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Archive for 2002 Archive for 2001 Archive for 2000 Archive for 1999 Archive for 1998 1997 1995-1996  

(listed in reverse chronological order)
Files continue on at 2003 archive

December 25, 2002 - January 1, 2003

Dr. Asplin
New Developments in Nephrolithiasis
(ASN Renal Week, Philadelphia, PA. November, 2002)     

Is bone mineral density reduced in calcium stone formers? Is this true for both absorptive and fasting hypercalciurics? Is fracture risk increased? Is this due to vitamin D, or to vitamin D receptor polymorphisms? What are the roles of calcium, sodium, protein, and acid content of the diet with regard to mineral balance? Do thiazides help bone in hypercalciurics? What about K citrate? Alendronate?

ASN Renal Week
Audiofile selection - ASN 2002 Renal Week (5-10 talks)
Interventional nephrology: Hands-on approach
Improving care of the vascular access; Planning and examination of the vascular access; Cannulation of vascular grafts and fistulas, Techniques for Monitoring Vascular Access; Fluoroscopy equipment; Establishing an Interventional Nephrology Facility.
(Besarab, Work, Brouwer, Sands, Vesely, Beathard)

December 18 - 24, 2002

Emerging Standards of Care: Implications of New K/DOQI Guidelines     

Dr. Eknoyan

Dr. Sarnak

Dr. Fishbane

(Three speakers and panel discussion. ASN 2002 Annual Meeting Satellite Symposium, November, 2002)

Dr. Eknoyan: How and why were the DOQI guidelines developed? How are they now being extended earlier in time to CKD? What is the timeline for new guidelines regarding bone disease, lipids, hypertension, and CVD in ESRD? What was the rationale for CKD guidelines? What are the implication of complications during CKD, especially anemia, and rationale for early management? Dr. Sarnak: Is LVH in CKD/ESRD eccentric or concentric? What is the role of traditional vs. non-traditional CV risk factors? What is the pathophysiology of increased cardiac output and vascular remodeling? What are the lastest data regarding the prognostic importance of vascular stiffness in ESRD? What is the role of anemia management and calcium/phosphorus control? Dr. Fishbane: Risk vs. reward of iron therapy. What is the anaphylactic risk of dextran vs. gluconate vs. sucrose? What are the potential adverse effects of free iron? How does transferrin saturation relate to free iron? What is the data regarding free iron release and transferrin saturation after 100 mg dose of IV iron sucrose? What are effects of iron dextran, gluconate, and sucrose on measures of oxidation?

Dr. Campese
Role of the Sympathetic Nervous System in the Control of Hypertension
(ASN Renal Week, Philadelphia, PA. November, 2002)     

From the Postgraduate Education programs of Renal Week. Dr. Campese describes how the kidneys, through an afferent neural pathway, can stimulate sympathetic outflow from the posterior hypothalamus and cause hypertension. He describes the intermediate steps in this pathway, and also how the renin-angiotensin system is involved. ESRD patients have increased sympathetic outflow, abrogated by nephrectomy. Practically, losartan appears to reduce central sympathetic outflow, and Dr. Campese presents data that nitric oxide and free radical generation may be involved as well. The new mechanistic information hints at new therapies that may be tried to control this type of hypertension.

ASN 2002 Renal Week
Audiofile selection - ASN 2002 Renal Week (5-10 talks)
New Concepts in Uremia Management; Frontiers in Renal Replacement Therapy
Management of CV Risk Factors; New Insights into Calcium/Phosphorus; The MIA Syndrome; Extracorporeal Rx for Non-Renal Diseases; Hemodiafiltration and Sorbent Technologies; Daily/Nocturnal Dialysis
(London, Martin Stenvinkel, Mehta, Winchester, Pierratos)

December 11 - 17, 2002

Dr. Burkart
The Development of New K-DOQI PD Guidelines
(ASN Renal Week, Philadelphia, PA. November, 2002)      

Now that ADEMEX and HEMO have reported, where do we stand with PD adequacy? Are the 2000 solute targets still appropriate? How should be begin to approach a new target if required? Should maintenance of residual renal function and ultrafiltration volume also be the subject of new targets? The K-DOQI guidelines for PD adequacy are in the process of being revised, and Dr. Burkart takes us through some of the thinking processes that are ongoing in his committee to arrive at the next update.

ASN 2002 Renal Week
Audiofile selection - ASN 2002 Renal Week (5-10 talks)
PGE Course: Basic Hemodialysis.
How hemodialysis works: Determinants of diffusive solute transport; Role of convection; Adequacy; Water treatment.
The Nephrologist in the Dialysis Unit: Anemia, iron, EPO; Vascular Access; BP and weight control.

(Clark, Henderson, Depner, Ward; Macdougall, Schwab, King)


December 4 - 10, 2002

Dr. Coe
Treatment Trials in Kidney Stone Disease
(ASN Renal Week, Philadelphia, PA. November, 2002)      

From the Postgraduate Education programs of Renal Week. Dr. Coe, one of the foremost authorities on renal stone disease, critically evaluates the clinical trials: Do thiazide diuretics prevent recurrence of oxalate stones? What about alkali therapy? What is the role of allopurinol in hyperuricosuric non-hypercalciuric stone formers? What about hyperhydration? Can this be explained by a stone clinic effect? What about dietary protein and sodium restriction? Does acetohydroxamic acid work for infection stones? In what areas do we need more clinical trials?

Audiofile selection - Prevention in Renal Disease (2-8 talks)
Nephroprevention: Panel Discussion
Transfer of scientific knowledge into clinical practice
(Naimark, Hostetter, Parfrey, Dirks)

November 27 - December 3, 2002

Dr. Tuttle
Microalbuminuria: The Kidney's Message About the Systemic Vasculature
(ASN Renal Week, Philadelphia, PA. November, 2002)      

Microalbuminuria (MA) has been related to renal outcomes in diabetics, but here Dr. Tuttle talks about its role as a marker of cardiovascular disease in both the diabetic and non-diabetic population. Microalbuminuria may, in fact, be a marker of the health of the systemic vasculature. Dr. Tuttle reviews how MA is linked to coronary artery disease, peripheral vascular disease, stroke, cardiovascular death, and all-cause mortality. MA is linked to pulse pressure, inflammatory syndrome markers, as well. Is MA a modifiable risk factor? What are the roles of ACEI / ATRA, statins, aspirin, intensive BP control, and a low protein diet?

Audiofile selection - Prevention in Renal Disease (2-8 talks)
Transplant and Polycystic Kidney Disease
Prevention of progression in the transplanted kidney; Prevention of progression in PKD.
(Halloran, Bennett)

November 20 - 26, 2002

Mini-Symposium: Asian Glomerulonephritis   

Dr. Woo

Dr. Lai

(Two speakers. Singapore KDF Third State-of-the-Art Conference. Singapore. September, 2002)

Dr. Woo: Predictors in the Progression of IgA Nephritis. What is the epidemiology of IgA in Asians? How does it present? What are good and bad prognostic indicators? What is the long-term outcome? How does actuarial renal survival compare in Asia, Europe, and in North America? What are the potential benefits of ACE-I or AT receptor antagonist therapies? Is response modulated by ACE gene polymorphism? Dr. Lai: Hepatitis and the Kidney. How do hepatitis B and hepatitis C differ in terms of renal involvement? What is the role of cryoglobulins in HCV? What is the clinical course of HCV-associated renal disease? When is interferon Rx indicated? What is the spectrum of HBV-associated renal disease? What is the Asian epidemiology? What are the newest treatment options?

