NKF Clinical Meeting 2013HEMODIALYSIS.COMExclusive interviewsEditor: Marie Benz, MDUpdated 4/15/2013For Informational Purp...
Medical Disclaimer | Terms and Conditions• The contents of the Hemodialysis.com Site, such as text, graphics, images, ando...
Cinacalcet –Troponins: Is There An Undiscovered Link??Hemodialysis.com Interview with Samra AbouchacraSenior consultant ne...
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THE “PHOSPHORUS OLYMPICS”: A Self-Management Approach for Enhancing Phosphorus Educationin a Multi-Site Dialysis ProgramHe...
THE “PHOSPHORUS OLYMPICS”: A Self-Management Approach for Enhancing Phosphorus Educationin a Multi-Site Dialysis ProgramHe...
Association Between Lack of Health Insurance and Risk of Death and ESRD: Results from the Kidney Early Evaluation Program ...
Association Between Lack of Health Insurance and Risk of Death and ESRD: Results from the Kidney Early Evaluation Program ...
Impact of In-Home Education Programs on the Graduation Rate of Young Adults with Kidney DiseaseHemodialysis.com Author Int...
Impact of In-Home Education Programs on the Graduation Rate of Young Adults with Kidney DiseaseHemodialysis.com Author Int...
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Pregnancy outcomes in Advanced Chronic Kidney DiseaseHemodialysis.com Author Interview: Dr. Zichun Feng PGY3Medical Reside...
Pregnancy outcomes in Advanced Chronic Kidney DiseaseHemodialysis.com Author Interview: Dr. Zichun Feng PGY3Medical Reside...
Pregnancy outcomes in Advanced Chronic Kidney DiseaseHemodialysis.com Author Interview: Dr. Zichun Feng PGY3Medical Reside...
Infection Rates and Associated Pathogens in Patients on Nocturnal Home Hemodialysis Over a Six Year PeriodHemodialysis.com...
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Dietary Sodium Intake in Hemodialysis Patients Does Not Correlate with Interdialytic Weight GainHemodialysis.com Author In...
Medication-Related Error in Outpatient Hemodialysis CenterHemodialysis.com Author Interview:Timothy Nguyen, PharmD, BCPS, ...
Medication-Related Error in Outpatient Hemodialysis CenterHemodialysis.com Author Interview:Timothy Nguyen, PharmD, BCPS, ...
Medication-Related Error in Outpatient Hemodialysis CenterHemodialysis.com Author Interview:Timothy Nguyen, PharmD, BCPS, ...
Perceptions of Facilitators and Barriers to Chronic Kidney Disease Educational SessionsAuthor Interview: Della Connor, APR...
Perceptions of Facilitators and Barriers to Chronic Kidney Disease Educational SessionsAuthor Interview: Della Connor, APR...
Perceptions of Facilitators and Barriers to Chronic Kidney Disease Educational SessionsAuthor Interview: Della Connor, APR...
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An Evaluation of Clinical Factors Associated with the Decision to Transfuse Chronic Dialysis PatientsCynthia WhitmanResear...
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From Hemodialysis.com• Please keep in mind that informationpresented in these abstracts is usuallypreliminary and will nee...
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NKF Spring Clinical Meeting 2013 Interviews: National Kidney Foundation

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Nephrology Research Interviews with researchers at the National Kidney Foundation Clinical Meetings 2013

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NKF Spring Clinical Meeting 2013 Interviews: National Kidney Foundation

  1. 1. NKF Clinical Meeting 2013HEMODIALYSIS.COMExclusive interviewsEditor: Marie Benz, MDUpdated 4/15/2013For Informational Purposes Only: Notintended as Specific Medical Advice1
  2. 2. Medical Disclaimer | Terms and Conditions• The contents of the Hemodialysis.com Site, such as text, graphics, images, andother material contained on the Hemodialysis.com Site ("Content") are forinformational purposes only. The Content is not intended to be a substitute forprofessional medical advice, diagnosis, or treatment. Always seek the advice ofyour physician or other qualified health provider with any questions you may haveregarding a medical condition. Never disregard professional medical advice ordelay in seeking it because of something you have read on the Hemodialysis.comSite!• If you think you may have a medical emergency, call your doctor or 911immediately. Hemodialysis.com does not recommend or endorse any specifictests, physicians, products, procedures, opinions, or other information that may bementioned on the Site. Reliance on any information provided by Hemodialysis.comor other Eminent Domains Inc (EDI) websites, EDI employees, others appearing onthe Site at the invitation of Hemodialysis.com or EDI, or other visitors to the Site issolely at your own risk.• The Site may contain health- or medical-related materials that are sexually explicit.If you find these materials offensive, you may not want to use our Site. The Siteand the Content are provided on an "as is" basis.For Informational Purposes Only: Notintended as Specific Medical Advice4/5/13 2
  3. 3. Cinacalcet –Troponins: Is There An Undiscovered Link??Hemodialysis.com Interview with Samra AbouchacraSenior consultant nephrologist and Chairman Nephrology DepartmentTawam Hospital United Arab Emirates• Hemodialysis.com: What are the mainfindings of the study?• Answer: A possible link between Cinacalcet-induced reductions in PTH & troponin levels inhemodialysis patients.• Hemodialysis.com: Were any of the findingsunexpected?• Answer: Not completely given the role ofinflammation in both.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice3
  4. 4. Cinacalcet –Troponins: Is There An Undiscovered Link??Hemodialysis.com Interview with Samra AbouchacraSenior consultant nephrologist and Chairman Nephrology DepartmentTawam Hospital United Arab Emirates(cont)• Hemodialysis.com: What should clinicians and patients take away fromthis study?• Answer: Treatment of SHPT in dialysis patients may have an impact oncardiac markers suggesting an association between hyperparathyroiddysfunction and ischemic heart disease; a relation which needs furtherstudy including the effects of confounding variables.• Hemodialysis.com: What recommendations do you have for futureresearch as a result of your study?• Answer: PTH-dependent and independent effects may be at play in theincreased cardiovascular risk in dialysis patients. This needs to be exploredin addition to role of inflammation and the correlation with clinicaloutcomes.• Citation:• Cinacalcet –Troponins: Is There An Undiscovered Link??• Presented at Spring NKF 2013 Meeting.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice4
