Tag Archives: dialysis

High Aluminum Amounts in Dialysis Fluid Prompts Recall

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NxStage Dialysis Treatment CompanyHARRISON, OH – Despite having her tap water tested, refraining from drinking soda from cans and carefully examining the labels of her food and makeup, Angie Caudill continued to experience the levels of one potentially toxic ingredient rising in her blood: aluminum.  “I did everything they told me to do,” said Caudill, “and it kept getting higher and higher.”

Caudill was diagnosed with kidney disease and has spent the last year using a home dialysis system.  In June 2014 she learned that the fluid she used for her dialysis treatment contained excess amounts of aluminum.  The company that sold the fluid was NxStage Medical Inc. based out of Lawrence, Massachusetts.  It is estimated that NxStage sold between 140,000 to 150,000 units of the fluid made between April 2013 and February 2014.  NxStage declined to make a statement on how many patients were estimated to have been affected.

On May 15, 2014, NxStage voluntarily recalled the fluid which is used specifically for home dialysis treatment.  Home dialysis, often referred to as peritoneal dialysis, differs from dialysis treatment offered in a hospital or dialysis center.  Home dialysis is administered by the patient and does not require a trained dialysis technician or nurse to assist with the procedures.  NxStage differs from this process.  They have developed a dialysis machine that is portable enough to use in the home.  The company says they are working with regulators to determine what caused the problem.

NxStage says there is no evidence that patients were harmed by the aluminum rich dialysis fluid, but the recall has upset many patients who have been using the fluid regularly.  The main reason patients are on dialysis is because their kidneys are unable to clean wastes and toxins from the blood.  Instead, they rely on dialysis fluids, like those provided by NxStage, to take the place of natural kidney functions.  Finding out that the fluid they use is contaminated has been quite disturbing.

Aluminum is found in many products, including anti-persperants, antacids, cookware and baking soda.  In general it is not harmful.  However, high exposure over time can cause aluminum to build up in the body resulting in bone disease, memory loss and even dementia.  People with kidney problems are especially at risk because their body has a more difficult time filtering out the metal.

Caudill said, “Patients are mad that there was no check in place because it’s something people depend on.  Their life depends on it.”  Another dialysis patient using NxStage’s dialysis fluid named Mark Wetzel of Elma, NY said the aluminum made him weak and his mouth was often dry with a metallic taste.  He utilized NxStage’s fluid on and off for more than nine years.

NxStage was founded in 1998 and makes the only portable home dialysis machine on the market.  The company expects to grow as more patients are switching to home dialysis treatments.

Dialysis Patients Turned Away at Queen’s West in Oahu

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OAHU, HI – According to a Hawaii News Now article, the Queen’s Medical Center West in Oahu is turning away dialysis patients on a daily basis. The center recently underwent $100 million in renovations.  Yet, an executive staff member of the facility said they are turning patients away because the dialysis facilities are not “cost effective.”

Hawaii News Now spoke with Sarah, a 72 year old dialysis patient, who currently lives in Kapolei and visits the center three times a week for dialysis treatment. Sarah recalled an incident in May where she was rushed to the new Queen’s West emergency room (ER) for shortness of breath and inability to walk. When she arrived, she found that the facility had no dialysis treatment stations available and as result could not be admitted.

Sarah waited for nearly 4 hours in the Queen’s ER waiting room, until she was eventually transferred by ambulance to the downtown Queen’s location for treatment. “And I waited that long. Just stayed in the room and waited,” Sarah said.

But this is not simply a one time occurrence. The following June Sarah experienced a similar emergency situation and was rushed to Queen’s West ER again. For a second time she arrived to find no dialysis treatment stations available. This time she waited six hours for a station to become available at the main hospital on the other side of the island. When asked if it was uncomfortable to be waiting that long she replied, “Oh yeah, because one o’clock in the morning already and then I’m still there waiting and I cannot really sleep during that night.”

