biggest concern particularly with nocturnal is venous needle dislodge, no good options to monitor for disruptions in the blood circuit. "Daily HD patients with grafts had lower complication rate compared to control group (people with grafts doing conventional incenter dialysis" "Incenter catheter infection rate 2.52%; infection rate after going home .05%

10:00  Prolonging Access Survival - Rosa Marticorina, BScN, RN
"Access most important aspect of dialysis" (I'd say it is the ante) the importance of buttonhole cannulation for people with fistula - showed slides of scan of buttonhole channel created with sharps and channel created with bioplug (not sure I got the name right) that dwells in the  buttonhole track between treatments between treatment and indwelling catheter which also stays in place between treatments. Very well defined channels using the indwelling devices. (indwelling approach looks like a great option for establishing robust buttonholes)

During questions someone from DaVita asked about graft survival when using a graft for frequent treatments. Lockridge commented that Ting showed no difference in graft survival among incenter patients doing 6x week vs those doing 3x. Work commented that 14g needles were "deadly to grafts". Lockridge mentioned that 16g and 17g needles can be very successfully used with grafts in combination with nocturnal where you can turn the blood pump speed down.(great reason to do nocturnal: if you have a graft you can use smaller gage needles and get the graft to last longer even with more frequent cannulation)

Break time. (need coffee)

10:50  Technical Requirements and Home Preparation - Scott Hansen
(he was who did my initial home survey) Four things he looks at: Utilities; Environment; Storage space; Ergonomic space. With 30 years of experience setting people up to do dialysis in their homes he has a well developed check list to evaluate the home's suitability and discuss any changes that need to be made. Know the building codes in your area for electrical and plumbing, "don't assume the manufacturers (of dialysis equipment) know your local requirements and responsibility to meet codes" Apartments and rentals are tougher than private homes, the older the building the more likely the problems. Don't use extension cords routinely.

11:15    Effective HHD Patient Education: What Do Patients Need to Know? - Michelle Carver, BSN, RN 
Our goal is for patients to do safe treatments. First thing to teach is how to wash your hands. "You'd be surprised" at what someone might think constitutes adequate hand washing. You have to get to know the patient - what do they know? but also what are their attitudes toward dialysis? It helps when teaching to know people's point of reference: are they a farmer? or an engineer? Ask for feedback. Tell people what to expect = alarms, a lot of alarms. (no mention of Carrie moments)

11:45   Training the Trainer: Staff Education - Leigh Mortier, RN
We (NxStage) have trained over 400 programs to provide NxStage "We should remember that we (trainers) went to school to be nurses not to be educators" but we can learn. Check out the Match D tool from the Medical Education Institute (pdf link) "You can't motivate someone else; you can invite them to learn" There is a lot of adult education theory you have to identify their learning style - do they learn best from books or from people? - adjust the teaching style to the learning style of the adult learner. You have to walk the talk - as the trainer you have to model ideal techniques. Final thought: for patients psychosocial issues more important than technical issues.

During questions: what should be the relationship between caregivers and the patients? - we NxStage think it should be 90% patient/10% caregiver (why not 100%? I asked mmm not a very good answer) Lockridge adds the importance of being honest up front - don't encourage the token helper. Don't encourage lack of communication. Blagg asks the audience if they have had or ever heard of someone dying while dialyzing alone? um no (the sound of crickets)

Lunch (I'm starving)

1:15   Follow-up Care: Identifying and Managing Problems 

1:18 Short and Long Term Blood Pressure Control - Joel Glickman, MD
Presents case study illustrating patient having a great deal of trouble incenter with BP control, switching to short daily resolves issue. Total dialysis time stays the same but with frequency BP improves. BP control results from improved volume control but some see improvement with out a change in volume status - BP improves due to improved vascular function - something is going on with more frequent dialysis beyond volume control. It's important to anticipate BP normalization when transitioning from conventional to frequent dialysis and acknowledge the dynamic nature of dry weight