  5. 5. THE “PHOSPHORUS OLYMPICS”: A Self-Management Approach for Enhancing Phosphorus Educationin a Multi-Site Dialysis ProgramHemodialysis.com Authors’ Interview:Rachel Linzon, Josie Caruso-Ditta, Marla McKerracher,York Region Chronic Kidney Disease Program – Mackenzie Health, Richmond Hill, Ontario, Canada.• Objective:• The “Phosphorus Olympics” initiative was created to test whether a self-management approach to phosphorus education would improve patients’decisions impacting dietary phosphorus intake, phosphate-binders usageand serum phosphorus levels.• Hemodialysis.com: What are the main findings of the study?• The “Phosphorous Olympics” was a continuous quality improvement (CQI)initiative which used a fun innovative approach to learning about dietaryphosphorus and binder usage. The goal was to empower 229 (50%)dialysis patients recruited to improve their ability to self-manage dietaryphosphorus intake and phosphate-binder usage. Participants’ serumphosphorus levels subsequently improved by 3.6%.• Statistically significant improvements were observed in patients’ decisionsimpacting: the use of the phosphorus education handout, reading foodlabels for hidden phosphate additives, consuming baked goods containingbaking powder, taking phosphate-binders with snacks and feeling incontrol of dietary phosphorus intake and phosphate –binder usage.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice5
  6. 6. THE “PHOSPHORUS OLYMPICS”: A Self-Management Approach for Enhancing Phosphorus Educationin a Multi-Site Dialysis ProgramHemodialysis.com Authors’ Interview:Rachel Linzon, Josie Caruso-Ditta, Marla McKerracher,York Region Chronic Kidney Disease Program – Mackenzie Health, Richmond Hill, Ontario, Canada.(cont)• Hemodialysis.com: Were any of the findings unexpected?• Response: There were no unexpected findings.• Patients enjoyed the self-management approach to phosphate education andrequested more similar initiatives in the future.• Hemodialysis.com: What should clinicians and patients take away from thisstudy?• Response: Think creatively for patient education! Incorporating fun and innovativeself-management approaches to phosphorus education, empowers andencourages independence in patients requiring renal replacement therapy.• Hemodialysis.com: What recommendations do you have for future research as aresult of your study?• Response: Continue to develop creative education tools and initiatives whichencourage self-management specifically addressing phosphate additives.• Citation:• National Kidney Foundation Spring 2013 Meeting Poster Presentation4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice6
  7. 7. Association Between Lack of Health Insurance and Risk of Death and ESRD: Results from the Kidney Early Evaluation Program (KEEP)Hemodialysis.com Author Interview:Claudine Jurkovitz, MD, MPHChristiana Care Center for Outcomes Research (CCOR)Christiana Care Health SystemJohn H. Ammon Education Center, 2nd Floor Newark, DE(cont)• Hemodialysis.com: What should clinicians and patients take away from this study?• Dr. Jurkovitz:• • Anybody should have easy access to care but more so patients at high risk for kidney diseasesuch as patients with diabetes, hypertension, cardiovascular disease or a family history of kidneydisease. These patients should be screened for kidney disease and their risk factors treatedappropriately.• Hemodialysis.com: What recommendations do you have for future research as a result of yourstudy?• Dr. Jurkovitz:• • Will the frequency of screening for kidney disease increase as the Affordable Care Act isimplemented? Among patients at high risk for kidney disease, what is the current resourceutilization (Physician visits, Emergency Department visits or hospitalizations) according to insurancestatus? Will resource utilization change with the implementation of the Affordable Care Act in thispopulation of patients?• Citation:• Association Between Lack of Health Insurance and Risk of Death and ESRD: Results from the KidneyEarly Evaluation Program (KEEP)National Kidney Foundation Spring 2013 MeetingPoster Number: 135Suying Li Keith Norris Georges Saab MDAndrew Bomback Adam Whaley-Connell Peter McCullough4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice7
  8. 8. Association Between Lack of Health Insurance and Risk of Death and ESRD: Results from the Kidney Early Evaluation Program (KEEP)Hemodialysis.com Author Interview:Claudine Jurkovitz, MD, MPHChristiana Care Center for Outcomes Research (CCOR)Christiana Care Health SystemJohn H. Ammon Education Center, 2nd Floor Newark, DE• Hemodialysis.com: What are the main findings of the study?• Dr. Jurkovitz:• • KEEP participants without insurance are at higher risk of deathand end-stage renal disease (ESRD) than participants with privateinsurance• Compared with those with insurance, KEEP participants withoutinsurance were less likely to have seen a physician in the past year.• Of participants with hypertension, those without insurancewere the least likely to achieve target levels of blood pressure• Hemodialysis.com: Were any of the findings unexpected?• Dr. Jurkovitz:• • We did not expect that lack of insurance would not only be arisk factor for death but also for ESRD in this population at high riskfor kidney disease.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice8
  9. 9. Impact of In-Home Education Programs on the Graduation Rate of Young Adults with Kidney DiseaseHemodialysis.com Author Interview: Lori L. Sanderson, PhD, LCSWLee Anne Gridley, TeacherPeter Yorgin, Nephrologist• Hemodialysis.com: What are the main findings of thestudy?• Dr. Sanderson: In this study population, pediatricdialysis and transplant patients who did not attendhome school were more likely to graduate from highschool (OR: 3.778). Subjects who received home schoolwere more likely to come from families of parents whodid not attend college, completed high school, workedoutside of the home, and spoke English as a secondlanguage. This study population was also more likely tobe of Hispanic origin. They were also more likely tohave received a kidney transplant rather than bereceiving dialysis treatments.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice9
  10. 10. Impact of In-Home Education Programs on the Graduation Rate of Young Adults with Kidney DiseaseHemodialysis.com Author Interview: Lori L. Sanderson, PhD, LCSWLee Anne Gridley, TeacherPeter Yorgin, Nephrologist(cont)• Hemodialysis.com: Were any of the findings unexpected?• Dr. Sanderson: It was suspected that many of the participants in the studypopulation would be of Hispanic origin since this is the primarydemographic of the area. Language spoken in the home, a parent’seducation level, and whether or not parents worked outside of the homewas suspected to influence the participant’s ability to graduate on timewhen enrolled in home school.• Hemodialysis.com: What should clinicians and patients take away fromthis study?• Dr. Sanderson: Prior to this study, our nephrologists and team did notplace a high priority on reassessing the patient’s need for continued homeschool. Nephrologist granted home school to patients with some of themost limited resources. Now, it has become a standard practice to makeevery effort to keep dialysis and post-kidney transplant patients in regularschool. We now use home school as a short term option only.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice10
