Phamily’s Post

CONGRATULATIONS RPA! Congratulations to the RPA, now celebrating 50 years of nephrology excellence. Over these decades the RPA has been the unwavering advocate for nephrologists, demonstrating their value in the care of people with kidney disease. RPA has tirelessly toiled in Washington, D.C. educating members of Congress and their staffs as well as Federal regulators about the epidemic of kidney disease, the critical role of nephrologists in achieving the best clinical outcomes for patients, the need for science-based quality metrics to drive clinical excellence as well as fairly determine payment for services. Thanks to RPA nephrologists and nephrology practice has continued to thrive, even through the scourge of COVID, where patients, nephrologists and the entire care delivery team were stressed to their limits, but still persevered.  But the job is not done. Nephrologists find themselves in the current environment of consolidation and corporatization of the dialysis industry, the increasing prevalence of value-based payment systems, and imperatives to dramatically increase the number of patients on home dialysis and receiving kidney transplants. So, what do nephrologists need now to continue to thrive and do what they want to do to maximize outcomes for patients? They want the tools and the autonomy in practice the help remedy the crisis of CKD in the U.S. that disproportionately impacts one of the most vulnerable and at-risk populations. They are looking for leadership that not only provides vision and direction but helps nephrologists themselves be the leaders in the practices and their communities. They want innovation- new and transformative approaches to improving clinical outcomes and do so while carefully stewarding limited resources. They want transparency from regulators and payers so that the rules of the game are clear, and they are recognized for their efforts and achievements. With all of these challenges and more, and as a proud past-President of RPA, I am confident that the continued work of the RPA, over the next many decades, will ensure that nephrologists are valued appropriately, that nephrology practice is viewed by physicians in training as a great specialty, and that people with kidney diseases will get the great clinical care and outcomes they need and deserve.  

Dialysis is undeniably a life-saving modality, a temporary lifeline for individuals battling end-stage renal disease (ESRD). However, it is neither a replacement for a kidney transplant nor a cure for this relentless condition. While dialysis sustains life, it brings its own set of challenges and hardships. Amidst these, the objectification and exploitation of patients, especially those undergoing in-center dialysis, is a grave and growing concern that demands immediate attention. Recently, a nephrologist who works for a sponsor visited an in-center dialysis clinic. This nephrologist's role should be to help, heal, and promote the well-being of patients. Instead, her visit in the capacity of representing a sponsor highlights a significant ethical issue. This wasn't a visit focused on patient care, but rather an impersonal attempt to gain insights for profit. Such actions are capriciously cruel, inhumane, and a blatant violation of the personal space and dignity of the patients. The presence of a nephrologist representing #pharma in the clinical environment introduces a clear conflict of interest and bias. It undermines the trust and transparency that should exist between patients and healthcare providers. The clinic's awareness and tacit approval of this visit further complicates the issue, suggesting a disturbing level of complicity. For decades, companies like DaVita Kidney Care and Fresenius Medical Care have thrived in an environment shrouded in secrecy, often prioritizing profit over patient care. The role of a #nephrologist should be to promote health and well-being, both physical and mental, not to serve as a conduit for corporate interests. The presence of a nephrologist in the capacity of representing a sponsor should alarm every patient and their families. This is an issue that transcends individual experiences and reflects systemic flaws within the healthcare industry. I urge the community to speak up against these unethical practices. We must demand transparency and accountability from healthcare providers and corporations alike. The objectification of patients for profit is unacceptable and should not be tolerated. It is time to question and challenge the actions of those who condone such behavior, from individual practitioners to corporate executives. We must collectively ensure that the primary focus remains on the well-being of patients, free from the corrupting influence of corporate interests. The dialysis community deserves better. We deserve respect, empathy, and genuine care. Let us unite and advocate for a system that truly prioritizes the health and dignity of all patients. Speak up. Demand change. Protect our community. #PatientRights #Dialysis #HealthcareEthics #ConflictOfInterest #ProtectPatients #EndExploitation #TransparencyInHealthcare #RespectAndDignity