1:34 Calcium and Phosphate Management - Brent Miller, MD
It is very important to track the calcium, phosphorus and PTH balance - outlines consequences of poor balance management - stakes are much higher with longer and/or more frequent treatments. For purpose of this talk we have to consider nocturnal and short as two very different modalities. Data on which current practices are based is old and inadequate. With calcium - we don't really know what we're doing. We put nocturnal patients on a 3 or 3.5 calcium bath but we don't know why it works. (indicates that the answer to Richard's question is Yes if you don't adjust the bath you can easily become phosphorus and/or calcium depleted doing daily nocturnal. This was a very meaty topic - excellant webinar fodder for HDC)

1:50 Anticoagulation - Andrew Davenport, MD
When selecting artificial kidneys for home recognize the difference in their impact on clotting. Bubbles cause clotting in artificial kidney heads - better priming/less bubbles mean less clotting  at the top of the kidney (that explains an ongoing issue on NxStageUsers) Discussion of heparin alternatives their advantages and problems. Lockridge asks about heparin and bone disease especially in light of nocturnal dialysis and increase use of heparin (great question). Answer the advantages of home nocturnal outweighs any risk. Being physically active leads to improved bone health. Question from Kjellstrand if the cause of clotting is the artificial kidney design and air bubbles then why can't they make a better kidney (snark) Answer it's expensive. (Another great webinar topic for HDC)

2:05 Anemia Management - Lisa Koester, MSN, ANP
Epo use declined initially and then increased somewhat (using NxStage) but levels off well below conventional incenter. Saw much greater reduction in EPO use with frequent nocturnal dialsyis - suspicion is that difference may be due to hemolysis from high pump speeds and issues around the administration route of Epo (for example some used the header port on the NxStage, didn't follow with saline).

2:20 Treatment Failure, Partner Burnout and Home Alone - Bessie Young, MD
(Dr. Young is the Medical Director of the NKC home program - the one I dialyze through) The one risk factor that correlated with not staying at home was age > 75. Partner burnout can come from a variety of issues - main complaint is dialysis takes too much time, particularly if people are also working. "We try to save (keep them at home) every patient" We'll try: Respite care. Retraining after access infection. Have people dialyzing alone at home - require use of MedicAlert system, also offer Assist Dogs.(no one has tried the assist option yet (I'll be trying that one day (hopefully years and years from now, my Aussie is 9))

2:32 Infections - Robert Lockridge, MD
For all people on hemodialysis about 5% of mortality is due to infections, A/V fistulas have lowest infection risk. Has about 90 patients incenter using buttonholes - very important to prepare and use buttonholes with proper techniques. Almost all infections, can be attributed to technique mistakes, fewer mistakes are seen among home patients then among incenter patients.

2:45 Monitoring and Measuring Outcomes - Michael Kraus, MD
"Kt/V means nothing for those on nocturnal", on short daily sKt/V should be above 2.0. Over all in their home program they've seen (in a program with 148 trained, 69 still on therapy) 5 cardiac deaths - similar to post transplant results. 22/80 patients working at time of training - all continue to work. 3 went back to work; 3 went back to school. These (work, travel, pregnancy) outcomes matter, Kt/V does not matter to any of these patients. Asks if you (the audience) know what you program charges? Less than 10 raise hand (I raise mine) - It's important; you should know (yes!)

3:12 Monitoring and Measuring Outcomes - Bessie Young, MD
Young is presenting for Thomas Depner, MD; always tough to pinch hit - comes up with another interesting program includes some NKC data. Compared to three times a week 65% better survival seen with more frequent compared to conventional incenter. NKC home census Short Daily-44 patients (NxStage) Nocturnal-10 patients (NxStage & B Braun) Conventional 3 or more times per week-15 patients (B-Braun). Can be hard to get patients to turn in their treatment logs in a timely manner (cough, cough) Uses HDCN Kt/V calculator. sKt/V goal should be 2.5

Break time. (need more coffee)