  11. 11. Impact of In-Home Education Programs on the Graduation Rate of Young Adults with Kidney DiseaseHemodialysis.com Author Interview: Lori L. Sanderson, PhD, LCSWLee Anne Gridley, TeacherPeter Yorgin, Nephrologist(cont)• Hemodialysis.com: What recommendations do you have for futureresearch as a result of your study?• Dr. Sanderson: When assessing the patient’s ability to graduatewith their peers from high school, further research should considerevaluating the duration of time in home education programs, theoverall health of the patient, the life expectations of the parentsregarding their children, and the children’s expectations ofthemselves. Future research could also evaluate the rationale forplacing patients in home school since this might also influence achild’s ability to succeed academically.• Citation:• National Kidney Foundation Spring 2013Impact of In-Home Education Programs on the Graduation Rate ofYoung Adults with Kidney DiseasePoster Number: 1624/5/13For Informational Purposes Only:Not intended as Specific Medical Advice11
  12. 12. Pregnancy outcomes in Advanced Chronic Kidney DiseaseHemodialysis.com Author Interview: Dr. Zichun Feng PGY3Medical Resident at Baylor College of Medicine.• Hemodialysis.com: What are the main findingsof the study?• Dr. Feng: Severe CKD (eGFR <30ml/min) inpregnancy is associated with increased risks ofadverse maternal and fetal outcomes. Theincidence of pre-term delivery, small forgestational age, and decline of maternal renalfunction increased with a decline in eGFR.Women with severe CKD may experience areduced rate of preeclapsia / eclampsia andpreterm delivery with earlier initiation of dialysis.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice12
  13. 13. Pregnancy outcomes in Advanced Chronic Kidney DiseaseHemodialysis.com Author Interview: Dr. Zichun Feng PGY3Medical Resident at Baylor College of Medicine.(cont)• Hemodialysis.com: Were any of the findings unexpected?• Dr. Feng: Previous studies have shown adverse fetal outcomes suchas intrauterine growthretardation, oligohydryamnios, polyhydramnios are also increasedin pregnancy with severe CKD.• However, in our studies, these adverse fetal outcomes were rareoccurrences and were not significantly different from mild CKD.• Hemodialysis.com: What should clinicians and patients take awayfrom this study?• Dr. Feng: Pregnancy with severe CKD carries high risks for bothmaternal and fetal adverse outcomes. Early initiation of dialysis inthis high risk group of women may reduce preterm delivery andpreeclampsia/eclampsia.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice13
  14. 14. Pregnancy outcomes in Advanced Chronic Kidney DiseaseHemodialysis.com Author Interview: Dr. Zichun Feng PGY3Medical Resident at Baylor College of Medicine.(cont)• Hemodialysis.com: What recommendations do you havefor future research as a result of your study?• Dr. Feng: Further studies with multicenter studies mayincrease sample size and increase statistical power of study.• In that case, prospective study of placing pregnant womenwith severe CKD on dialysis and their pregnancy outcomesmay also be pursued.• Citation:National Kidney Foundation Spring Meeting• Pregnancy outcomes in Advanced Chronic Kidney DiseasePoster Number: 158Authors: Rajeev Raghavan Silvia Feng Charles Minard4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice14
  15. 15. Infection Rates and Associated Pathogens in Patients on Nocturnal Home Hemodialysis Over a Six Year PeriodHemodialysis.com Author Interview: Marisa Battistella, BSc Phm, Pharm D, ACPRPharmacy Clinician Scientist Assistant ProfessorLeslie Dan Faculty of Pharmacy, University of TorontoClinical Pharmacist-Nephrology University Health Network• Dr. Battistella: Our study consisted of a 6 year retrospective analysis of the90 NHD patients.• We evaluated the culture and sensitivity of all samples drawn in NHDpatient, prescribed antibiotics and clinical demographic data such asage, gender, race, primary renal disease, comorbidities and duration ofdialysis.• Out of the 90 patients we investigated, 64 of them had a culture andsensitivity sample drawn at least once. Rates of exit site infections andbacteremia were defined according to Health Canada and Centre ofInfectious Disease definitions. There is a low exit site infection rate-averaging less than 5 per year and the most common organism causingexit site infections is staph aureus. There is a much higher rate ofbacteremia infections averaging about 20 infections and the mostcommon organisms causing bacteremia infections are Coagulase-NegativeStaphylococci and Staphylococcus Aureus. Bacteremia infections were themost common type of infection in home hemodialysis patients but otherinfections included urine, pneumonia and fistula/graft but at a much lowerrate.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice15
  16. 16. Infection Rates and Associated Pathogens in Patients on Nocturnal Home Hemodialysis Over a Six Year PeriodHemodialysis.com Author Interview: Marisa Battistella, BSc Phm, Pharm D, ACPRPharmacy Clinician Scientist Assistant ProfessorLeslie Dan Faculty of Pharmacy, University of TorontoClinical Pharmacist-Nephrology University Health Network(cont)• Hemodialysis.com: Were any of the findings unexpected?• Dr. Battistella: There were larger number of samples drawnbut most of them were negative suggesting unnecessarylaboratory measurements.• However, the number of samples drawn has decreasedover the number of years. The reason for this decrease maybe that patients are more familiar with the signs andsymptoms of a true infection• Hemodialysis.com: What should clinicians and patientstake away from this study?• Dr. Battistella: Careful monitoring of infections andeducating patients on proper techniqu4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice16
  17. 17. Infection Rates and Associated Pathogens in Patients on Nocturnal Home Hemodialysis Over a Six Year PeriodHemodialysis.com Author Interview: Marisa Battistella, BSc Phm, Pharm D, ACPRPharmacy Clinician Scientist Assistant ProfessorLeslie Dan Faculty of Pharmacy, University of TorontoClinical Pharmacist-Nephrology University Health Network(cont)• Hemodialysis.com: What recommendations do youhave for future research as a result of your study?• Dr. Battistella: Our next steps are to evaluate theinfection outcomes and treatment outcomes in thispopulation.• Citation:National Kidney Foundation Spring Clinical Meeting2013• Infection Rates and Associated Pathogens in Patientson Nocturnal Home Hemodialysis Over a Six YearPeriodPoster Number: 914/5/13For Informational Purposes Only:Not intended as Specific Medical Advice17