Audiofile selection - Prevention in Renal Disease (4-8 talks)
Pandemic is here; Pathogenesis; Diabetes in aboriginal people; Microalbuminuria; Lessons about early diabetic nephropathy from renal biopsies; Strategies for stemming the pandemic; Analysis of treatment trials; Role of aldosterone in cardiorenal protection.
(Friedman, Scholey, Hegele, Mogensen, Mauer, Brenner, Bargman, Hostetter)

November 12 - 19, 2002

Dr. Kupin
Renal Tubular Acidosis
(ASN Board Review Course, San Francisco, CA. August, 2002)      

Why does a person with proximal RTA not develop bone disease or nephrocalcinosis? Do RTA patients continue to accumulate acid? Why is RTA difficult to treat? Why is distal RTA easier to treat? Why do distal RTA patients present with stones, nephrocalcinosis, and bone disease? How can we use urine net charge, osmolar gap, and other urinary electrolytes to help diagnose patients metabolic acidosis?

Hypertension and renal disease: Cause or effect; Hypertension and minorities; the price of being Black; Genes and environment in essential hypertension; Review of hypertension treatment trials; Prevention of progressive ischemic nephropathy.
(Logan, Agodoa, Hamet, Ritz, Mendelssohn)

November 6 - 12, 2002

Mini-Symposium: Morbidity and Mortality Rates of Asian ESRD Patients.   

Dr. Choong

Dr. Lai

Dr. Daugirdas

(Three speakers. Singapore KDF Third State-of-the-Art Conference. Singapore. September, 2002)

Dr. Choong: How is dialysis paid for in Singapore? What is the mix of HD, PD, Transplant? What are the major comorbidities? What are the outcomes? Dr. Lai: What is the approach to CKD and ESRD patients in Hong Kong? Why do they have so many PD patients? What are the outcomes? How does presence of hepatitis affect outcomes? How does PD dose affect outcome in Hong Kong? Dr. Daugirdas: Has the survival gap between U.S. and Japanese dialysis patients closed? Is better survival in Japan due to difference in acceptance rates? What about U.S. Asian dialysis patients? How is the BMI - survival relationship unique in U.S. Asian dialysis patients? Might the Asian diet, in particular, ingestion of soy isoflavones, explain better Asian dialysis patient survival, or can this be explained by the dialysis prescription?

Audiofile selection - Prevention in Renal Disease (4-6 talks)
Glomerular Diseases
Mechanisms of progression: insights from cell signaling; Mechanisms of injury and progression; Proteinuria: cause or effect; Update on treatment trials in glomerular diseases; New approaches to treatment of glomerular diseases; Is there a role for dietary protein restriction in progressive renal disease?
(Scholey, Shankland, Remuzzi, Korbet, Cattran, Kopple)

October 30 - November 5, 2002

Dr. Bakris
Treatment of Hypertension in Renal Parenchymal Disease
(ASN Board Review Course, San Francisco, CA. August, 2002)      

A practical summary of the recent trials pertaining to diabetes, hypertension, and treatment options. To what extent is diabetes driving the recent increase in ESRD? What should the goal systolic and diastolic BP be in patients with kidney disease with or without proteinuria? How do proteinuria and microalbuminuria differ as outcome predictors? How does one handle the acute reduction in GFR with ACE inhibitors? How does one approach potassium increases? What is the role of combination ACE-I, ARB therapy? Do dihydropyridines have a role? What are the most recent guidelines for combination therapy?

ADC Meeting
Audiofile selection - ADC 2002 (8-10 talks)
Surgical Challenges in Dialysis Patients
Abdominal aortic aneurysm: Open surgery vs. stent graft; Difficult peritoneal access; Acute surgical abdomen in the PD patient; Steal syndrome; Parthyroidectomy: Immediate autotransplant vs. cryopreservation; Peripheral vascular disease; Approach to failing blood access; Desperate blood access; Catheter-based chronic dialysis.
(Nichols, Smith, Koivunen, Huber, Beathard, Canaud)

October 23 - 29, 2002

Iron at the Front Lines: A Practical Approach to IV Iron Management   


Dr. Van Wyck

Ms. Salvato

Dr. Silverberg

(Three speakers. ANNA 2002 Annual Meeting Satellite Symposium. Orlando, FL, May, 2002)

A practical approach to management of iron repletion. Dr. Van Wyck: What are the stages of iron depletion, and which serum marker represents which area of body stores? How does a maintenance iron protocol affect EPO requirement? Total iron dose? Serum ferritin levels? If we target TSAT of 30-50%, what happens to the total dose of iron given? To the serum ferritin? What is the maximum recommended TSAT target? Ferritin target? What did a multicenter safety study show regarding iron sucrose? Ms. Salvato: What are the cost issues involved with various forms of IV iron? Which forms of iron require a test dose? Which forms can be given slow IV push? Dr. Silverberg: How are left ventricular hypertrophy, congestive heart failure, and anemia related? What effects do correction of anemia with IV iron and epoetin alfa have on functional NYHA Class in patients with congestive heart failure? Panel discussion: Speakers respond to questions from the audience.

Dr. Arruda
Disorders of Potassium Metabolism: Case Discussions
(ASN Board Review Course, San Francisco, CA. August, 2002)      

A series of 11 or so case presentations, all dealing with interesting and sometimes complicated patients with hypokalemia or hyperkalemia. How do we separate out effects of old vomiting, recent vomiting, starvation, and diuretic abuse by urinary electrolytes? How does the urine net charge fall down in ketoacidosis or glue sniffing? How do we separate out Bartter's and Gitelman's syndromes from furosemide and thiazide ingestion? Practical, real-life problem-solving by one of the noted authorities in the acid-base field.

ADC Meeting
Audiofile selection - ADC 2002 (8-10 talks)
Special session for medical directors
Role of medical director in QA; What medical directors should know about water quality; Leadership.
(McMurray, Van Stone, Wright)

Diagnostic and interventional nephrology  
Complications of tunneled dialysis catheters and their management; Monitoring catheter and access function; Graft and fistula declots and angioplasties; Techniques for placement of PD catheters; Diagnostic renal ultrasound and renal biopsy.
(Ward, Besarab, Beathard, Ash, O'Neill)

October 16 - 22, 2002

Dr. Kupin
Management of Hepatorenal Syndrome
(ASN Board Review Course, San Francisco, CA. August, 2002)      

This is part two of the talk posted last week, which detailed pathophysiology and diagnosis. Now we move on to therapy: When is albumin indicated? Large-volume paracentesis? What should be the target blood pressure? How does one define diuretic-resistant and diuretic-intractable ascites? Are vasopressin agonists indicated? What is the role for octreotide? What about midodrine? What is one suggested regimen for albumin/midodrine/octreotide? When is TIPS indicated? What is the MARS system, and when should it be used?