3:58  Regulatory Issues and Economic Realities - Robert Provenzano, MD
The new Conditions for Coverage are important, reimbursement changes are important "doctors are very bad at this, we are trained to act as though we know what is going on and doctors are traditionally bad at accepting change" In 2020 we're expecting to have over 500,000 people on dialysis. Today 2.2 billion is being spent by EGHPs for 5,100 people on dialysis or with ESRD (was not able to qualify if this was all CKD stage 5 (including transplant) or just dialysis. I think it is just dialsyis and not including medications). More changes in dialysis payment in the last three years than in the previous 30. In 2000 there were 53 patients per a nephrologist; in 2003 59 per and in 2008 it's 82. Medicare underpays docs. "Healthcare is not free market" (he's a great presenter of data I am personally very interested in and covered way more ground than I could keep up with here, if you have a chance to hear him speak take the opportunity)

4:30 The Patients’ Views - Cathy Haskins, Bill Peckham
Why Did I Make the Transition to Home Hemodialysis? How Dialysis Fits into My Daily Routine? How Does Home Hemodialysis Influence My Quality of Life?

This ends the live blogging portion of the show.

New HOPEline flyer available

By Bill Peckham

The Renal Support Network runs a national phone support service so that anyone in the country who is dealing with CKD can know that support is a phone call away:

The HOPEline offers experience, strength and hope from one person who has lived successfully with chronic kidney disease to another. The toll-free line (800) 579-1970 is available Monday - Friday from 10 am to 8 pm (Pacific Standard Time).

There is now a flier available as a PDF file that you can download and print at home. Then share it with your local nephrologist's office, dialysis or transplant center.

If you need a bit of hope, give them a call; if you want to help others put up a flier.

Your fistula after transplant: To keep or not to keep?

By Anna Bennett

I am quite attached to my curvy, lumpy up-arm fistula (it is not my fistula's fault that it is big, snakelike and has an aneurysm).  We have been through a lot over the past few years.  But now I am realizing that stenosis does not stop after your transplant.  While I was on dialysis, I had a standing 3 month appointment for a fistulagram and angioplasty.  My rather robust vascular system seems intent on shutting my fistula down.  This is considered access failure - even though my fistula has been on vacation since my transplant last November.  And my last echo cardiogram showed a thickening of the left ventricle - all signs pointing to tying off my fistula at the 1 year mark.

Which leads to my question: What should we do with our access after transplant?

My surgeon says after one year tie it off.  Well, that freaks me out a little - if it is tied off, it can't be untied if/when my graft fails.  I certainly don't want to have to have a second fistula placed if that were the case.  Bill has had his fistula for almost 20 years (knock wood) there is no reason why mine can't last  - if I am proactive in getting it checked out and serviced as needed.

I hit the web for some research, and this is some of what I found:

Arteriovenous fistula after renal transplantation: utility, futility or threat? Nephrology Dialysis Transplantation 2006 21(2):254-257; doi:10.1093/ndt/gfi276

AV fistula closure reduces left ventricular volume and mass in renal transplant patients. Whether fistula closure will reduce the associated high cardiac morbidity and mortality is unknown. There are clearly insufficient data yet to promote systematic closure of AV fistulas in kidney transplant patients with stable renal function, unless symptoms are present. The balance might favour closure in selected asymptomatic patients, with a large AV fistula, a dilated left ventricle,a low probability of graft loss and a high risk of cardiac events. Randomized large-scale prospective studies are clearly needed and, potentially, will better define the protective role of fistula closure.

Effect of closure of the arteriovenous fistula on left ventricular dimensions in renal transplant patients Nephrol Dial Transplant (2001) 16: 368-372

Closure of the arteriovenous fistula in stable renal transplant patients results in a decrease in LVMi, due to a reduction in LVEDD. The change in LVMi is significantly related to the LVMi and LVEDD before fistula closing. In patients with a well-functioning allograft and persistent LV dilatation, closure of the AV fistula might be considered.

Arteriovenous fistula closure after renal transplantation: a prospective study with 24-hour ambulatory blood pressure monitoring.  Transplantation. 2008 Feb 15;85(3):482-5.

Because the increase in diastolic blood pressure after arteriovenous fistula closure occurred regardless of the preoperative level of diastolic pressure, we suggest that blood pressure should be monitored after fistula closure, particularly when preoperative diastolic blood pressure is borderline or elevated.