  18. 18. Dietary Sodium Intake in Hemodialysis Patients Does Not Correlate with Interdialytic Weight GainHemodialysis.com Author Interview: Deepika Jain, MDRenal fellow, The Renal Electrolyte DivisionUniversity of Pittsburgh Medical Center Pittsburgh, PA• Hemodialysis.com: What are the main findings of the study?• Dr. Jain: Our study was aimed to analyze the baseline self reported sodiumintake in maintenance hemodialysis population and see if it correlateswith interdialytic weight gain. We know that sodium intake plays animportant role in blood pressure and cardiovascular outcomes in nondialysis patients. In dialysis population, there is some evidence thatsodium load affects volume control, but how much of it actuallyassociated with self reported dietary sodium intake in unknown.• Our study showed that there was no correlation between self reporteddietary sodium intake and interdialytic weight gain. This correlation didnot change when presence or absence of urine output was accountedfor. Mean sodium intake in our cohort was 2.29 gram sodium/day andinterdialytic weight gain was 1.23 kg/day. Male gender and longer time ondialysis subjects were more likely to have higher dietary sodium intake.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice18
  19. 19. Dietary Sodium Intake in Hemodialysis Patients Does Not Correlate with Interdialytic Weight GainHemodialysis.com Author Interview: Deepika Jain, MDRenal fellow, The Renal Electrolyte DivisionUniversity of Pittsburgh Medical Center Pittsburgh, PA(cont)• Hemodialysis.com: Were any of the findings unexpected?• Dr. Jain: Our findings were somewhat surprising becausethe sodium intake and weight gain did not correlate witheach other. The sodium intake restriction has been themain focus of volume management and blood pressurecontrol in dialysis population. The sodium intake wasrecorded by performing three dietary recalls on differentdays to account for variations in intake during the week.• Even if we consider the underreporting of sodium intakewith the dietary recall method, the average sodium intakein our group was 2.29 grams/day ( according to currentguidelines recommendations are at 2-3gram sodium perday) which means that a number of our patients were likelycompliant with sodium restriction guidelines.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice19
  20. 20. Dietary Sodium Intake in Hemodialysis Patients Does Not Correlate with Interdialytic Weight GainHemodialysis.com Author Interview: Deepika Jain, MDRenal fellow, The Renal Electrolyte DivisionUniversity of Pittsburgh Medical Center Pittsburgh, PA(cont)• Hemodialysis.com: What should clinicians andpatients take away from this study?• Dr. Jain: Our results suggest that self reported sodiumintake did not associate with interdialytic weight gain.Of course, one cannot overlook the underreportingwith dietary sodium recall method. But we feel thatthere could be other sodium loading processes in ourdialysis population which could be contributing to theinterdialytic weight gain like sodium load fromdialysate, excessive ultrafiltration rates, rapid shiftspost dialysis stimulating thirst leading to increasedvolume status.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice20
  21. 21. Dietary Sodium Intake in Hemodialysis Patients Does Not Correlate with Interdialytic Weight GainHemodialysis.com Author Interview: Deepika Jain, MDRenal fellow, The Renal Electrolyte DivisionUniversity of Pittsburgh Medical Center Pittsburgh, PA(cont)• Hemodialysis.com: What recommendations do youhave for future research as a result of your study?• Dr. Jain: We feel that the sodium intake restrictionguidelines in dialysis population should be studied indetail again taking into account other sodium exposureparameters. Ours is an observational study and hence apossibility of potential biases always exists.• Citation:• Dietary Sodium Intake in Hemodialysis Patients DoesNot Correlate with Interdialytic Weight GainPoster Number: 133 Deepika JainUniversity of Pittsburgh, Renal Fellow4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice21
  22. 22. Medication-Related Error in Outpatient Hemodialysis CenterHemodialysis.com Author Interview:Timothy Nguyen, PharmD, BCPS, CCP, FASCPAssistant Professor of Pharmacy, Clinical Pharmacology, & NephrologyArnold & Marie Schwartz College of Pharmacy & Health Sciences Long Island University & Mount Sinai Kidney Center• Hemodialysis.com: What are the mainfindings of the study?• Dr. Nguyen: The main finding of this study isthat hemodialysis patients commonlyexperience medication-related problems anddrug interactions due to multiple medicationsthat they are taking for their kidney diseaseand co-morbidities.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice22
  23. 23. Medication-Related Error in Outpatient Hemodialysis CenterHemodialysis.com Author Interview:Timothy Nguyen, PharmD, BCPS, CCP, FASCPAssistant Professor of Pharmacy, Clinical Pharmacology, & NephrologyArnold & Marie Schwartz College of Pharmacy & Health Sciences Long Island University & Mount Sinai Kidney Center(cont)• Hemodialysis.com: Were any of the findings unexpected?• Dr. Nguyen: We know that dialysis patients have many co-morbid disease conditions and that they need to take manymedications, but we did not expect that those medicationsthat were suppose to help but ended up being actuallyharmful.• Hemodialysis.com: What should clinicians and patientstake away from this study?• Dr. Nguyen: Clinicians and patients should appreciate thecomplex condition dialysis patients have, appreciate themultiple medications they take, recognize potential formedication-related problems and prevent further negativeconsequences.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice23
  24. 24. Medication-Related Error in Outpatient Hemodialysis CenterHemodialysis.com Author Interview:Timothy Nguyen, PharmD, BCPS, CCP, FASCPAssistant Professor of Pharmacy, Clinical Pharmacology, & NephrologyArnold & Marie Schwartz College of Pharmacy & Health Sciences Long Island University & Mount Sinai Kidney Center(cont)• Hemodialysis.com: What recommendations do you have for futureresearch as a result of your study?• Dr. Nguyen: Future research should help improve dialysis patientsvia understanding the complexity of the medicationregimens, recognizing for potential adverse events, increasingsurveillance and reducing the numbers of medication-relatedproblems.• Citation:• Medication-Related Error in Outpatient Hemodialysis CenterPoster Number: 154Timothy Nguyen PharmD and Brian Radbill MDDepartment of Medicine-Renal Medicine Mt. Sinai Hospital NYNational Kidney Foundation 2013 Spring Clinical MeetingsApril 2 – 6, 2013 – Walt Disney World Swan andDolphin, Orlando, Florida4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice24