ADC Meeting
Audiofile selection - ADC 2002 (8-10 talks)
CMMS Clinical Performance Measures. Tools for Guiding Care and Improving Outcomes in Your Dialysis Unit.
Nutrition; Dialysis Adequacy; Vascular Access; Anemia
(McCann, Butera, Dinwiddie, Biddle)

Role of Primary Care Physicians vs. Nephrologists in CKD  
Attitudes of patients, PCPs, and nephrologists; PCP experiences and expectations; Coordinating care between a pre- dialysis program and PCPs; Canadian guidelines; USA guidelines
(Mendelssohn, White, Licht, Nolph)

October 9 - 16, 2002

Taking Control of Chronic Kidney Disease: Beyond the Kidney (6 talks)   


Ms. Campoy

Dr. Schoolwerth

Ms. Compton

Ms. Lane

Ms. Bova-Collis

(Five speakers. ANNA 2002 Annual Meeting Satellite Symposium. Orlando, FL, May, 2002)

This symposium details how each member of a team of health professionals approaches the problem of providing optimal care for patients with chronic kidney disease (CKD). Sally Campoy was the moderator. What bad things can happen when early intervention fails. Dr. Anton Schoolwerth: What are the K/DOQI stages of CKD? Who is at risk? How should we screen? What is KEEP? How can we address anemia, phosphorus control and nutrition? Ann Compton: What are the goals of patient education? Who should be on the collaborative team? What is the nursing contribution? Kathy Lane: What are hidden areas of non-compliance? What is the dietitian role? Renee Bova-Collis: What are the typical problems that the Social Worker needs to address in CKD patients? Panel discussion: An illustrative case summary with questions and comments pulls it all together.

Dr. Kupin
Hepatorenal Syndrome: Diagnosis and Pathophysiology
(ASN Board Review Course, San Francisco, CA. August, 2002)      

How do we define the hepatorenal syndrome? What are the diagnostic criteria? How specific are urinary indices? What is the rationale for a therapeutic fluid challenge? Underfill, overfill, vasodilatation theories - how do they differ? What is the recent evidence regarding the role of nitric oxide? What are the two types of hepatorenal syndrome? An illustrative case is presented to tie these concepts together. Next week: Management of hepatorenal patients.

ADC Meeting
Audiofile selection - ADC 2002 (8-10 talks)
1) Fundamentals of Extracorporeal Dialysis (hemodialysis, hemofiltration, hemodiafiltration) Session II. 
Anticoagulation; Acute complications; Dialyzer reuse; Basics of biocompatibility; Ultrafiltration and antihypertensive medications; Dialytic removal of drugs and poisons; Holistic approach
(Fischer, Ing, Van Stone, Cheung, Salem, Winchester, Twardowski)

2) Basic hemodialysis - Clinical  
Water treatment, Cannulation techniques, Anticoagulation therapy and protocols
(Amato, Dinwiddie, Pittard)

October 2 - 8, 2002

Dr. Dubose
Metabolic Alkalosis
(ASN Annual Board Review Course, San Francisco, CA. August, 2002)     

How does one approach metabolic alkalosis? Differentiate from respiratory acidosis? Determine when it is a mixed acid-base disorder? When and how is alkalosis perpetuated by the kidney? How do contraction and expansion-associated alkaloses differ? What are the renal causes of alkalosis? How do we separate out Bartter, Gitelman, and Liddle syndromes? Several illustrative cases are discussed.

ADC Meeting
Audiofile selection - ADC 2002 (8-10 talks)
1) Fundamentals of Extracorporeal Dialysis (hemodialysis, hemofiltration, hemodiafiltration)  
Uremic toxin removal with different strategies; Understanding diffusion, convection, osmosis, and adsorption; Solute compartmentalization, Essentials of water treatment; Design and membrane characteristics of hemodialyzers; Components of blood and dialysate circuit; Components and modeling of dialysis solutions.
(Vanholder, Clark, Depner, Canaud, Ward, Ahmad)   

2) Education  
Can pre-ESRD education change outcomes? Formal patient education program and improved outcomes; Staff education - what works
(Robinson, Hall, Butera)   

September 25 - October 1, 2002

Dr. Blantz
Edema Formation and Its Therapy
(ASN Annual Board Review Course, San Francisco, CA. August, 2002)     

Why does edema form? What are Starling forces? What are factors determining capillary hydrostatic and interstitial pressure? How does the renin-angiotensin axis affect edema? Which diuretics are best? What are advantages/disadvantages of thiazides? Of loop diuretics? Of bumetanide? What are the side effects of various diuretic classes in edema management? How can ACE-I and ARBs be used as adjunctive therapy in the management of edema?

ADC Meeting
Audiofile selection - ADC 2002 (8-10 talks)
1) Quotidian Dialysis - Afternoon Session  
Report of ISHD Registry; Setting up for nocturnal HD; Setting up for in-center short daily HD; Patient education and training; London, Ontario experience with long nocturnal vs. short hemeral HD; Are vascular access outcomes worse in frequent hemodialysis?; Reuse of dialyzers for daily home HD; Costs of daily vs. routine HD.
(Lindsay, Lockridge, Ting, Anderson, Leitch, Ponferrada, Mohr)   

2) Manifestations of ESRD: Assessment  
Assessment - Parts 1 and 2.

September 18 - 24, 2002

Dr. Dubose
Electrolyte / Acid-Base Emergencies in the ICU
(ASN Annual Board Review Course, San Francisco, CA. August, 2002)     

This was a rather informal workshop session at the Board Review course. Dr. Dubose quickly overviews the various types of problems an intensivist might see, and then proceeds into a number of cases where complex electrolyte and acid-base problems are illustrated and solved.

ADC Meeting
Audiofile selection - ADC 2002 (8-10 talks)
1) Quotidian Dialysis - Morning Session  
Physiology - time-averaged deviation; Kinetics of middle molecules; Intradialytic and interdialytic symptoms; Anemia control; Quality of life; Blood pressure control and myocardiopathy; Bone disease.
(Kjellstrand, Daugirdas, Vos, Ting, Blagg, Pierratos)   

2) Clinical Topics  
Nursing implications of CKD; Organizing a patient support group
(Youngblood; Norman)   

September 11 - 17, 2002

Dr. Mujais
Peritoneal Dialysis Adequacy: Implications of ADEMEX
(U.S. National Kidney Foundation Spring Clinical Meetings, Chicago, IL. April, 2002)   

Dr. Mujais presents the primary data from the ADEMEX trial and reviews how it was designed to answer questions raised while formulating the NKF-K/DOQI guidelines of peritoneal dialysis adequacy. What were the entry criteria? What were the doses and how were they delivered? What were the results and what implication does this have for PD adequacy guidelines in the future?