Cardiac impact of the arteriovenous fistula after kidney transplantation: a case-controlled, match-paired study (Transplant International, Volume 21, Number 10, October 2008 , pp. 948-954(7))

In kidney transplant (KT) recipients, cardiac impact of the persistence of an asymptomatic arteriovenous fistula (AVF) for hemodialysis has not been fully elucidated.

My final decision will be based upon the advice of my Surgeon. Dr. Benvenisty has been right beside me for my journey from pre dialysis through transplant, and he'll still be there if my graft should fail.  Access issues should always be at the forefront of thought for anyone living with CKD5 - without access, the disease wins.

A high profile transplant story

by Anna Bennett

On Friday, December 11, 2008, ABC TV's 20/20 broadcast the story of Ani Mozian-Whitney, a 1995 transplant recipient, who had a baby girl in early 2008, and then her transplant failed.  Ani is also a field producer for 20/20, and she was transplanted in 1995 by Dr. Alan Benvenisty (who also did my transplant).  When her transplant was failing, her boss, Joan LeFosse became not only her assigning producer - but also her donor.  And Dr. Benvenisty performed Ani's second transplant in June of this year.

Here is the article, Life Given Back' to New Mom by ABC News Colleague 'Little Blessed Baby' Inspires Kidney Donation, Leads to Remarkable Journey, by Bob Brown. But even better than the article is the video.

The crew from 20/20 had an all access pass to the ups and downs of the transplant, they were in pre op, surgery and post op, recovery.  Here are the videos (in two parts):

Part One (background and the story of the baby, friendship and loss of the first transplant)

Part Two (the medical aspect, plasmapheresis, both the donor surgery and the transplant surgery)

I am grateful to Ani and Joan for allowing us to follow on their journey.  Of course it was very familiar to me, she had her transplant with my surgeon, at St Luke's where I had my transplant. I had been hearing about this since November 3rd, and I met Ani at my last clinic visit. 

This broadcast showcases the emotional rollercoaster that someone with CKD5 is on.  The highs of having a transplant and starting a new family, the lows of having that transplant fail, back to the high of an altruistic donor offering a kidney when they weren't even asked.  It is the story of friendship and hope for everyone who has chosen translplant as their renal replacement therapy while they live with CKD5. 

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• 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 Wikipedia

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

CKD links and resources

From Dialysis From the Sharp End of the Needle:

• Main Link Page
• Big List of CKD Blogs
• CKD Blog Reports
• 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 Wikipedia

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

New links added on Sunday July 5th

CKD Shopping

• Myra Schwartz kidney shaped jewelry

Professional Organizations

• Association of Renal Industries
• The Association of the British Pharmaceutical Industry (ABPI)
• The British Association For Paediatric Nephrology  (BAPN)

CKD links and resources

From Dialysis From the Sharp End of the Needle:

• Main Link Page
• Big List of CKD Blogs
• CKD Blog Reports
• 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 Wikipedia

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

CKD links and resources

From Dialysis From the Sharp End of the Needle:

• Main Link Page
• Big List of CKD Blogs
• CKD Blog Reports
• 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 Wikipedia

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

CKD links and resources

From Dialysis From the Sharp End of the Needle:

• Main Link Page
• Big List of CKD Blogs
• CKD Blog Reports
• 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 Wikipedia

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

New links added on Sunday June 8th

Wikipedia

• Chronic kidney disease
• Dialysis
• Hemodialysis
• Home hemodialysis
• Nephrology
• User:BillpSea

From Dialysis From the Sharp End of the Needle:

• Main Link Page
• Big List of CKD Blogs
• CKD Blog Reports
• 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 Wikipedia

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

New links added on Sunday June 8th

Wikipedia

• Chronic kidney disease
• Dialysis
• Hemodialysis
• Home hemodialysis
• Nephrology
• User:BillpSea

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 Equity Links

New links added on Sunday June 1st (thanks Anna)

Equity Links

AMEX
Xcorporeal, Inc.    XCR  Xcorporeal's Wearable Artificial Kidney (WAK) prototype device was featured in the December 15, 2007 journal issue of The Lancet.