Responding to the identified problem was Susan Murray, Chief Operating Officer of Queen’s West. “It is not cost effective to have the staff and equipment in place for that low volume,” she said. Typical staff include dialysis technicians and nursing professionals.  Queen’s main location at Punchbowl has approximately 20-30 patients that need acute dialysis at any given time. On average only about two patients per day actually require dialysis treatment at Queen’s West. “Services evolve as the needs grow,” Murray said, “As West grows in volume, West will probably provide acute dialysis services at the appropriate time.”

$2.2 million Dialysis Center Approved in Graham, NC

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GRAHAM, NC – After an agreement to move existing dialysis treatment centers in Alamance County to the newly proposed facility, the plan for a $2.2 million dialysis center in Graham, NC has been approved.  Renal Treatment Centers, a subsidiary of one of the nation’s largest kidney care companies, DaVita, will be responsible for the new center.  Renal Treatment Centers already owns two other dialysis centers in Alamance County.

The new Graham location would create a 10-station Kidney Disease Treatment Center which would be certified as an end stage renal disease (ESRD) facility.  According to the Certificate of Need Section of the N.C. Department of Health and Human Services, the new center would “provide in-center hemodialysis and home training for peritoneal dialysis and home hemodialysis.”

The new facility is expected to open in late 2015.  A proposed timeline stated that plans would be completed by March 1, 25 percent of construction should be completed by June 15, and the center should be open for service delivery by December 1.

The center plans include relocating eight existing dialysis stations from the Burlington Dialysis Center and two from the North Burlington Dialysis Center.  Even with the relocation, the Burlington center would maintain 17 stations for patients there and the North Burlington center would maintain 11 stations.

One major factor influencing the decision for the relocation were the letters written by 31 dialysis patients supporting the proposed Graham site.  According to the application, “All of the patients have indicated in their letters that they live closer to the proposed Graham facility and that the facility will be more convenient for them.”

Dialysis Tech Jobs in Graham, NC

According to the Bureau of Labor Statistics (BLS) dialysis technicians, categorized under the “health technologist” occupational category, are expected to experience good job growth in North Carolina.  The BLS projects that dialysis tech jobs in North Carolina will increase by 18% over the next ten years, resulting in more than 800 new jobs in the state.  Health technologists earn a competitive salary. For more information on becoming a dialysis technician, check out dialysis technician training in North Carolina. Dialysis Tech Jobs in North Carolina

Dialysis Clinic Inc. confronts discrimination suit in Sacramento

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SACRAMENTO, CA – The U.S. Equal Opportunity Employment Commission (EEOC) has alleged that nationwide healthcare provider Dialysis Clinic Inc. is guilty of discrimination for firing and refusing to rehire a nurse who took too long to complete her treatment for breast cancer.  The EEOC was founded in 1965 during a growing movement for equality and social justice and has since been dedicated to equal opportunity at the workplace.  This was the basis of the discrimination suite filed against Dialysis Clinic Inc. for its behavior in Sacramento.

Francisca Lee is 71 years old and had worked for 14 years at the company’s South Sacramento location on East Southgate Drive.   According to the company’s complaint, she was diagnosed with breast cancer and took medical leave to have a mastectomy and chemotherapy.

Four months later Lee received a notification in the mail that her employment was being terminated.  Apparently her leave exceeded the time limit dictated by the company’s medical leave policy.  At the time she received the notification, Lee had already been cleared by her physician to return to work without restrictions in less than two months.

Lee was told that she could reapply for the position.  She did more than two months later, after her medical clearance.  However, she was rejected and the company hired a newly-licensed nurse instead.

The American’s with Disabilities Act (ADA) protects a qualified employee from being terminated due to disabilities.  The law also requires employers to provide reasonable accommodation to a job applicant or employee, unless doing so would impose a hardship on the employer.