Dr. Teitelbaum
How Should ADEMEX Results Affect Practice in the United States?
(U.S. National Kidney Foundation Spring Clinical Meetings, Chicago, IL. April, 2002)   

What did the Maiorca and CANUSA studies show in terms of survival and adequacy? How can ADEMEX results be interpreted with these earlier studies in mind? Was ADEMEX power sufficient? Was the follow-up period sufficiently long? What can we learn from looking at a pair of illustrative cases?

ADC Meeting
Audiofile selection - ADC 2002 (9 talks)
1) Establishing and maintaining a home hemodialysis program  
Essential components for a successful HHD program; Selecting patients for home dialysis therapies; Patient education and training strategies; Follow-up and monitoring of outcomes; Vascular access for home hemodialysis; Dialyzer reuse in home hemodialysis: How do you do it?
(Brunson, Blagg, Leitch, Anderson, Ponferrada)   

2) New trends in vascular access  
Arteriovenous access stenosis: Can it be prevented? Should we tailor venous catheter dimensions to patient body size?
(Haq; Twardowski)   

3) Developing effective communication pieces for patients  
How can we develop effective communication pieces for patients?
(Nadglowski, Ricca)   

September 4 - 10, 2002

Dr. Tomlanovich
Transplantation Overview
(ASN/ISN World Congress of Nephrology, San Francisco, CA, October, 2001)   

This is the last of the ASN/ISN 2001 talks we will be posting on HDCN (ASN 2002 coming soon!). Dr. Tomlanovich gave a review of recently published papers, focusing on four issues: (1) Islet Cell Transplantation; (2) Use of Marginal Donor Kidneys, (3) Immunosuppresion withdrawal, and (4) Transplantation in patients infected with HIV.

ADC Meeting
Audiofile selection - ADC 2002 (9 talks)
1) Old and new optimal PTH targets: PTH regulation of calcium metabolism and the implications for cardiovascular disease in ESRD  
Cardiovascular consequences of renal osteodystrophy; Evolution of PTH assays, and how to interpret them; PTH and other biochemical markers of renal osteodystrophy.
(Block, Cantor, Gao)   

2) Coagulation and anti-coagulation in hemodialysis  
Pitfalls in the use of anticoagulants; Effects of artificial surfaces on blood coagulation; Experience with various anticoagulants in the dialysis population.
(Green, Fischer, Davenport)   

3) Surviving the nursing shortage  
The nursing shortage: reasons for it and strategies to deal with it; Achieving operational excellence and efficiency in providing patient care during a nursing shortage.
(Bednar, Lunn)   

August 28 - September 2, 2002

Dr. Goodman
How Do Calcium/Phosphorus Abnormalities Contribute to Cardiovascular Risk?
(U.S. National Kidney Foundation Spring Clinical Meeting, Chicago, IL. Washington, DC. April, 2002)   

How is calcium metabolism deranged in uremia? How is phosphorus involved? What new information do we have about how vascular calcification proceeds? How does sevelamer impact on vascular calcification? What is the role of warfarin in calciphylaxis?

ADC Meeting
Audiofile selection - ADC 2002 (9 talks)
1) Defects in peritoneal cavity boundaries (abdominal leaks and hernias)  
Scope of the Problem; Defects of the Abdominal Wall; Defects Involving the Thoracic Cavity; Imaging Modalities.
(Teitelbaum, Burkart, Katyal)  

2) Successful Quality Outcomes Initiatives  
Vascular Access; Patient Education; PD Adequacy; Nutrition
(Harbert, Hall, Jones, McCann)   

August 21 - 27, 2002

Dr. Mendley
Psychological, Cognitive, Developmental and Family Dynamic Factors in Childhood Chronic Renal Failure
(U.S. National Kidney Foundation Spring Clinical Meeting, Chicago, IL. Washington, DC. April, 2002)   

The last talk from a special NKF symposium an renal disease in children. What are the factors that affect psychosocial adjustment to ESRD in children? How does this change after transplantation? How does ESRD affect the child's developmental level? How does it impact the family system? What are the cognitive effects of ESRD?

ADC Meeting
Audiofile selection - ADC 2002 (9 talks)
1) Regulatory and Risk Management Issues in Dialysis Facilities  
New dialysis regs, HIPAA; Influencing public policy in dialysis units; ESRD patient safety initiative
(Gravely, Harper, Harbert)

2) Defining and Achieving Quality in a Dialysis Program  
Components of an effective QI program; What Do Patients Expect? Perspective from Other Countries; What Do Regulatory Agencies Require?
(Wick, James-Hartwell, Lambert, Payne)

3) Regulatory Issues in Dialysis Facilities  
Oversight - Network and State Responsibilities; Preparing for a State Survey
(Payne, Punch)

August 14 - 20, 2002

Improving Vascular Access Outcomes Using an Innovative Subcutaneous Access System (3 talks)   


Ms. Nardini

Ms. Chmielewski

Ms. Hlad

Mr. Nettleton

(Three speakers. ANNA 2002 Annual Meeting Breakfast Symposium. Orlando, FL, May, 2002)

This is the second in a series of ANNA 2002 Annual Meeting Satellite Symposia that are being extended on HDCN. Jean Nardini, Past-President of ANNA, was the moderator. Chris Chmielewski: What is the usage of vascular access in the United States and what do the DOQI guidelines recommend? What is the Life-Site™ subcutaneous vascular access system? Where can it be implanted? How does it work? How is it irrigated? How do performance and side effects compare with the Tesio catheters? What does one do if infection is suspected? Tammy Hlad: What are the detailed steps in cannulating this subcutaneous device? How is the buttonhole method used? What is the ON and what is the OFF procedure? How does one manage common complications? Carl Nettleton: What is a patient perspective on using subcutaneous vascular access?

Dr. Culleton
How to Reduce CV Risk in the Patient with Chronic Kidney Disease
(U.S. National Kidney Foundation Spring Clinical Meeting, Chicago, IL. Washington, DC. April, 2002)   

From a cardiovascular symposium at the meeting. How do we manage currently known CV risk factors in patients with chronic kidney disease? How do we deal with traditional risk factors such as hypertension, diabetes, smoking, cholesterol, and obesity? What about risk factors linked to CKD that impact on the cardiovascular system, including anemia, inflammation, homocysteine, and oxidative stress?

