Discover and read the best of Twitter Threads about #dialysis

Most recents (13)

1. So, I dug out my old senior talk on the economics of #dialysis when I was a @BMCimRES resident pre-AAKH.

This slide struck me for 2 reasons.

In a surprising twist of fate, one reason links to the @MonganInstitute, where I am currently a research fellow.

THREAD:
2. Some background:

Before 1972, dialysis was unaffordable. To triage care, committees were forced to decide which patients could receive dialysis

To advocate for Medicare coverage for patients with kidney failure, @NKF provided cost estimates to the US Senate in the 1970s.
3. The first thing that struck me was:

These costs are GUESTIMATES, informed by expert opinion from Drs. Belding Scribner and Samuel Kountz!!

These pioneers advocated for home dialysis/transplantation and shaped the 1972 amendment to help our patients/advance the field

But..
Read 10 tweets
I listened to (while doing some admin) @ISPD1 webinar on dispelling #myths in #peritoneal #dialysis by the inimitable @PD_perls- really interesting content and I’ve added some of my own myths that I’ve been presented with over the years that I’ve lead the service @HeartlandsUHB
Myth #1- Previous abdominal surgery and PD are not compatible..

This is the commonest reason why patients are not offered PD
Advanced laparoscopic tube placement can do away with most issues as this slide shows:
We have also done some percutaneous blind and fluoroscopy guided procedures in patients with simple scars such as a C-section; appendectomy and laparoscopic cholecystectomy and overall, not had any issues
Read 33 tweets
How many families have a loved one coping/fighting #Cancer #epilepsy, needs #dialysis or insulin for #diabetes? Due to #COVID2019 there’s 2.4m backlog, a 10m waiting list expected through no deal. Shortage/delay of medicines from the EU would be the last straw. #No2DeathByNoDeal
Here is the full list of medications which could be affected by a no-deal Brexit, according to E-Surgery:

Acamprosate (Campral) treats alcohol dependence
Aciclovir (Acyclovir) treats herpes, simplex virus infections, chickenpox,shingles
continued
Read 21 tweets
1/ #Nephrology #POCUS case study:
Dr. X is rounding on an ESRD pt who initially presented with dyspnea after missing a dialysis (HD) session; underwent dialysis in the hospital. Pt asymptomatic at the time of exam and lung #ultrasound revealed 👇 Further story in thread #MedEd
2/ Based on the 2-zone lung #POCUS, Dr. X orders for another session of HD. Notably, pt says he is at his 'dry weight' and HD nurse says they could only get 1.5L off during first session. Dr. X doesn't change his/her mind.
Info on various lung scan zones👇
3/ Patient becomes hypotensive during HD and only ~500cc fluid could be removed.
Why can't we get more fluid out of a hypervolemic patient? Dr. X is perplexed and decides to more #POCUS Here is the IVC
Read 16 tweets
#POCUS teaching case: #Dialysis patient c/o sob, reports weight gain. BP low to begin with (~100-110 mmHg systolic) & drops further during ultrafiltration. Dr. X performs IVC #ultrasound at the bedside and sees this 👇 - probably volume depleted? See #thread
#MedEd #nephrology
2/ Dr. X orders to stop ultrafiltration. BP stabilized a little bit.
All done?
Wait, something doesn't make sense. Why did the patient gain weight? (usually #dialysis patients know their dry weight well). Why sob?
In the meanwhile, radiology tech performs chest #X-ray 👇
3/ That's not good. Diagnosis is apparent but lets get Dr. Y who does more than just IVC #POCUS
Subcostal view 👇
Significant pericardial effusion
Read 12 tweets
Seeing this discussion, thought of doing a short #tweetorial on the lung #POCUS scan zones I've come across. Some of them (like 24-zone method) have been utilized to study lung congestion in #dialysis patients
1st slide: 👇
24-zones: better illustrated. #POCUS
Additional zone (#4) added to the commonly used 8-zone method to include the right middle lobe. #POCUS
Read 6 tweets
@UCIkidney @kamkalantar hosted dinner discussion last night: #AdvancingAmericanKidneyHealth Executive Order
@MSchreiber_MD and @DrBobPro @DaVita | Mark Shapiro (Balboa Nephrology Medical Group)
Big changes happening and #nephrologists need to step up… #nephtwitter
1/x
Starting Jan 2020 half of #nephrology groups in the US will be assigned to the CMS Kidney Care First (KCF) accountable care model.
If you’re picked you HAVE TO participate, but can opt to switch to one of the other #KCC (Kidney Care Choices) models:
innovation.cms.gov/initiatives/ki…
2/x
The other payment models (Comprehensive Kidney Care Contracting #CKCC options) vary in amount of risk the neph practice is willing to take on for care of the #CKD patient.
This is at the level of the #nephrology practice NOT at the dialysis unit.
3/x
Read 12 tweets
Did my fellows' curriculum lecture today, "Images in #Nephrology"
Thought of sharing the slides as a tweetorial. Goal is to present some 'classic' images that aid in kidney-related diagnoses. Not exhaustive; plan to make 2nd part as well.
#MedEd #FOAMed Not much POCUS involved!
1st question. Classic image but rarely encountered. Note the super high blood urea nitrogen and serum creatinine.
Here is the answer.....
Read 61 tweets
#BlackoutInfo What might be consequences of a national or even european #Blackout, lasting more than 72 hours in our electricity addicted society? How is our country prepared for? And how much our politicians engage for this catastrophic case?
#BlackoutInfo Within hours after a national #Blackout for 90% of all homes no more drinking water will flow out of the tap. Flushing the WC will work only one last time. Therefore risk of diseases is growing fast. No human can stand more than 3 days without water supply...
#BlackoutInfo As a follow of a national #Blackout production of food isn’t possible anymore. Distributing still available stockpiles is becoming difficult & very quick impossible. Automated warehouses can’t deliver anymore, because all is offline. Supermarkets run out of stocks.
Read 27 tweets
Today is #WorldKidneyDay, so here is a thread about living on #dialysis & #OrganDonation. My name is Belinda Otas. I’m #African. I’m #Nigerian. I'm #Benin. I’m #British & I’m #Black. Beyond the nationalities or passports with my name, I also believe in our shared humanity.
I was 16, when I was diagnosed with End Stage Renal Failure (ESRF.) I had no idea what was happening to me because at the time, it made no sense. However, I remember the pain of that period like noonday. I lived on dialysis until i was 22. #dialysis #OrganDonation #renalhealth
It took over my teenage years. I don’t remember having much of a life as a teenager because dialysis was 3x a week & every session was 4hrs. Add the time it takes to recover from being exhausted by the process, my day was pretty much over. #dialysis #OrganDonation #renalhealth
Read 70 tweets
#Venezuela's #NicolasMaduro:
"We had a large shipment of medicines to last the country for a year,a large batch of raw materials for food. The bank account was frozen,the contracts were cancelled & the money is seized. They suffocate us,steal our money & put a show for the world"
#US ECONOMIC BLOCKADE BLOCKING THE HEALTH SECTOR
Nov. 2017:The transnational Pharmaceutical companies Baster,Abbot & Pfizer refused to issue exportation certificates to #Cancer drugs,making it impossible for #Venezuela to buy them
…agoalbasolidarity.files.wordpress.com/2018/06/doc_sa…👈
#US BLOCKADE OF #VENEZUELA'S ACCESS TO MEDICINE
July 2017: The Citibank bank (#USA) refuses to receive #Venezuelan funds from the Central Bank for the import of 300 thousand doses of insulin, destined to cover the demand of 450 thousand registered patients.
Read 62 tweets
Pilot Intervention Addressing Social Support and Functioning of Low Socioeconomic Status–Older Adults With ESRD: The Seniors Optimizing Community Integration to Advance Better Living With ESRD (SOCIABLE) Study bit.ly/2Dzz3OE

@DrDeidraCrews @sarah_szanton @tkmcudjoe
This is an innovative pilot tested home based program for older low socioeconomic status adults on hemodialysis aimed at improving physical and social function.

@JanieceLTaylor @lakencroberts @DeanDrexelCNHP @Aging_scholar
Why: Older ESRD patients experience increased morbidity, fatigue and decreased physical function. Multiple studies note improvement in health/functional outcomes with social support however few intervention studies aim at improving this..
Read 8 tweets
This looks to be fun look at renal research around the world. I made my picks the way I make my picks at a horse track - I went by the titles. I expect as with #nephmadness as the results come in I'll learn why my picks were wrong and then more about the research that advances.
@RSNhope @ihatedialysis @KidneyPatients @DialysisAtHome @hdunews this is a new social media "game" that pits various renal research studies from around the world against each other in a World Cup style competition. This is a fun
gateway to the world of renal research
We with CKD should familiarize ourselves with the language of research and what is now being worked on so that as opportunities arise to engage we will be prepared to contribute #kidneyresearch #dialysis #kidney
Read 3 tweets

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