“Given the ADA’s mandate, I would urge employers to be flexible concerning leave extensions if it causes no undue hardship,” said EEOC San Francisco Regional Attorney William R. Tamayo. “Ms. Lee has over 30 years’ experience in dialysis treatment and really wanted to work.”

Of course people are upset about the discrimination issue, but many are wondering why Dialysis Clinic Inc. would sacrifice such a valuable employee with a good record over some arbitrary time limit.

Dialysis Clinic Inc. serves patients with advanced kidney disease in more than 27 states, including 3 centers in Sacramento.  Many students who graduate from dialysis technician training in Sacramento go to work at these facilities.

Choices for Dialysis Patients at the End of Life

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When kidney dialysis was introduced in the 1940s it was originally intended as a life saving treatment.  It was mainly used for young patients with acute renal failure and helped them until their kidneys could function without the therapy.  Since then the use and frequency of dialysis has changed.  Today the average dialysis patient is 65 years old and is used as a maintenance treatment just as often as it is for acute episodes.

There are some medical professionals that believe dialysis is simply prolonging an inevitable conclusion of this patient population: death.  “Many of these patients don’t realize they are in the final phase of life because no one has talked forthrightly with them,” said Mildred Z. Solomon, EdD, president of The Hastings Center. A 2013 analysis published in the Journal of General Internal Medicine (2013;28:1511-1516) found that patients with end stage renal disease (ESRD) reported they did not know their medical prognosis and couldn’t recall being offered dialysis alternatives.  Another report in Medical Anthropology Quarterly (2005;24:297-324), found that of all the patients researchers spoke with at two Californian dialysis clinics, only 4 confirmed they initiated dialysis treatments by choice.

Give People a Choice, It Might Be Their Last Chance to Make One

There is a growing movement of physicians and bioethics organizations that believe such patients should be given more information about their illness and more choices about how they want to spend their final years alive.  “We haven’t had a grown-up conversation that this is a stage of life patients are in and death may not be that far away,” Dr. Solomon said. “People want to have that sort of conversation and are expecting it from their doctors, but physicians aren’t initiating it.”  Patients are surrounded by medical staff all the time, including nurses and dialysis technicians.  But these staff are not necessarily trained or equipped to have these types of conversations with patients.  It’s important that the primary physicians and specialists step up and take lead.

It’s a difficult job, but somebody has to be straightforward with patients and give them the choice of how they want to end their lives.  “Everything we know about patients suggests that most of them want to have the conversation,” said Lewis Cohen, MD, professor of psychology at Tufts School of Medicine in Boston. “And patients want doctors to be the ones to broach the subject.”  Dr. Cohen recommended the following guidelines for having such a conversation with ESRD patients:

  • Identify patient preferences. What kind of care do they want? Who should speak with them if they are unable to communicate?
  • Ascertain if the patient is even willing to hear about dialysis alternatives.
  • Ascertain what the patient already knows about their medical condition. Many patients want to get the issue of death out in the open and would rather have the discussion with medical professionals than family or friends.
  • Provide as much information to patients as possible.
  • Give the patient a specific estimate of prognosis.
  • Inquire about the patient’s goals and expectations of treatment.

Patients should hear about their options and receive thorough thoughtful recommendations from practitioners.  By exploring their thoughts, beliefs, ideas and expectations, you can help dialysis patients make the best choices for their unique situation.

CMS ESRD Quality Incentive Program Results for 2014

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End stage renal disease (ESRD) is a permanent failure of the kidneys that is most often caused by diabetes or high blood pressure. Patients with ESRD must receive dialysis or a kidney transplant to stay alive. Dialysis is the process of artificially removing excess fluid and toxins from the blood, a process normally done by the kidneys. Without dialysis these toxins will build up in the blood causing serious health problems and eventually death.

What is the QIP?