  25. 25. Perceptions of Facilitators and Barriers to Chronic Kidney Disease Educational SessionsAuthor Interview: Della Connor, APRNThe University of Texas at Tyler• Hemodialysis.com: What are the main findings of thestudy?• Della Connor: Trusting relationships must existbetween healthcare providers and patients to addressbarriers to educational sessions.• Providers must recommend educational sessions topatients, telling them of the potential benefits ofattendance, concentrating on the effects of slowing theprogression of Chronic Kidney Disease (CKD). Accommodation issues, such as work andtransportation, must be addressed to facilitateattendance at these sessions.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice25
  26. 26. Perceptions of Facilitators and Barriers to Chronic Kidney Disease Educational SessionsAuthor Interview: Della Connor, APRNThe University of Texas at Tyler(cont)• Hemodialysis.com: Were any of the findings unexpected?• Della Connor: Patients expressed that they were willing toshare their diagnosis of diabetes with others, but didnot want them to know about their kidney disease. Priormedia attention to CKD and celebrities with this diseaseprocess are seldom viewed favorably.• Another surprise finding was that patients identified theirnephrologist as the one person who could convince themto attend CKD educational sessions. They picked thenephrologist over family members, and other healthcareproviders.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice26
  27. 27. Perceptions of Facilitators and Barriers to Chronic Kidney Disease Educational SessionsAuthor Interview: Della Connor, APRNThe University of Texas at Tyler(cont)• Hemodialysis.com: What should clinicians andpatients take away from this study?• Della Connor: Clinicians need to recommendthese classes. They need to explain the benefitsof attendance and especially point out theevidence that the classes may slow theprogression to dialysis. Both clinicians andpatients need to engage more with mainstreammedia to portray accurate representations ofpersons living with CKD.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice27
  28. 28. Perceptions of Facilitators and Barriers to Chronic Kidney Disease Educational SessionsAuthor Interview: Della Connor, APRNThe University of Texas at Tyler(cont)• Hemodialysis.com: What recommendations do you have for futureresearch as a result of your study?• Della Connor: Additional research is needed in this emerging fieldof attendance of CKD education sessions for patients in all stages ofthe disease process.• A cohesive CKD education program, such as Your Treatment, YourChoice (National Kidney Foundation, 2012), needs to be comparedto other CKD educational programs, to determine the best learningprogram for these patients. Specific CKD education measurementtools must also be developed.• Citation:• National Kidney Foundation Spring 2013 Meeting Poster Number:814/5/13For Informational Purposes Only:Not intended as Specific Medical Advice28
  29. 29. An Evaluation of Clinical Factors Associated with the Decision to Transfuse Chronic Dialysis PatientsCynthia WhitmanResearch Coordinator for the UCLA/VA Center for Outcomes Research and Education.(cont)• Hemodialysis.com: What are the main findings of the study?• Cynthia Whitman: The main findings of our study include:• Among 10 patient clinical attributes studied, hemoglobin (Hb) level wasfound to be the most important for driving provider decision-makingregarding red blood cell transfusions in CKD patients, however thisattribute alone does not inform providers enough for them to base theirdecisions.• 92% of providers transfused when Hb was 7.5 g/dL.• In multivariable regression, we found Veterans Administration providers 6times as likely to transfuse earlier at 8.0 g/dL, than others.• The more experienced providers had (at least 20 years) and the moreexposure they had to patients, the more selective they were about usingtransfusions in CKD patients, and the more likely they were to require thepatients to exhibit more serious clinical characteristics such as ironrepletion.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice29
  30. 30. An Evaluation of Clinical Factors Associated with the Decision to Transfuse Chronic Dialysis PatientsCynthia WhitmanResearch Coordinator for the UCLA/VA Center for Outcomes Research and Education.• Hemodialysis.com: Were any of the findingsunexpected?• Cynthia Whitman:• We did not expect providers with less experienceto recommend transfusions more often thanmore experienced providers.This findinghighlights the greater awareness that providerswith more experience may offer regarding thepotential negative consequences of RBCtransfusions, rather than reliance onerythropoiesis-stimulating agents (ESAs).4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice30
  31. 31. An Evaluation of Clinical Factors Associated with the Decision to Transfuse Chronic Dialysis PatientsCynthia WhitmanResearch Coordinator for the UCLA/VA Center for Outcomes Research and Education.(cont)• Hemodialysis.com: What should clinicians and patients take awayfrom this study?• Cynthia Whitman:• Clinical vignettes presented using conjoint analysis provide aninsight into provider preferences for recommending/performingblood transfusions.• In the debate over best-practice management of CKD patients, weunderstand that there are many patient factors that are takentogether when providers make their decisions.• While hemoglobin level is responsible for 29% of the decision-making process, it is by no means the stand-alone factor that isconsidered; patient functional status and cardiovascularcomorbidities play a substantial role in this process as well (16%and 12%, respectively).4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice31
  32. 32. An Evaluation of Clinical Factors Associated with the Decision to Transfuse Chronic Dialysis PatientsCynthia WhitmanResearch Coordinator for the UCLA/VA Center for Outcomes Research and Education.(cont)• Hemodialysis.com: What recommendations do you have for futureresearch as a result of your study?• Cynthia Whitman:• Findings suggest that in order to better understand the RBCtransfusion decision-making process in CKD patients the next stepmay be to conduct a case-study/ chart analysis of actual transfusionevents, taking intoconsideration provider type, region, andexperience.• Educational interventions aimed at providers about current practiceguidelines, and the benefits and risks of ESAs and transfusions mayensure/contribute to more informed and uniform decisions.• Citation: National Kidney Foundation 2013: Abstract PosterPresentation #50.4/5/13For Informational Purposes Only:Not intended as Specific Medical Advice32