NASDAQ
Abraxis Bioscience Inc.    ABII
Amgen     AMGN
Dialysis Corporation of America    DCAI
NxStage Medical, Inc.    NXTM
Rockwell Medical Technologies, Inc.    RMTI

NYSE
Baxter International Inc.  BAX
Davita, Inc.   DVA   
Fresenius Medical Care AG & Co. KGaA (FMC-AG & Co. KGaA)  FMS  & FMSPR

Other
GAMBRO used to be public and is now private, it was delisted from the Stockholm stockmarket.

• 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 Equity Links

New links added on Sunday June 1st (thanks Anna)

Equity Links

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

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

New links added on Sunday May 4th

Professional Organizations

• The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI)
• Fistula First

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

New links added on Sunday April 27th

Professional Organizations

• International Society for Hemodialysis
  • Quotidian Dialysis Registry

CKD Shopping

• Care Wear
• Kidney Fun Mall
• My Kidney Gear

CKD links and resources

CKD links and resources

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

Dialysis and CKD Recipes and Nutrition Information	Renal Industry Blogs
CKD & Transplant Research	CKD Related Professional Organizations
Dialysis and CKD Advocacy Groups	Dialysis and CKD Information/News
US Government	Nonprofit Dialysis Providers
For Profit Dialysis Providers	Dialysis and CKD Knowledge
Medical Journals	US ESRD Networks
Dialysis Equipment Manufacturers	International Dialyzor Associations

New links added on Sunday April 20th

Medical Journals

• American Journal of Nephrology
• British Medical Journal
• Clinical Journal of the American Society of Nephrology
• Hong Kong Journal of Nephrology
• Internet Journal of Nephrology
• Journal of Nephrology
• Nephrology Dialysis Transplantation
• Nephrology Dialysis Transplantation PLUS

US ESRD Networks

• Forum of ESRD Networks
• ESRD Network of New England (Network 1)
• The End Stage Renal Disease Network of New York (Network 2)
• The Trans-Atlantic Renal Council (Network 3)
• ESRD Network 4 (Network 4)
• Mid-Atlantic Renal Coalition (Network 5)
• Southeastern Kidney Council (Network 6)
• FMQAI (Network 7)
• Network 8 Inc. (Network 8)
• The Renal Network, Inc. (Network 9)
• The Renal Network, Inc. (Network 10)
• Renal Network 11 (Network 11)
• Heartland Kidney Network (Network 12)
• ESRD Network 13 (Network 13)
• The ESRD Network of Texas (Network 14)
• The Intermountain ESRD Network (Network 15)
• Northwest Renal Network (Network 16)
• Western Pacific Renal Network, LLC (Network 17)
• The Southern California Renal Disease Council (Network 18)

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

Dialysis and CKD Recipes and Nutrition Information	Renal Industry Blogs
CKD & Transplant Research	CKD Related Professional Organizations
Dialysis and CKD Advocacy Groups	Dialysis and CKD Information/News
US Government	Nonprofit Dialysis Providers
For Profit Dialysis Providers	Dialysis and CKD Knowledge
Medical Journals	US ESRD Networks
Dialysis Equipment Manufacturers	International Dialyzor Associations

New links added on Sunday April 20th

Medical Journals

• American Journal of Nephrology
• British Medical Journal
• Clinical Journal of the American Society of Nephrology
• Hong Kong Journal of Nephrology
• Internet Journal of Nephrology
• Journal of Nephrology
• Nephrology Dialysis Transplantation
• Nephrology Dialysis Transplantation PLUS