The Centers of Medicare & Medicaid Services (CMS) began their ESRD Quality Incentive Program (QIP) in 2008 through a series of reforms. QIP is a performance-based incentive program and was the first of its kind in the United States. The program was designed to promote high quality services in outpatient dialysis facilities to patients with ESRD. The CMS ESRD QIP will reduce payments to facilities that do not meet or exceed QIP performance standards. The maximum payment reduction that can be applied by CMS is two percent.

2014 CMS ESRD QIP Results

DaVita Dialysis Centers Outperform all Other Dialysis Providers in 2014 CMS ESRD QIPEvery year since its creation, the CMS ESRD QIP has published public performance results for dialysis facilities across the country. In 2014 DaVita dialysis centers ranked highest in the nation above all other dialysis providers with 98.4% of all centers ranking in the top clinical performance tier. QIP takes into account three major clinical areas when scoring facilities: anemia management, urea reduction ratio and vascular management. Many of these services are delivered by dialysis nurses and dialysis technicians. By the end of 2012 DaVita reported that 99.4 percent of all their patients were above the 65 percent baseline.

About DaVita Dialysis Centers

DaVita HealthCare Partners Inc. is a Fortune 500 company and one of the leaders of kidney care services in the United States. As of March 2014 there were 2,098 outpatient DaVita dialysis centers across the country, serving more than 165,000 patients. Because of the aging population and increased frequency of diabetes in the U.S. dialysis has been in growing demand. DaVita is one the top providers for dialysis services, proven with the 2014 CMS ESRD QIP results.

DaVita to Open New Dialysis Clinic in San Rafael, CA

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DaVita plans to open new dialysis treatment clinic in San Rafael, CAAccording to DaVita spokesman Justin Sorbis, the Denver-based DaVita HealthCare Partners Inc. opens approximately 150 dialysis centers each year. The company plans to open their second Marin County center in San Rafael, CA some time in 2015.

Sorbis said that the new center will have 28 dialysis stations capable of treating more than 200 patients each day. Patients will be able to book appointments as early as 4AM. A typical dialysis treatment takes 3-4 hours.

Dialysis Technician Jobs in San Rafael

Sorbis said that the new center will bring 20 new jobs to the area. This is good news for students interested in dialysis technician training in San Rafael. Dialysis technicians are responsible for operating and maintaining the dialysis machines used during treatment. They monitor patient progress and ensure the machines are properly cleaned and sanitized before used by another patient.

The future location of the San Rafael DaVita clinic is expected to be built in the downtown area. 1415 Third Street and 814 E Street. The new center is expected to have very little impact to the area, one of the properties a historic Victorian-era residence.

 

The need for more dialysis clinics grows every year. “Unfortunately, dialysis is a growing business model because so many patients end up with kidney failure as a result of high blood pressure and diabetes,” said Sorbis. DaVita is one of the largest kidney care companies in the world. They opened their first Marin County dialysis center at 650 Las Gallinas Ave in 2008.

Race and Income Potentially Increase Risk of Death in Dialysis Patients

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NEW YORK CITY, NY – A recent study released by Dr. Tanya Johns and her colleagues at Albert Einstein College of Medicine in New York City indicates that young black adult dialysis patients who live in poor neighborhoods are much more likely to die than their white counterparts.

In higher income areas racial differences were not such a pronounced factor. This indicates that the correlation is more closely related to economic status than race. “In our study, young black patients’ risk of death was worse when they lived in poor neighborhoods. We need to better understand how the wealth of someone’s neighborhood affects patients’ health while on dialysis,” said Johns. The study that was published in the Journal of the American Society of Nephrology states that among dialysis patients between the age 18 and 30, blacks are nearly twice as likely to die at a young age.

The study analyzed data from more than 11,000 young white and black adults with kidney failure. All patients began dialysis between 2006 and 2009. After a 23-month follow up, the study identified a higher risk of death in young black adults in poor neighborhoods. They found that black dialysis patients were 1.5 times more likely to die than whites.