  33. 33. Cost implications of switching from sevelamer to lanthanum carbonatewithin a bundled reimbursement scenarioInterview with Dr. Michael S Keith Shire Pharmaceuticals, Wayne, PA, USA(cont)• Hemodialysis.com: What are the main findings of thestudy?• Dr. Keith: The key finding from this post hoc analysis isthat phosphate control was similar regardless of theprior sevelamer dose a patient received. Overall meanphosphate binder doses were SH 7703 mg/day and LC2800 mg/day. Drug cost-savings were realized whenapplying clinically utilized doses of lanthanumcarbonate (LC) 3000 mg/day ($26.46/day) andsevelamer hydrochloride (SH) from doses of 6400mg/day ($29.68/day) and above. Cost savings were ashigh as $18/day when converting patients from SH9600 mg/day to LC 3000 mg/day.4/5/13For Informational Purposes Only: Notintended as Specific Medical Advice33
  34. 34. Cost implications of switching from sevelamer to lanthanum carbonatewithin a bundled reimbursement scenarioInterview with Dr. Michael S Keith Shire Pharmaceuticals, Wayne, PA, USA• Hemodialysis.com: Were any of the findings unexpected?• Dr. Keith: We expected there would be a comparative dosing pointwhere LC would be more cost-effective than SH, with similarphosphate control, but the inflexion point at which this occurredwas perhaps surprisingly low, which represented a large percentageof patients taking SH monotherapy in the original study.• Hemodialysis.com: What should clinicians and patients take awayfrom this study?• Dr. Keith: In this study, 65% of patients were taking SHmonotherapy doses of 6400 mg/day or more at baseline. If thesepatients were switched to LC 3000 mg/day their costs and theirdaily pill burden could be reduced, while maintaining similarphosphate levels. Therefore, converting patients to LC may be aviable and cost-efficient alternative to continuing to escalate thedose of SH to 6400 mg/day or above.4/5/13For Informational Purposes Only: Notintended as Specific Medical Advice34
  35. 35. Cost implications of switching from sevelamer to lanthanum carbonatewithin a bundled reimbursement scenarioInterview with Dr. Michael S Keith Shire Pharmaceuticals, Wayne, PA, USA(cont)• Hemodialysis.com: What recommendations do you have for futureresearch as a result of your study?• Dr. Keith: This study evaluated the cost implications of treatmentswitching in the USA. Additional studies would be useful to assesswhether similar conclusions can be drawn for Europe and Asia.• Citation:• Presented at National Kidney Foundation NKF Spring 2013 Meeting• Cost implications of switching from sevelamer to lanthanumcarbonate within a bundled reimbursement scenario• Michael S Keith,1 Rosamund J Wilson,2 J Brian Copley1• 1Shire Pharmaceuticals, Wayne, PA, USA• 2Spica Consultants, Marlborough, UK4/5/13For Informational Purposes Only: Notintended as Specific Medical Advice35
  36. 36. Influence of Wasting on Hyperparathyroidism in Black Diabetic Hemodialysis PatientsHemodialysis.com Interview with Rapeepat Lekkham, MDNephrology Fellow,Albert Einstein Medical Center,Philadelphia, PA• Hemodialysis.com: What are the main findings of the study?• Dr. Lekkham: We conducted the retrospective study onhemodialysis patients who mainly (92.9%) were black and stratifiedby the absence or presence of wasting syndrome (which defined byserum albumin less than 3.8 g/dl, normalized protein nitrogenappearance (nPNA) less than 0.8 g/kg/day and BMI less than 23kg/m2) and the association with secondary hyperparathyroidism.Compared to non-diabetic patients, our study found that diabeticpatients had a higher mean serum iPTH. Also, serum iPTH washigher in all diabetic non-wasting subgroups patients as well. Otherrelated parameters including mean serum phosphate, serumalkaline phosphatase, the requirement of cinacalcet, vitamin Danalogues and phosphate binders were comparable in both groups.4/5/13For Informational Purposes Only: Notintended as Specific Medical Advice36
  37. 37. Influence of Wasting on Hyperparathyroidism in Black Diabetic Hemodialysis PatientsHemodialysis.com Interview with Rapeepat Lekkham, MDNephrology Fellow,Albert Einstein Medical Center,Philadelphia, PA(cont)• Hemodialysis.com: Were any of the findings unexpected?• Dr. Lekkham: Even though the main finding of our study showedthat the serum iPTH in diabetic patients was higher in the non-wasting condition especially defined by BMI more than or equal to23 kg/m2. Surprisingly, when we did subgroup analysis in diabeticpatients who had obesity (BMI more than or equal to 30kg/m2), this association was no longer exist.• Hemodialysis.com: What should clinicians and patients take awayfrom this study?• Dr. Lekkham: There are several factors that potentially related ormodified the severity of secondary hyperparathyroidism inhemodialysis patients that both nephrologists and patients shouldbe aware of. Our study suggests that non-wasting condition but notobesity is associated with the severity of secondaryhyperparathyroidism in black diabetic hemodialysis patients.4/5/13For Informational Purposes Only: Notintended as Specific Medical Advice37
  38. 38. Influence of Wasting on Hyperparathyroidism in Black Diabetic Hemodialysis PatientsHemodialysis.com Interview with Rapeepat Lekkham, MDNephrology Fellow,Albert Einstein Medical Center,Philadelphia, PA(cont)• Hemodialysis.com: What recommendations do you have for futureresearch as a result of your study?• Dr. Lekkham: There are several limitations to our study which wewould hope that future research would be able to address. Thefurther studies with multicenter studies may increase sample sizeand statistical power of study. Also the population in our studymainly were mainly African American descent, the result may be ormay not be able to apply to the general hemodialysis population.Finally, to generalize and reproduce the result of furtherstudies, the standard definition of wasting condition is required.Citation:• Influence of Wasting on Hyperparathyroidism in Black DiabeticHemodialysis Patients• NKF Spring Clinical Meetings April 20134/5/13For Informational Purposes Only: Notintended as Specific Medical Advice38