US ESRD Networks

• Forum of ESRD Networks
• ESRD Network of New England (Network 1)
• The End Stage Renal Disease Network of New York (Network 2)
• The Trans-Atlantic Renal Council (Network 3)
• ESRD Network 4 (Network 4)
• Mid-Atlantic Renal Coalition (Network 5)
• Southeastern Kidney Council (Network 6)
• FMQAI (Network 7)
• Network 8 Inc. (Network 8)
• The Renal Network, Inc. (Network 9)
• The Renal Network, Inc. (Network 10)
• Renal Network 11 (Network 11)
• Heartland Kidney Network (Network 12)
• ESRD Network 13 (Network 13)
• The ESRD Network of Texas (Network 14)
• The Intermountain ESRD Network (Network 15)
• Northwest Renal Network (Network 16)
• Western Pacific Renal Network, LLC (Network 17)
• The Southern California Renal Disease Council (Network 18)

A Dialyzor's Guide to Medical Journals

By Anna Bennett

This is Anna guest blogging again. As I type this, Bill is at 35,000 feet jetting his way to Cleveland, laptop and PowerPoint in hand for another meeting.

Often when a person (or a family member) is first diagnosed with CKD, they make note of what the Doctor has told them, then go home and hit the internet. Bill compiles a comprehensive list of CKD links and resources that he updates frequently, and today, I've started doing some cyber digging around for Nephrology Medical Journals.

Upon entering medical school, future MD's are signing up for a lifetime of learning. Research changes medicine on a continuous basis, and the best way to convey medical discoveries or theories is by publishing an article in a medical journal. Most journal articles are peer reviewed (other Dr.'s in the field review the article before publication) so you are not just reading one person's writings, they've been vetted.

I like to think that a proactive dialyzor is like a Jailhouse Lawyer, out of necessity, we are self-taught about our disease, reading journals can be a part of that education. (I'll admit that some of the scientific stuff is hard to follow, but when you do stumble across something that "clicks", well then you have advanced your cause)

Sir Francis Bacon was on to something when he said "Knowledge is Power".  Much of the medical information that your read in newspapers or on line publications is gathered from Journals, here is your chance to go to the source.  Here are just a few of the journals available on the net (some have free access, some have free access for older articles):

American Journal of Nephrology

British Medical Journal

Clinical Journal of the American Society of Nephrology

Hong Kong Journal of Nephrology

Internet Journal of Nephrology

Journal of Nephrology

Nephrology Dialysis Transplantation   

Nephrology Dialysis Transplantation PLUS  

Nephrology Rounds is derived from recent Division rounds at Brigham and Women's Hospital, and has been designed as an efficient resource for the busy physician. The selection of topics and all editorial content are determined solely by the members of the Nephrology Division.

AAKP 2008 Kidney Beginnings: Live schedule

The AAKP has an upcoming program in Oakbrook, IL on April 20. The program Kidney Beginnings: Live is scheduled for three cities in May; Washington, D.C. May 10; Santa Ana, CA May 10, Newark, NJ May 31. Here's what you'll get:

Kidney Beginnings: Live is a FREE educational program that educates individuals about the basics of kidney disease and proper kidney care. Programs feature topics such as:

• What the kidneys are, what they do and how to care for them;
• Managing conditions that may lead to chronic kidney disease (CKD);
• Side effects and challenges CKD patients face, such as anemia;
• Diet management;
• And much more!

Programs last approximately three hours and feature presentations given by healthcare professionals. In addition, attendees have the opportunity to ask questions in an open forum setting.

If you or a loved one is diagnosed with severe kidney disease attend one of these meetings and start working your way up the learning curve. Knowledge is Power.

CKD links and resources

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

Dialysis and CKD Recipes and Nutrition Information	Renal Industry Blogs
CKD & Transplant Research	CKD Related Professional Organizations
Dialysis and CKD Advocacy Groups	Dialysis and CKD Information/News
US Government	Nonprofit Dialysis Providers
For Profit Dialysis Providers	Dialysis and CKD Knowledge
Dialysis Equipment Manufacturers	International Dialyzor Associations

New links added on Sunday April 13th

Nonprofit Dialysis Providers

• WellBound

CKD links and resources

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

Dialysis and CKD Recipes and Nutrition Information	Renal Industry Blogs
CKD & Transplant Research	CKD Related Professional Organizations
Dialysis and CKD Advocacy Groups	Dialysis and CKD Information/News
US Government	Nonprofit Dialysis Providers
For Profit Dialysis Providers	Dialysis and CKD Knowledge
Dialysis Equipment Manufacturers	International Dialyzor Associations