Dialysis and Poverty in the United States

Poverty in the United StatesIt is well known that minority groups in the United States in general have higher poverty rates. According to the U.S. Census Bureau the highest national poverty rates were for American Indians and Alaska Natives (27.0 percent) and Blacks or African Americans (25.8 percent). The 2007–2011 national poverty rate for Whites was 11.6 percent, and most states (43) as well as the District of Columbia had poverty rates lower than 14.0 percent for this group. Knowing this could explain why young black adult dialysis patients have higher risk of death.

The study did was not explained in terms of medical factors. It also did indicate additional medical conditions such as blood pressure, to generate the results.

New Dialysis Machine Able to Treat Newborns

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VICENZA, ITALY – Italian researchers have developed a dialysis machine that can successfully treat newborns. They invented the machine to treat newborn infants suffering from kidney failure.

In some cases dialysis machines used for adults can be adjusted to work for small children. But newborn infants are so small, using an adult dialysis machine is very difficult, if not impossible. “To try to treat the patient with an adult machine is like trying to fix a watch with a tool that you use for a large car,” said Dr. Claudio Ronco, director of the department of nephrology at San Bortolo Hospital.

Newborns are incapable of withstanding the force of adult-size dialysis machines. Researchers said that using such machines can overpower a infant’s delicate blood vessels. “The neonate is so small that it requires dedicated technology,” said Ronco.

Researchers have named the new machine the CARPEDIEM (Cardio-Renal Pediatric Dialysis Emergency Machine). It is designed to provide kidney dialysis to infants and small children between 4.4 and 22 pounds. One of the major differences from the adult-size machine is the blood flow and filtration. Adult-size machines user much larger catheters and handle higher blood flow. The CARPEDIEM uses very small catheters that protect the infant’s blood vessels.

Since the first use of CARPEDIEM, ten other infants in Europe have been treated. It is the hope of Ronco and other researchers to present the new technology to the U.S. Food and Drug Administration for approval. “There is definitely an interest in the United States for this machine,” he said.

What is Dialysis?

Dialysis, sometimes referred to as “renal dialysis” is the process of removing waste products and excess liquid from the blood. Dialysis is necessary when a patient has suffered kidney damage or kidney failure. Dialysis procedures are often delivered by a dialysis technician. The technician is responsible for working with the patient and monitoring the patient’s response to the dialysis.

Atrial Fibrillation Patients At Risk During Dialysis

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A recent study published in the medical journal Heart found that atrial fibrillation (AF) patients who receive regular dialysis treatment have more episodes of irregular heartbeat on dialysis days. The study also shows that irregular heartbeats for AF patients occur more often during the dialysis treatment.

Dialysis and Atrial Fibrillation

Irregular heartbeat of Atrial Fibrillation patient.

Several hospitals in the Netherlands studied 40 dialysis patients enrolled in the implantable cardioverter defibrillator-2 (ICD-2) trial. An ICD is an electronic device implanted inside the chest that constantly monitors heart rate and rhythm. Whenever the heart begins to beat irregularly, the ICD delivers energy to the heart muscle, bringing it back into a normal rhythm. Because all 40 dialysis patients had such devices, researchers were able to look at heart rhythm data during dialysis.

During a 28-month follow up period, the ICD-2 devices detected a total of 428 AF episodes in 14 different patients. Analysis found that AF occurred more frequently on days when the patient was receiving hemodialysis, especially during the dialysis procedure. Dialysis technicians are often required to monitor the vital signs of a patient before, during, and after dialysis. They attend dialysis technician school to learn how to do this.

The authors of the study wrote, “This study provides insight in the exact timing of AF onset in relation to the dialysis procedure itself. Researchers hope to use the study results to identify further areas of investigation. One key factor is how poor kidney function causes the need for hemodialysis and is also an independent factor in AF. “These findings might help to elucidate some aspects of the pathophysiology of AF in dialysis patients and could facilitate early detection of AF in these high-risk patients.”