Discussion re dialysis on The Kidney Doctor

[MooseMom]

Remember Robin Fields' articles on dialysis in ProPublica?  There is a discussion about this over on www.thekidneydoctor.org  that I would urge you all to go have a look at.  You can leave comments if you'd like.

[Bill Peckham]

Good comments MM. I have a commentary going up tonight and I think Peter has one coming too.

[MooseMom]

Good comments MM. I have a commentary going up tonight and I think Peter has one coming too.

As I expected.  I didn't think the two of you were going to let this plum of a chance pass you by.  I can't wait to read what you both have to say!!!  Yay for Bill and Hemodoc!

[Hemodoc]

Dr. Singh placed Bill's and my commentary together, fitting really. As Bill said, we gave them a good one two punch. IF only they would honestly evaluate the situation and focus on clinical outcomes. Interestingly, many believe that better clinical outcomes would be less costly in total costs. I believe Dr. Singh will have several more commentaries on this issue over the next few days.

[MooseMom]

Outstanding reading...truly outstanding, and I am so grateful to both of you, Bill and Hemodoc, for advocating for us all.  I am very glad you both were asked to contribute to the blog.  Dr. Singh knew what he was doing when he approached the two of you.

In my travels through various renal blogs, I see usually quite a few comments whenever the topic is dialysis.  And quite right, too!

Hemodoc and Bill giving the one-two punch...    

[tyefly]

Good reading...thx to all

[lmunchkin]

Iam so thankful to the two of you!  I just hope it helps to open up the eyes of others as to the Renal Community situation!  If I can do anything to help, from a caregivers point, please let me know!

lmunchkin

[Bill Peckham]

Reading Jay Wish's post I am just thinking how much information is obscured with language. I probably do it too.

[MooseMom]

Reading Jay Wish's post I am just thinking how much information is obscured with language. I probably do it too.

No, you don't.

What is an "incident patient"?

[Bill Peckham]

incident are the people starting dialysis

prevalent are those already on dialysis

[Bill Peckham]

The blog is called the Kidney Doctor so I guess I shouldn't complain when they talk like kidney doctors but really Dr. Finnian McCausland's post needs to be unpacked because I think there is good information in there for dialyzors.

He writes "In addition, we noted that the pre-dialysis serum sodium concentration appears to be relatively preserved among hemodialysis patients, irrespective of the baseline dialysate sodium concentration used in their treatments, which supports the concept of an osmolar set-point."

An osmolar set-point is the idea that the body wants its sodium level where it wants its sodium level. That the body is born with an idea about the proper sodium level in its fluid (and by extension it has in mind an ideal level of hydration). What I think dialyzors should understand is that given the body wants its sodium level where it wants its sodium level, the body will not like it if the sodium level goes out of range.

In general Dr. McCausland is saying that the data suggests a customized dialysate sodium level for patients, which makes sense but his data doesn't fully support my bias for low dialysate sodium levels.  I am not able to read his entire 2011 paper - it behind a pay wall - and the abstract doesn't give enough detail.

Dialysate sodium levels - both prescribed and delivered - need more attention. I was glad to see this commentary as part of the discussion.

[MooseMom]

The blog is called the Kidney Doctor so I guess I shouldn't complain when they talk like kidney doctors but really Dr. Finnian McCausland's post needs to be unpacked because I think there is good information in there for dialyzors.

Please unpack to your heart's content because I have to admit that Dr. McCausland's post was too complicated for my tiny brain.

[Hemodoc]

I don't believe he went far enough with his commentary to castigate the practice of sodium profiling to prevent intradialytic hypotension from shortened dialysis sessions and high ultrafiltration rates. The issue of modifying sodium to individual patients fits a smarter way of doing dialysis and is relatively easy to achieve. However, the units spend a lot of their time placing patients on sodium profiles which adds sodium, i.e. salt, to their dialysate which is then absorbed by the patient. This leads to a cycle of thirst, weight gain and high ultrafiltration rates requiring intervention to prevent hypotension that in reality is iatrogenic in nature.

Yes, his article and comments are important, but aside from advertising his article, I wish he had mentioned the most important sodium issue of advocating against sodium profiling.