New links added on Sunday April 6th

CKD & Transplant Research

• Kidneeds

US Government

• Dialysis Outcomes and Practice Patterns Study (DOPPS)

 

CKD links and resources

Links accessed on March 30, 2008

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

Dialysis and CKD Recipes and Nutrition Information	Renal Industry Blogs
CKD & Transplant Research	CKD Related Professional Organizations
Dialysis and CKD Advocacy Groups	Dialysis and CKD Information/News
US Government	Nonprofit Dialysis Providers
For Profit Dialysis Providers	Dialysis and CKD Knowledge
Dialysis Equipment Manufacturers	International Dialyzor Associations

New links added on Sunday March 30

International Dialyzor Associations

• British Kidney Patient  Association (BKPA)
• European Kidney Patients’ Federation (CEAPIR)
• International Federation of Kidney Foundations
• Kidney Dialysis Foundation (Singapore)
• Kidney  Alliance (UK)
• Kids Kidney Research (UK)
• Muslim Kidney Action Association (Singapore)
• National Kidney Foundation (Singapore)
• Renal Information Exchange Group (UK)
• Scottish Kidney Federation (UK)
  

CKD & Transplant Research

• Kids Kidney Research (UK)
• Kidney Research UK (formerly National Kidney Research Fund) (UK)
• SW Thames Institute for Renal Research

Links to chronic kidney disease information

Rather than repost my growing list of links each Sunday, I have made a static CKD link page (I still frequently check to make sure all the links are current). Each week I will post here the links that I have added; this week they are the manufacturers.

• Dialysis Equipment
  
  • Home Dialysis Central Compilations
  • Dialysis Machine Museum
  • PD Machines
  • Home Hemo Machines
  • Reverse Osmosis Machines
  • Dialysis Water Treatment Manufacturers
    
    • Mar Cor Purification
    • AmeriWater®
    • Applied Water Engineering, Inc.
  • Dialysis Machine Manufacturers
  • Baxter
  • B Braun
  • Gambro
  • Fresenius
  • NxStage
  • Nipro’s Surdial®

Links to chronic kidney disease information - from CKD stage one through dialysis and kidney transplant

Links accessed on March 15, 2008

• Dialysis and CKD Blogs
• Dialysis and CKD Discussion Boards
• Dialysis and CKD Listservs
• Dialysis and CKD Recipes and Nutrition Information
  • USDA Nutrient Data Laboratory
  • Recipes from the Northwest Kidney Centers
  • Culinary Kidney Cooks
    • Recipe of the Week
  • IHD Diet and Recipes Discussion Board
  • Recipes from Davita
    • Davita video recipe for Crunchy Oven-Fried Catfish

Links to chronic kidney disease information - from CKD stage one through dialysis and kidney transplant

Links accessed on March 8, 2008

• Dialysis and CKD listservs
• Dialysis and CKD discussion boards
• Dialysis and CKD blogs
• Dialysis and CKD knowledge sites:
  • Home Dialysis Central
    • Find a home dialysis clinic near you (new zip code search for home dialysis programs)
    • Forums
  • Kidney School
  • KidneyTimes
  • Life Options Rehabilitation Program
    • In Control NN&I insert
    • Toll-free Helpline: (800) 468-7777
  • Nocturnal Home Haemodialysis
    • How Dialysis Works - The “Agar Patented Explanation”
    • Nocturnal Home Haemodialysis - A Brief Overview
• CKD & Transplant Research
  • Kidney Research UK
  • National Organization for Rare Disorders
  • NephCure Foundation
  • Polycystic Kidney Disease Foundation
  • Renal Research Institute
  • University Kidney Disease Research Associates (aka Southern California Kidney Institute)

Links to chronic kidney disease information - from CKD stage one through dialysis and kidney transplant