ADC Meeting
Audiofile selection
Middle molecules (low molecular proteins, peptides, kinetics)  
Overview of uremic toxicity; Uremic toxicity of low-molecular weight proteins; Adsorptive approaches to low-molecular protein removal; Effects of time and frequency on middle molecule removal; Conventional (thrice-weekly) hemodialysis schedules; Low-molecular weight protein removal in dialysis - is beta2 microglobulin a good surrogate?; Membrane properties that balance middle molecule removal and albumin losses;
(Vanholder, Cheung, Winchester, Pierratos, Ward, Leypoldt, Clark. ADC 2002, Tampa, FL)   

August 7 - 13, 2002

Caring for the Renal Failure Patient: Optimizing Iron Therapy (3 talks)   


Dr. Folkert

Ms. Javier

Dr. O'Mara

(Three speakers and panel discussion. ANNA 2002 Annual Meeting Breakfast Symposium. Orlando, FL, May, 2002)

This is the first in a series of ANNA 2002 Annual Meeting Satellite Symposia that are being extended on HDCN. Dr. Folkert: What is the optimum amount of iron to give and how? How does one keep the hemoglobin in the target range? How can one maximize the benefits of epoetin and IV iron therapy? Ms. Javier: How does one approach iron therapy in PD patients? What are the limitations of oral iron dosing? What is the University of Illinois protocol for treatment of PD patients with higher dose IV iron? Dr. O'Mara: She presents an iron management flow chart based on K/DOQI guidelines, discussing each aspect in the decision tree. Finally, Dr. O'Mara presents her experience at Dialysis Clinics, Inc. (DCI) in treating patients with iron deficiency from a pharmacologist point of view.

Dr. Filler
Therapy of Focal Glomerulosclerosis in Children
(U.S. National Kidney Foundation Spring Clinical Meeting, Chicago, IL. Washington, DC. April, 2002)   

The second lecture of a symposium focusing on health care in children with kidney disease. How does FSGS present in children? What are the indications for biopsy? Should steroids be used, and if so, for how long? What is the failure rate? The rate of recurrence in transplants? If steroids fail, what are the available treatment options? Is cyclophosphamide therapy an evidence-based choice? What about cyclosporin? Plasmapheresis? Other immunosuppressive drugs?

ADC Meeting
Audiofile selection
Future of PD in North America  
PD in 2002 and beyond; Predialysis PD patient education; Educating nephrology fellows in PD; Physician attitudes toward PD use; Future advances in PD; Do economic factors explain recent decline in PD?; Integrated care for North America; Is PD underused in older patients?
(Blake, Oreopoulos, Burkart, Mehrotra, Mendelssohn, Lameire, Amedia, Burkart, Teitelbaum. ADC 2002, Tampa, FL)   

July 31 - August 6, 2002

Dr. Portman
Current Concepts in the Diagnosis and Management of Pediatric Hypertension
(U.S. National Kidney Foundation Spring Clinical Meeting, Chicago, IL. Washington, DC. April, 2002)   

Is the BP elevated for this pediatric patient? How does one diagnose white coat hypertension in a child or adolescent? What is the BP load and BP index? How do BP and end-organ damage interact in children? When should one work up for secondary hypertension? What are practical treatment options?

ADC Meeting
Audiofile selection
USA vs. Japanese dialysis patient comparisons; Sclerosing peritonitis  
DOPPS Study data; USA vs. Japanese comparison useless or useful; Overview of sclerosing peritonitis; Japanese experience; Early diagnosis; Medical management; Surgical management.
(Mapes, Friedman, Kjellstrand; Kawaguchi, Pollock, Yamamoto, Selgas, Nakayama, Kawanishi. ADC 2002, Tampa, FL)   

July 24 - 31, 2002

Dr. Mattern
Maximizing the Use of Technology in Nephrology Practice
(Renal Physicians Association (RPA) Annual Meeting, Washington, DC. March, 2002)   

How are nephrologists using the internet today? What are the numbers? What are the safeguards required for communications with patients? What is the RPA doing to help nephrologists in this regard? What is Medem and how does one go about using Medem to make a physician practice website? What is a step by step approach to customize your website using Medem? What is the role of the web for online medical consultation? Incidentally, most all of the RPA 2002 talks are already on HDCN as downloadable audiofiles at this link.

ADC Meeting
Management of dialysis hypotension; Restless legs syndrome and sleep; Acute renal failure   Does sodium profiling work? Cool dialyate; Hypotension in PD; Management of dialysis hypotension; Restless legs syndrome; Sleep and dialysis; ARF prevention; Dialysis strategies in ARF; Predictors of survival in ARF
(Daugirdas, Lopot, Oreopoulos, Sherman; Dinwiddie, Parker; Safirstein, Depner, Paganini ADC 2002, Tampa, FL)   

July 17 - 23, 2002

Dr. Wrong
Distal Renal Tubular Acidosis: From the Ammonium Chloride Test to Genetic Analysis.
(National Kidney Foundation of Illinois Special Symposium, Chicago, IL. September, 2001)   

From a symposium organized by Dr. Todd Ing in honor of Dr. Oliver Wrong and Dr. Lee Henderson. Dr. Wrong recounts the early development of the ammonium chloride loading test to diagnose distal RTA, and moves on to how information accumulated to characterize Dent's disease, familial RTA, and genetic abnormalities of the band 3 exchanger and chloride channels. He finishes up with recent work showing how ovalocytosis can team up with other abnormalities to cause RTA in Southeast Asia.

ADC Meeting
PD Fundamentals. Board Review - Day 2. (audio only)   Ultrafiltration failure; Adequacy of PD; Cardiovascular Complications; Mortality Prediction Methods; Anemia Management; Peritonitis Treatment in APD; New Dialysis Solutions; Clinical Application of the PETT; Blood Glucose Management; Diabetics on PD.
(Venkataraman, Blake, Vonesh, Nissenson, Diaz-Buxo, Mehrotra, Khanna, Wyne, Burkart. ADC 2002, Tampa, FL)   

July 9 - 16, 2002

The Advancement of Clinical Practice in Chronic Kidney Disease   

Dr. Schoolwerth

Dr. Bolton

Dr. McClellan

Dr. Parfrey

Dr. Al-Ahmad

Dr. Reddan

(Four speakers and panel discussion. RPA 2002 Annual Meeting Satellite Symposium, March, 2002)

Dr. McClellan: New K/DOQI guidelines regarding CKD let us stage the level of chronic kidney disease. Prevalence of CKD in the KEEP study is high. Patients with congestive heart failure have a high prevalence of CKD. Dr. Parfrey: Volume vs. pressure overload cardiomyopathy. In CRI, cardiovascular disease is increased, but causality remains to be proven. What are the predictors of de novo CHF in CKD? Effects of normalization of Hb on LV dilatation and hypertrophy. Dr. Al-Ahmad: Anemia in the SOLVD trial linked to mortality. Interventional studies to correct anemia in CKD - effects on LVMI and functional measures. Dr. Reddan: Treating anemia in CKD - small interventional trials, CHOIR study (in progress) experimental design.