  39. 39. The PICC Epidemic and the Kidney PatientHemodialysis.com eInterview: Rita McGill MDAllegheny General HospitalPittsburgh, PA USA• The major finding of this study is that more than 20%of hospital inpatients have PICC lines. Compared tohospital patients in general, PICC patients are sickerand have more chronic kidney disease. This isparticularly unfortunate, since national ASDINguidelines advise against PICC placement in kidneypatients. Despite this recommendation, CKD patientsactually bear a disproportionate brunt of the PICC‘epidemic, with a PICC rate of 30%, which is higher thanother patients.• The reasons for the enthusiastic embrace of excessPICC lines are complicated, and often reflectconvenience more than actual health benefits4/5/13For Informational Purposes Only: Notintended as Specific Medical Advice39
  40. 40. The PICC Epidemic and the Kidney PatientHemodialysis.com eInterview: Rita McGill MDAllegheny General HospitalPittsburgh, PA USA(cont)• Clinicians should come away with a heightenedawareness that indiscriminate use of PICCs in CKDpatients is apt to create future problems whenpatients require fistula access for dialysis. Furtherstudy is needed to define effective strategies forPICC avoidance and CKD patient protection, anddefine the underlying factors that are promotingan epidemic of PICC placement.• Citation:• Spring NKF Clinical Meeting Poster:‘The PICC Epidemic and the Kidney Patient”4/5/13For Informational Purposes Only: Notintended as Specific Medical Advice40
  41. 41. Pilot Study of a Physician-Delivered Education Tool to Increase Patient Knowledge About CKDHemodialysis.com Authors’ eInterviewJ.A. Wright Nunes, MD MPH University of Michigan Health SystemKerri Cavanaugh, MD MHS Vanderbilt University Medical Center• Hemodialysis.com: What are the main findings of thestudy?• Answer: The main finding of the study was that asimple, efficient educational worksheet designed tofacilitate patient-provider communication about kidneydisease, increased patient knowledge in fundamental areasrelated to their kidney health.• We are also encouraged by the very positive response inpatients who received the educational worksheet, as wellas the providers who delivered the tool in practice.4/5/13For Informational Purposes Only: Notintended as Specific Medical Advice41
  42. 42. Pilot Study of a Physician-Delivered Education Tool to Increase Patient Knowledge About CKDHemodialysis.com Authors’ eInterviewJ.A. Wright Nunes, MD MPH University of Michigan Health SystemKerri Cavanaugh, MD MHS Vanderbilt University Medical Center (cont)• Hemodialysis.com: Were any of the findingsunexpected?• Answer: Although the educational worksheetincreased patient knowledge in many areas, patientsreceiving the intervention were still less likely toacknowledge their ‘decreased kidney function’ andwere less likely to understand that there were stages ofchronic kidney disease (CKD). We believe these issuesreflect patient difficulty understanding the meaning ofthe term ‘kidney function’ and reflect debate amongstproviders about CKD staging and its definition.”4/5/13For Informational Purposes Only: Notintended as Specific Medical Advice42
  43. 43. Pilot Study of a Physician-Delivered Education Tool to Increase Patient Knowledge About CKDHemodialysis.com Authors’ eInterviewJ.A. Wright Nunes, MD MPH University of Michigan Health SystemKerri Cavanaugh, MD MHS Vanderbilt University Medical Center (cont)• Hemodialysis.com: What recommendations do youhave for future research as a result of your study?• Answer: Although results of our study areencouraging, this was a pilot design, using a historicalcohort for comparison. Randomized trials are neededto study the impact of education interventions onintermediate measures and long term clinicaloutcomes.• Citation:• Pilot Study of a Physician-Delivered Education Tool toIncrease Patient Knowledge About CKD• Spring National Kidney Foundation NKF Meetings 21034/5/13For Informational Purposes Only: Notintended as Specific Medical Advice43
  44. 44. Disease Progression and Surgical Parathyroidectomy in the EVOLVE TrialHemodialysis.com eInterview with:Patrick Parfrey, MD, FRCPC, FACP on behalf of the EVOLVE investigatorsUniversity Research Professor at Memorial University St. John’s, Newfound• Hemodialysis.com: What are the main findings of the study?• Dr. Parfrey: The EVOLVE trail enrolled 3883 patients with secondaryhyperparathyroidism from 22 countries , randomly allocated them to thecalcimimetic, cinacalcet ,or placebo, and followed them for up to 64months. Parathyroidectomy was undertaken in patients with severeunremitting hyperparathyroidism: PTH level prior to surgery 2143 mg/dl inthe cinacalcet group and 1873 in the placebo group.• Selection bias was observed in that surgery was undertaken in youngerpatients, of longer dialysis vintage, with less co-morbidity.• In addition the rates of parathyroidectomy differed across countries withthe lowest rate in USA.• Surgery was undertaken significantly less frequently in the cinacalcettreated patients compared to placebo treated patients:7% v 14%,hazardratio= 0.44.95% confidence intervals 0.36-0.54.4/5/13For Informational Purposes Only: Notintended as Specific Medical Advice44
  45. 45. Disease Progression and Surgical Parathyroidectomy in the EVOLVE TrialHemodialysis.com eInterview with:Patrick Parfrey, MD, FRCPC, FACP on behalf of the EVOLVE investigatorsUniversity Research Professor at Memorial University St. John’s, Newfound(cont)• Hemodialysis.com: Were any of the findings unexpected?• Dr. Parfrey: There were substantial differences in themanagement of severe hyperparathyroidism across theworld, and severe unremitting hyperparathyroidismoccurred frequently despite good use of conventionaltherapy to treat hyperparathyroidism, including Vitamin Dagents and phosphate binders.• Hemodialysis.com: What should clinicians take from yourstudy?• Dr. Parfrey: Cinacalcet is an effective drug to preventsevere unremitting hyperparathyroidism in hemodialysispatients. It’s side effects include nausea and vomiting ,andit can induce hypocalcemia.4/5/13For Informational Purposes Only: Notintended as Specific Medical Advice45
  46. 46. Disease Progression and Surgical Parathyroidectomy in the EVOLVE TrialHemodialysis.com eInterview with:Patrick Parfrey, MD, FRCPC, FACP on behalf of the EVOLVE investigatorsUniversity Research Professor at Memorial University St. John’s, Newfound(cont)• Hemodialysis.com: What recommendations do you havefor future research as a result of your study?• Dr. Parfrey: EVOLVE was designed to test the hypothesisthat prevention of hyperparathyroidism with cinacalcetcould prevent cardiovascular events. The answer was non-definitive, although there was suggestive evidence toindicate a clinical effect on cardiovascular events.• Further trials to provide a definitive answer are indicated.• Citation:• Disease Progression and Surgical Parathyroidectomy in theEVOLVE Trial• NKF National Kidney Foundation Spring Clinical Meetings4/5/13For Informational Purposes Only: Notintended as Specific Medical Advice46