Frailty in Patients on Dialysis, in Kidney International 2024, International Society of Nephrology (ISN) Gordon CK Chan ... Philip KT Li (Hong Kong) et al Kam Kalantar-Zadeh 👩🦯discusses the underlying causes of #frailty👨🦽in patients on #dialysis & examines the methods and difficulties involved in managing frailty among this group https://lnkd.in/gmNwV-Gm

ICU nephrology has pretty clearly shown we need to move away from creatinine alone (huge mismatches w/GFR among other things). In our latest research letter in Intensive Care Medicine, we demonstrate the high individual variability in GFR estimates using creatinine and cystatin C in clinic follow up following AKI and critical illness, as well as look at how these surrogates in the MAKE (major adverse kidney event) outcome relate to the development of worsening kidney disease over time. https://lnkd.in/eDWWTMxG

Cannabinoids for wound care: According to the American Professional Wound Care Association, non-healing wounds impact 15% of Medicare beneficiaries, and the costs associated with treating them can reach $30 Billion. The anti-inflammatory properties of cannabinoids are driving investigations into potential therapies for an entire spectrum of disease states, and treatment for chronic wound healing is one of them. Results of a recently completed study found that an experimental cannabinoid-based topical medicine achieved an extraordinary 90% success rate in healing chronic wounds. Dr. Vincent Maida, a palliative medicine specialist at the University of Toronto and principal investigator of the study, recruited thirty patients in an open-label study testing his proprietary Topical Cannabis-Based Medicines (TCBM). Twenty-seven of the participants achieved complete closure of wounds that, in some cases, had resisted healing for over a decade. Dr. Maida has been investigating cannabinoids for treating pain and wounds for over 20 years. During a graduate program on wounds at University of Toronto’s Dalla Lana School of Public Health, he encountered a pre-clinical study showing evidence of the efficacy of cannabinoids for wound healing. He recalls: “My supervisor thought I was off my rocker that I thought that cannabinoids could be effective for treating integumentary (the skin and mucous membrane system) and wound conditions. Since then the basic science has been catching up and validating all of my research.” [Forbes 2018] 

Here are points about nephrologists and what they do: 1. Nephrologists are medical doctors who specialize in the diagnosis, treatment, and management of kidney-related conditions and diseases. 2. They are experts in understanding the structure, function, and diseases of the kidneys and urinary system. 3. Nephrologists evaluate and manage various kidney disorders, including chronic kidney disease, acute kidney injury, glomerulonephritis, and kidney stones. 4. They monitor and manage patients with conditions that can affect kidney function, such as diabetes, hypertension, and autoimmune diseases. 5. Nephrologists oversee dialysis treatments for patients with end-stage kidney disease, including hemodialysis and peritoneal dialysis. 6. They assess patients for kidney transplantation and provide pre-transplant evaluation, post-transplant care, and ongoing management of transplant recipients. 7. Nephrologists interpret laboratory tests, imaging studies, and kidney biopsies to diagnose and monitor kidney diseases. 8. They collaborate with other healthcare professionals, including primary care physicians, urologists, surgeons, and dietitians, to provide comprehensive care for patients with kidney disorders. 9. Nephrologists educate patients about kidney health, lifestyle modifications, medication management, and the importance of adherence to treatment plans. 10. They conduct research to advance the understanding of kidney diseases, develop new treatment strategies, and improve patient outcomes. This information is intended as a patient education resource only and should not be used for diagnosing or treating a health problem.