ADC Meeting
PD Fundamentals. Board Review. Day 1. (audio only)   Role of primary care; Nutritional assessment; Inpatient PD; Applied PD physiology; Glucose degradation products; Vascular calcification; Peritonitis and host defense; Sclerosing peritonitis.
(Mendelssohn, Lindholm, Aholt, Nolph, Krediet, Misra, Holmes, Pollock. ADC 2002, Tampa, FL)   

June 26 - July 8, 2002

Cardiac Calcification in ESRD: New Information Revealed   

Dr. Slatopolsky

Dr. Giachelli

Dr. Chertow

Dr. Raggi

(Four speakers and panel discussion. ASN/ISN World Congress of Nephrology Satellite Symposium, October, 2001)

Dr. Slatopolsky: Vascular calcification is not passive, but an active process in which vascular smooth muscle cells acquire osteoblast-like functions. Dr. Giachelli: There are similarities between vascular and bone calcification. In culture, smooth muscle cells calcify their matrix when exposed to high phosphate levels. This is blocked by an inhibitor of sodium phosphate cotransport. Dr. Chertow: The treat-to-goal study was a randomized comparison of sevelamer with calcium carbonate or acetate. With both binders phosphate was controlled, but serum calcium levels were higher with calcium-containing phosphate binders. With calcium-containing phosphate binders, PTH was more suppressed. With sevelamer serum cholesterol was lowered. Dr. Raggi: The degree of coronary artery vascular calcification can be very high in uremics. This correlated with poor CV outcome. In the treat-to-goal study, with sevelamer aortic or coronary artery calcification did not progress over a 1-year observation period, whereas with calcium-containing phosphate binders calcification was substantially increased.

ADC Meeting
Clinical Topics III (audio only)   Early vs. late start; Is short thrice weekly tx outdated?; Incremental dialysis dosing; Standards of care of US dialysis; PD vs. HD on residual GFR; Nutritional status in U.S. CKD patients
(Lindberg, Collins, Charra, Burkart, Misra. ADC 2002, Tampa, FL)   

June 18 - 25, 2002

Dr. Salusky
Extraskeletal Calcification in Uremia: Cardiovascular Implications
(ASN/ISN World Congress of Nephrology, October 2001, San Francisco)   

What contributes to cardiovascular disease in uremia? What is the evidence for increased extraskeletal calcification? What is the role of phosphorus and vitamin D? How are EBT scores related to CAD? What are the risk factors associated with coronary calcification in ESRD? Is use of calcium-containing binders related to EBT coronary or aortic calcification score?

ADC Meeting
Clinical Topics II (audio only)   Sevelamer vs. calcium-binders; Lipid Management; AV access complications; CRP implications in ESRD; Ultrapure dialysate; Glitazone for diabetic management; Worldwide peritonitis rates; Calcimimetics; Pre-procedure antibiotic prophylaxis
(Voinescu, Wyne, Haq, Lindholm, Ledebo, Holmes, Lindberg, Katyal. ADC 2002, Tampa, FL)   

June 7 - 17, 2002

Dr. Szerlip
Lactic Acidosis
(ASN/ISN World Congress of Nephrology, October 2001, San Francisco)   

From Renal Week, the Intensive Care sessions. What are the types of lactic acidosis? What is the role of the anion gap? What drugs are associated? What are the problems with giving Carbicarb? How and when should THAM be used? When should lactic acidosis be treated?

ADC Meeting
Transplantation (audio only)   (Lameire, Venkataraman, Burkart, Teitelbaum. ADC 2002, Tampa, FL)   

Clinical Topics I (audio only)  (Voinescu, Krediet, Haq. ADC 2002, Tampa, FL)   

May 28 - June 6, 2002

Dr. Ruoss
Fluid Management and Hemodynamic Monitoring
(ASN/ISN World Congress of Nephrology, October 2001, San Francisco)   

From Renal Week, the Intensive Care sessions. What are the goals of IV fluid resuscitation? Is crystalloid or colloid better? Is there a place of albumin? Hydroxyethylstarch? What do the meta- analyses show? What should the CVP be? Should cardiac output be augmented? When should pulmonary artery catheters be used? Can their use be harmful? What do we know about fluid management in ARDS?

ADC Meeting
Opening Remarks and Keynote Addresses (audio only)   (Lameire, Twardowski, Nolph, Lockridge. ADC 2002, Tampa, FL)   

Clinical Issues of the Long-Term ESRD Patient (audio only)   (Charra, Block, McCann. ADC 2002, Tampa, FL)   

May 21 - 27, 2002

Mr. Fischbach
Using AAMI Standards to Develop a High Quality Reuse Program
(NephroAsia 2001, Singapore)   

Another reuse talk, this one given at NephroAsia in Singapore in June of 2001. Mr. Fischbach is a product specialist for Minntech, which markets a peracetic acid-based reuse solution. What areas do the AAMI reuse standards cover? How can AAMI standards be applied to 3 representative patient problems? (1) infection with nontuberculous mycobacteria, (2) pyrogen reactions related to header disassembly, and (3) inadequate dialyzer performance. Note that AAMI and FDA reuse standards are a moving target. For the latest reuse news, go to this link.

ADC Meeting
Industry Speaks II   (Ojo, Rutherford, Vonesh, Dadson. ADC 2002, Tampa, FL)   

Industry Speaks III   (Ash, Abeles, Ledebo, Cantor, Mujais, Van Wyck, Bell, Galli. ADC 2002, Tampa, FL)   

May 14 - 20, 2002

Mr. Levin
Dialyzer Reprocessing
(Robert Levin. RRI International Conference on Dialysis IV, Phoenix, AZ)   

What are the common reuse chemicals and procedures? What are the advantages and disadvantages of each? How should a reuse room be set up? What must be monitored? What are the AAMI standards? How does anticoagulation impact on reuse? How should blood line size and needle size be optimized to ensure delivery of adequate dialysis?

This talk is paired with those by Dr. DeOreo and Dr. Gennari from the same meeting for on-line CME/CEU credit.

ADC Meeting
In Search of Better Peritoneal Dialysis Solutions (audio only)
(Mehrhotra, Wolfson, Diaz-Buxo, Martis) ADC 2002 22nd Annual Meeting, Tampa, FL)   

Industry Speaks I (audio only)
(Peterson, Kjellstrand, Griffin) ADC 2002 22nd Annual Meeting, Tampa, FL)   

May 7 - 13, 2002

Dr. Lindholm
The Role of V in Peritoneal Dialysis Outcomes and Adequacy
(Bengt Lindholm, M.D., Ph.D. ASN/ISN 2001 Annual Meeting, San Francisco, CA)   

How is Kt/V determined in PD vs. HD? What are the implications for different estimates of urea distribution volume (V) or total body water? How firm is the evidence that increased dose of PD improves outcome? What did the ADEMEX study add to this debate?

ADC Meeting
ESRD payment models and how they influence outcomes (audio only)
(Neumann, Amedia, Amerling, Blake) ADC 2002 22nd Annual Meeting, Tampa, FL)   

Optimal vs. adequate dialysis (audio only)
(Hakim, Lowrie, Vanholder, Ikizler, McMurray) ADC 2002 22nd Annual Meeting, Tampa, FL)   

April 30 - May 6, 2002

RPA website
RPA 2002 Annual Meeting Audiofiles (Downloadable)
(various authors, Renal Physicians Association 2002 Annual Meeting, March, 2002)   

This week we are experimenting with something a bit different. Later we will be posting 4-5 of these talks in the usual slide/audio format, but here we are making available, as audio only, a broader selection of talks from the RPA meeting, including most of the talks from each of the five general sessions. Quality improvement is highlighted, as are two guideline development reports to help patients prepare for renal replacement therapy. Use of mid-level care providers, legal aspects of using physician extenders, increasing patient volume and quality, are also covered, as are legislative issues (Congresswoman Shelley Berkley, D-NV), and CMS and privacy issues.