Links accessed on March 1, 2008

• Dialysis and CKD listservs; (what the listservs are talking about)
• Dialysis and CKD discussion boards
• Dialysis and CKD blogs
• Dialysis and CKD knowledge sites:
  • Home Dialysis Central
    • Find a home dialysis clinic near you
    • Forums
  • Kidney School
  • KidneyTimes
  • Life Options Rehabilitation Program
  • Nocturnal Home Haemodialysis
• CKD related professional organizations:
  • American Society for Artificial Internal Organs (ASAIO)
  • Association for the Advancement of Medical Instrumentation (AAMI)
  • American Nephrology Nurses Association (ANNA)
  • American Society of Nephrology (ASN)
  • American Society of Transplantation
  • International Society of Nephrology (ISN)
  • International Society for Peritoneal Dialysis (ISPD)
  • National Association for Nephrology Technicians/Technologists (NANT)
  • National Renal Administrators Association (NRAA)

Links to chronic kidney disease information - from CKD stage one through dialysis and kidney transplant

• Dialysis and CKD listservs; (what the listservs are talking about)
• Dialysis and CKD discussion boards
• Dialysis and CKD blogs
• Dialysis and CKD knowledge sites
  • nocturnaldialysis.org
  • kidneyschool.org
  • KidneyTimes
  • Home Dialysis Central
• US ESRD Networks
  • Strategic Partnership for Change
  • Pandemic
  • Decreasing Dialysis Patient-Provider Conflict

Links to chronic kidney disease information - from CKD stage one through dialysis and kidney transplant

There is a great deal of information available on the internet if you are dealing with chronic kidney disease i.e slowing the progression of CKD, using hemodialysis, peritoneal dialysis or a kidney transplant. Corporate sites, educational sites and many ways to connect with people dealing with CKD throughout the world.

• Best US dialysis provider: the Northwest Kidney Centers
• Dialysis and CKD listservs (what the listservs are talking about)
• Dialysis and CKD discussion boards
• Dialysis and CKD blogs
• US government web sites
  • Medicare
  • General Information
  • Dialysis Facility Compare
  • Preparing for Emergencies: A Guide for People on Dialysis
  • You Can Live - Your Guide to Living with Kidney Failure
  • Food and Drug Administration
    • Living Day-to-Day with Kidney Dialysis
  • National Kidney and Urologic Diseases Information Clearinghouse
    • Anemia in Kidney Disease and Dialysis
    • Treatment Methods for Kidney Failure: Peritoneal Dialysis
    • Treatment Methods for Kidney Failure: Hemodialysis
    • Vascular Access for Hemodialysis
    • Hemodialysis Dose and Adequacy
• Dialysis and CKD knowledge sites
  • nocturnaldialysis.org
  • kidneyschool.org

There is a great deal of information available on the internet if you are dealing with chronic kidney disease i.e slowing the progression of CKD, using hemodialysis, peritoneal dialysis or a kidney transplant. Corporate sites, educational sites and many ways to connect with people dealing with CKD throughout the world.

• Best US dialysis provider: the Northwest Kidney Centers
• Dialysis and CKD listservs (what the listservs are talking about)
• Dialysis and CKD discussion boards
• Dialysis and CKD blogs
• US government web sites
  • Medicare
  • General Information
  • Dialysis Facility Compare
  • Preparing for Emergencies: A Guide for People on Dialysis
  • You Can Live - Your Guide to Living with Kidney Failure
  • Food and Drug Administration
    • Living Day-to-Day with Kidney Dialysis
  • National Kidney and Urologic Diseases Information Clearinghouse
    • Anemia in Kidney Disease and Dialysis
    • Treatment Methods for Kidney Failure: Peritoneal Dialysis
    • Treatment Methods for Kidney Failure: Hemodialysis
    • Vascular Access for Hemodialysis
    • Hemodialysis Dose and Adequacy
• Dialysis and CKD knowledge sites
  • nocturnaldialysis.org
  • kidneyschool.org

There is a great deal of information available on the internet if you are dealing with chronic kidney disease i.e slowing the progression of CKD, using hemodialysis, peritoneal dialysis or a kidney transplant. Corporate sites, educational sites and many ways to connect with people dealing with CKD throughout the world.