  47. 47. Withdrawal from dialysis and palliative carefor severely ill dialysis patients in terms of patient-centered medicineHemodialysis.com Author Interview: M.D. Hideaki IshikawaTokai Central Hospital of Japan Mutual Aid Association of Public School Teachers• Hemodialysis.com: What are the main findings of the study?• Answer: In daily works for our dialysis patients, we occasionally havesome difficulty in diagnosis of severely ill patients. Although dialysis is life-sustaining therapy, however, it can no longer be helpful to improve theirlife expectancy in that situation.• Moreover, we feel that dialysis itself may be burdensome for theseseriously ill patients such as terminal phase of cancer, severe heartfailure, sepsis due to infectious diseases and so on.• So, in our hospital, we sometimes recommend or propose “withdrawalfrom dialysis (WD) ” for them as an optional treatment. As a result, webelieve that the patients can die with peace and dignity.• In my opinion, current end-of-life care for dialysis patients who areseriously ill have not be sufficient. We assessed the quality of end-of-lifecare using “QODA” scale and verified that it may be acceptable andworth considering for better clinical care to them.4/5/13For Informational Purposes Only: Notintended as Specific Medical Advice47
  48. 48. Withdrawal from dialysis and palliative carefor severely ill dialysis patients in terms of patient-centered medicineHemodialysis.com Author Interview: M.D. Hideaki IshikawaTokai Central Hospital of Japan Mutual Aid Association of Public School Teachers(cont)• Hemodialysis.com: Were any of the findings unexpected?• Answer: It is related to the limitations of our study. There is no establishedconsensus about withdrawal from dialysis in Japan, so a number of patients couldnot accept WD until their painful death.• Hemodialysis.com: What should clinicians and patients take away from thisstudy?• Answer: For clinicians, our results suggested that withdrawal from dialysis maypossibly improve our practice for end-of-life care of severely ill dialysis patients. Inaddition, palliative care is also necessary to control severe intolerable symptomssuch as pain, respiratory distress, etc. after withdrawal from dialysis.• In summary, nephrologists are required to be trained to get skills to undertakesatisfactory management of end-of-life care.• For patients, We think every dialysis patients should consider their preference ofof end-of-life care even if they are doing well at present.• The obvious statement about their living will may be useful for both physicians andpatients to refine a treatment of the end-of-life care.4/5/13For Informational Purposes Only: Notintended as Specific Medical Advice48
  49. 49. Withdrawal from dialysis and palliative carefor severely ill dialysis patients in terms of patient-centered medicineHemodialysis.com Author Interview: M.D. Hideaki IshikawaTokai Central Hospital of Japan Mutual Aid Association of Public School Teachers(cont)• Hemodialysis.com: What recommendations do you have for further research as aresult of your study?• Answer: The term “patient-centered-medicine” has currently been focus in somestudies.• As physicians for dialysis patients, we need to reevaluate whether our clinicalpractices contribute to patients’ satisfaction even if they are in terminal stage.• In that context, we think our concept of withdrawal from dialysis option forseverely ill dialysis patients is consistent with the concept.• We think that it may be also worth discussing in further research whether non-dialysis care for end-stage-renal disease patients who are severely ill is areasonable option for some patients.• Citation:• Withdrawal from dialysis and palliative care for severely ill dialysis patients interms of patient-centered medicine• Hideaki Ishikawa Waichi Sato Chisato Shigematsu Saori Tsukushi JunichiSakamoto Shoichi Maruyama Seiichi Matsuo• NKF 2013 Spring Clinical Meetings Abstract4/5/13For Informational Purposes Only: Notintended as Specific Medical Advice49
  50. 50. Do ESRD patients really want to know prognosisHemodialysis.com eInterview with Krishna Manda, MDBerkshire Medical Center in Pittsfield, Mass.• Dr. Manda:• • Our small study shows that dialysis patientsare at risk of “optimistic bias”.• • Despite the extremely high mortalityassociated with ESRD, most of our patients do notbelieve their health will deteriorate in future anda large number do not know the meaning of theword, prognosis, and/or are hesitant to havediscussions on this subject with theirnephrologist.4/5/13For Informational Purposes Only: Notintended as Specific Medical Advice50
  51. 51. Do ESRD patients really want to know prognosisHemodialysis.com eInterview with Krishna Manda, MDBerkshire Medical Center in Pittsfield, Mass. (cont)• Hemodialysis.com: Were any of the findings unexpected?• Dr. Manda:• • A surprising finding was that only half (54%) of thesample expressed a desire to have a meeting with thenephrologist to learn about their prognosis.• • 84% of patients thought they knew what “prognosis”meant, but only 62% of this subgroup were found duringthe interview to know the correct meaning.• • The sample was optimistic about the future, and 92%of patients felt their health would likely remain stable orimprove over the next six months.4/5/13For Informational Purposes Only: Notintended as Specific Medical Advice51
  52. 52. Do ESRD patients really want to know prognosisHemodialysis.com eInterview with Krishna Manda, MDBerkshire Medical Center in Pittsfield, Mass. (cont)• Hemodialysis.com: What should clinicians and patients take awayfrom this study?• Dr. Manda: End-of-life care can be improved by acquaintingpatients with their prognoses and instituting ongoing conversationsabout terminal care goals and preferences.• Hemodialysis.com: What recommendations do you have forfuture research as a result of your study?• Dr. Manda: This study model should be expanded to a large groupof patients to know what ESRD patients know about theirprognosis, what their expectations/preferences are about end oflife care if that situation comes.• Source:• National Kidney Foundation• Manda K, et al “Do ESRD patients really want to know prognosis?”NKF 2013; Abstract 1464/5/13For Informational Purposes Only: Notintended as Specific Medical Advice52
  53. 53. From Hemodialysis.com• Please keep in mind that informationpresented in these abstracts is usuallypreliminary and will need to be confirmed byfurther research and published in peer-reviewed journals.4/5/13For Informational Purposes Only: Notintended as Specific Medical Advice53

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