All told, 19 lectures have been made available in audio format, as .wma files. You can listen to them directly on your PC using Windows Media Player, or you can right click on them to download them, and then burn them to a CD or to your portable MP3 player for listening in your car, on the beach, or wherever.

April 23 - 29, 2002

Dr. Gennari
Dialysate Selection in the Hemodialysis Unit
(John Gennari, M.D., RRI International Dialysis Conference IV, January, 2002)   

What is the best dialysate sodium level to use? What happens if one chooses too low or too high? What is the place for sodium gradient dialysis? What should dialysate bicarbonate be? What about dialysate potassium? Is a zero potassium bath potentially dangerous? How should choice of dialysate calcium depend on choice of phosphate binder?

April 15 - 21, 2002

Dr. DeOreo
Understanding the Finances of an Individual Dialysis Facility
(Peter DeOreo, M.D., RRI International Dialysis Conference IV, January, 2002)   

What are the four revenue streams of a typical U.S. dialysis unit? What are the factors that one needs to know to determine whether or not a given unit will lose or make money? Which factors affect revenues? Expenses? What is the composite rate, and how has it changed recently? How is payer mix important? What is the role of ancillary income? How can one affect staffing and supply costs?

April 6 - 12, 2002

Ms. Dinwiddie
Vascular Access: The Catheter Conundrum
(Lesley Dinwiddie, R.N., HDCN Nursing Channel Lecture Series, April, 2002)   

What is a conundrum? What are the K-DOQI targets regarding tunneled cuffed catheters? When should they be used? Where should they be placed? What are the complications, including SVC syndrome and fibrin sheath formation? What are options for lytic therapy? What is the role of antibiotic lock solutions?

March 29 - April 5, 2002

Dr. Pierratos
Comparison between Short Daily and Slow Nocturnal Hemodialysis
(Andreas Pierratos, M.D. ASN/ISN World Congress of Nephrology, October, 2001)   

Much activity in the past week regarding daily and nocturnal hemodialysis, including FDA approval of the AKSYS machine, and launching of the daily / nocturnal HD channel on HDCN. This week we post a second lecture by Dr. Andreas Pierratos, who pioneered the slow nocturnal form of therapy in Toronto. Dr. Pierratos compares short daily with long nocturnal schedules. He first reviews short daily HD (SDHD) and looks at quality of life and effects on LVH, use of antihypertensives, and changes in nutritional status and anemia. He finishes with some review of middle molecule and phosphate removal. With long nocturnal HD the same issues are reviewed and compared, and the question of cost is discussed.

March 22 - 28, 2002

Dr. Pierratos
Daily and Nocturnal Hemodialysis: Is Renal Osteodystrophy Better?
(Andreas Pierratos, M.D. ASN/ISN World Congress of Nephrology, October, 2001)   

If you halve the dialysis time of a 3x/week schedule and give dialysis 6x/week, what happens to the serum phosphorus? Are there any other issues related to bone disease? What about nocturnal dialysis? Is osteopenia due to negative calcium balance a risk? Does one still need phosphorus binders? Does nocturnal dialysis improve tumoral calcification? Vascular calcification? Is there a risk of adynamic bone disease? How should one supplement phosphate to these patients?

March 15 - 21, 2002

Dr. Traeger
The Impact of Short Daily Hemodialysis on Nutrition and Quality of Life
(Jules Traeger, M.D., Ph.D., ASN/ISN World Congress of Nephrology, October, 2001)   

Prof. Traeger describes his continued experience with an observational cohort of patients that was switched from 3x/week hemodialysis to a short daily schedule, keeping total weekly time constant. He presents data about changes in dietary intake of energy and calories, serum albumin, cholesterol, and dry weight. He also presents data on changes in quality of life, and compares his results to a review of similar observational studies by Lacson.

March 7 - 13, 2002

Current Implications of Abnormal Bone Pathology: Consequences and Therapy   

Dr. Moe

Dr. Martin

Dr. Slatopolsky

(Three speakers and panel discussion. ASN/ISN World Congress of Nephrology Evening Symposium, October, 2001)

Dr. Moe: What are the causes of osteoporosis? Are hip fractures increased in dialysis patients? In transplant patients? What are the risk factors for fracture? What is the role of gonadal hormones? What is renopause? What is the role of osteoprotegerin and how does this relate to vascular calcification? Dr. Martin: What are PTH receptors doing in all of these tissues? What are the non-bone actions of PTH? What are PTH effects on intracellular calcium? On lipoprotein lipase? On NO synthase? Is PTH a uremic toxin? How should the new assays, including Scantibodies, be interpreted? Dr. Slatopolsky: How can one alter the vitamin D molecule to make it less calcemic? How is 19-nor (Zemplar, or paricalcitol) different from calcitriol? How do 19-nor and 1-alpha-D2 (doxercalciferol, or Hectorol) compare with regard to their actions on calcium and phosphorus?

February 26 - March 6, 2002

Dr. Williams
Advances in Management of Acute Liver Failure
(Roger Williams, MD, CBE, FRCP. ASN/ISN 2001 World Congress of Nephrology, October, 2001)  

What are the major classes of acute liver failure? What new information explains hyperammonemia and encephalopathy in variceal hemorrhage? With spontaneous bacterial peritonitis, how can one improve renal function? What is the pathophysiology of hepatorenal syndrome? What is the role of nitric oxide and splanchnic vasodilatation? How does vasopressin plus albumin help hepatorenal syndrome? What is the MARS extracorporeal system and when should it be applied?

February 19 - 25, 2002

Dr. Bunchman
Pediatric Critical Care Nephrology
(Timothy Bunchman, M.D. ASN/ISN 2001 World Congress of Nephrology, October, 2001)  

Part of the Intensive Care Nephrology section of talks from ASN/ISN Renal Week. What are the indications for renal replacement therapy in infants and children? How is RRT different in this population? How do we size therapy, including blood and dialysate/replacement fluid flow rates? What are the potential complications? Which modality is best? How can these therapies be tailored for specific conditions?

February 12 -18, 2002

Dr. Germain
End-of-Life Care: Symptom Management
(Michael Germain, M.D. ASN/ISN 2001 World Congress of Nephrology, October, 2001)  

Part of the Palliative Care symposium at the ASN/ISN. This particular talk focuses on routine management of common patient complaints: Pruritus, restless leg syndrome, muscle cramps, and intradialytic symptoms. Management is put into a palliative care concept, which is broadened to include patients not at imminent risk of dying. What works for treating itching in these patients? What causes restless leg syndrome and how can we treat it? What about muscle cramps? What are the side effects of quinine? Do we have a treatment algorithm for intradialytic symptoms that works?