DR ELLIE CANNON: Are statins responsible for my kidney illness? https://ift.tt/VCNlkz4 Q: I’ve been taking a statin and a blood strain medicine for a number of years now. However at a current checkup I used to be instructed I had developed persistent kidney illness, which got here as a complete shock. I’m 80 and have all the time had good well being. Might my medicine have brought on this kidney downside? Dr. Ellie replies: Statins and blood strain medicines are essential medicine to scale back the chance of coronary heart illness — however in some instances, these drugs could cause different issues. Statins scale back ldl cholesterol, which is without doubt one of the fat within the bloodstream that may contribute to deadly coronary heart illness or having a stroke. Statins should not identified to trigger persistent kidney illness, however in uncommon instances the drugs can set off a situation known as rhabdomyolysis, which might injury the kidneys. One of the vital frequent sorts of blood strain medicines are angiotensin receptor blockers, or ARBs, and infrequently impact the kidneys. Statins should not identified to trigger persistent kidney illness, however in uncommon instances the drugs can set off a situation known as rhabdomyolysis, which might injury the kidneys These ARB medicines loosen up the blood vessels by blocking the manufacturing of sure hormones within the kidneys, which helps decrease blood strain. Nonetheless, this could additionally restrict kidney operate, which might typically result in persistent kidney illness, the place the organs slowly cease working. Nonetheless, it is very important level out that the advantages of taking these medicine virtually all the time outweigh the dangers. Hypertension is without doubt one of the most typical causes of persistent kidney illness. Which means not taking ARB medicine is extra more likely to result in kidney illness than taking them. The medication is even thought-about secure sufficient to be prescribed repeatedly to sufferers who have already got kidney issues, albeit at a decrease dose. As well as, persistent kidney illness is a quite common situation, affecting round one in 5 folks over the age of 80. Whatever the trigger, it’s essential that you simply discover out the severity of your persistent kidney illness. Within the meantime, don’t cease taking your different common prescriptions until your physician tells you in any other case. Q: After having a current stroke, I developed extreme ache and was prescribed each day morphine. Nonetheless, it makes me really feel like a zombie for hours afterwards. My physician says that gradual launch morphine tablets should not at present obtainable within the UK – is there the rest I can take as an alternative? Dr. Ellie replies: Sadly, GPs and pharmacists at present spend a whole lot of time coping with drug shortages. For an individual with persistent ache, the scenario is especially critical. Ache administra...

Concurrent renal replacement therapy & extracorporeal membrane oxygenation: what pediatric nephrologists need to know

In the latest episode, Dr. Matthew Sparks of Duke University discusses the transformative role of SGLT2 inhibitors in managing diabetic kidney disease. With proven renal & cardioprotective benefits, these meds are reshaping nephrology. https://bit.ly/4fflFy9

Navigating the world of dialysis is like walking a tightrope between survival and subjugation. When you’re tethered to a machine that filters your blood for hours on end, the last thing you want is to feel like a cog in a machine. But for many, dialysis has become exactly that—a site where the forces of government and corporate interests converge, often reducing patients to mere variables in an equation optimized for cost and efficiency. I’ve spent years witnessing how this subtle, yet pervasive, control manifests in the lives of those with End-Stage Renal Disease. The strict schedules, the regimented diet plans, and the constant monitoring are not just for medical necessity; they also serve as tools of control. Decisions about treatment options, such as in-center hemodialysis versus peritoneal dialysis, are frequently dictated by factors other than patient preference, with some options being promoted over others due to cost efficiency or institutional convenience. The autonomy of the patient—an autonomy that should be sacrosanct—is often sidelined. Imagine being told that your dialysis treatment, a lifeline quite literally, must fit within a schedule that maximizes clinic throughput rather than your quality of life. The reality is that many patients don’t even realize they have the right to question this system. They have become so accustomed to this mode of existence that they no longer see themselves as agents of their own health. But this is not just about institutional control; it’s about the commodification of human life. Dialysis is big business. Corporations have turned life-sustaining treatment into a marketable product, with patients as both the consumers and the consumed. We’re talking about a system where profit margins dictate the level of care provided, and where the patient’s voice is often drowned out by the clinking of coins. I recall a conversation with a nephrologist who lamented the lack of options available to his patients. He knew that home dialysis offered more flexibility and better outcomes for many, but the infrastructure wasn’t there—at least not in a way that made it accessible to those who needed it most. Why? Because it wasn’t profitable enough for the companies involved. Patients were left to contend with a system that valued their dollar more than their dignity. This is where we must draw a line. It is imperative that we shift the focus back to the patient. We need to demand a system where autonomy isn’t just a buzzword, but a fundamental right. Where the choice between HHD and PD is made based on what’s best for the patient, not what’s best for the bottom line. Schweda, M., Schicktanz, S., Wöhlke, S., & Apitzsch, B. (2022). Patient autonomy and corporate interests in dialysis: Ethical challenges and potential solutions. Journal of Medical Ethics, 48(3), 206-213. #ESRD #ESKD #CKD #Nephrologist #Dialysis #HHD #PD