February 5 -11, 2002

Dr. Funder
Aldosterone, Salt, and Cardiac Fibrosis
(John Funder, M.D., Ph.D. ASN/ISN 2001 World Congress of Nephrology, October, 2001)  

How is the aldosterone receptor related to glucocorticoid receptors? Why does cortisol stimulate both, and what is the role of 11-beta dehydrogenase enzyme? What are aldo receptors doing in the brain? In blood vessels? Is aldosterone made in the failing heart? What did the RALES study show? Was hyperkalemia a problem? Why should spironolactone prevent cardiac hypertrophy and/or fibrosis? Is there more to the mineralocorticoid receptor than just aldosterone? This was the Claude Amiel lecture of the ASN/ISN meeting.

January 29 - February 4, 2002

Dr. Pusey
Glomerulonephritis: Anti-GBM Disease
(Charles D. Pusey, M.D., ASN/ISN 2001 World Congress of Nephrology, October, 2001)  

Anti-GBM disease is characterized by rapidly progressive glomerular nephritis with lung hemorrhages. What is the pathology and what are the variants of clinical presentation? Are the anti-GBM antibodies pathogenic? What are they targeted against? Is cell-mediated immunity involved? What are the current treatment recommendations? Are cases where serum creatinine is greater than 5.6 hopeless? How predictive is the percent crescents on survival? When should plamapheresis be used? For how long? When should it be stopped?

January 15 - 22, 2002

The Evolution of Chronic Kidney Disease: Defining a Model for Care.   

Dr. McClellan

Dr. Provenzano

Dr. Silverberg

(Three speakers, two moderators, one commentator, and panel discussion. ASN/ISN World Congress of Nephrology Evening Symposium, October, 2001)

Dr. McClellan: What are the data in family members of ESRD patients (KEEP Study)? What is the prevalence of anemia in early renal insufficiency (PAERI Study)? What is renal function like in patients with congestive heart failure (CHF)? Dr. Provenzano: How should we screen for and manage anemia in CKD patients? What should target Hb be? How often should epoetin alfa and other epo derivatives be dosed? What is the approach to iron therapy in CKD patients? Dr. Silverberg: How does the heart compensate during anemia? What happens to cardiac function when you treat CKD patients with anemia? Does treatment of anemia in congestive heart failure patients help the heart disease? CME and CEU credits are offered for this symposium. You need to print out the evaluation form, take the post-test, and send it to the CME or CEU provider for your CME or CEU certificate (up to 1.5 hours of Category I credit).

Dr. Daugirdas
Kt/V, Body Mass Determinants, and Survival
(John T. Daugirdas, M.D., ASN/ISN 2001 World Congress of Nephrology, October, 2001)  

What is the debate about dialysis adequacy for 3x/week treatment? Some say the benefits level off at a URR of 65%, others suspect that survival benefits continue beyond this point, up to at least 75%. What are the factors in cross-sectional studies that confound the analysis? Does small patient size explain the J-curve (increase in mortality at high URR) found in some studies? How does body size affect mortality in ESRD patients? This lecture offers both CME and CEU credits.

January 8 - 14, 2002

Dr. Clark
Solute Control and Dose of Dialysis
(William Clark, M.D., ASN/ISN 2001 World Congress of Nephrology, October, 2001)  

Adequacy for ESRD hemodialysis is becoming clear, but much less is known about adequacy in the acute ICU renal failure situation, or when CRRT is being used. What are the adequacy issues with acute renal failure? Is the steady-state assumption valid? How do we quantify adequacy in the ICU? How much replacement fluid should we give to achieve a given level of BUN with CRRT? What are causes of adequacy problems in ARF? How much recirculation is associated with temporary venous catheters? What is EKRU? What levels are achieved with IHD, SLED, and CRRT? What do the Paganini and Schiffl studies suggest about dialysis dose in the ICU and survival? What did the Ronco paper show regarding CRRT dose and survival? Is timing of CRRT initiation important?

This lecture will offer both CME and CEU credits. The CE credit part of this activity is not yet ready. Look on the ASN/ISN 2001 Home Page and check for the post-test icon. It will initially be grey. When it turns blue, the on-line CME/CEU activity will be ready.

January 1 - 7, 2002

Ms. Hansen
Dialysis Patient Education
(Susan K. Hansen, R.N. HDCN Nursing Channel CEU Lecture Series, January, 2002)  

In the current U.S. dialysis climate, what are the barriers to effective patient teaching? Dialysis staff, administration, and the patient all contribute. What are the major patient-specific problems that can be addressed? Ms. Hansen focuses on three patient problems: Low literacy level, cultural diversity, and the elderly patient, and presents useful techniques that can be used when each of these problems are present. Particularly useful are her pointers in dealing with elderly patients, who may have hearing or visual impairment, or diminished cognitive ability.

With this lecture, we now inaugurate on-line CEU credits on HDCN, sponsored by the Renal Education Association. For the moment, CEUs are free to paid subscribers of HDCN. The entire documentation process, including submission and scoring of the post-test, submission of the evaluation form, and generation of the CEU certificate, has been automated to proceed on-line.

New Therapies for Anemia Management in CKD: An Interactive Symposium.   

Dr. Pereira

Dr. Collins

Dr. Levin

Dr. Locatelli

(Four speakers and one panel discussion. ASN/ISN World Congress of Nephrology Satellite Symposium, October, 2001)

This satellite symposium focused on management of anemia in the CKD population. The original presentation at San Francisco made extensive use of audience response pads, such as those used in "Who Wants to be a Millionaire?". We have reproduced the interactivity of the original symposium on HDCN, and also have made available the opportunity for the HDCN users to make their own choices and compare their answers with those of the San Francisco audience in October.

Dr. Pereira begins by introducing the new K-DOQI CKD guidelines, and emphasizes why anemia treatment of this population is so important. He emphasizes the high prevalence of CKD in the U.S. and analyzes 3 separate databases to show how anemia is undertreated in CKD patients. Dr. Collins focuses on the outcome penalty associated with anemia in terms of increased hospitalizations and mortality, and shows that costs are actually less for those CKD patients treated with epoetin prior to dialysis. Dr. Levin discusses anemia and heart disease and reviews the results of three normalization of Hgb trials (US, Canadian, and Australian). She points to some preliminary data suggesting that treatment of anemia may actually slow the rate of decline in renal function. Dr. Locatelli discusses EPO pharmacokinetics in CKD, and shows how modification of the erythropoietin molecule was used to create darbepoetin alfa (Aranesp), a compound with a threefold prolongation in plasma half-life. A number of early trial results are presented giving epoetin or darbepoetin alfa weekly, every 2 weeks, or monthly.

CME credits are offered for this symposium. You need to print out the evaluation form, take the post-test, and send it to the CME provider for your CME certificate (up to 2.0 hours of Category I credit).

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