Headline: Kidney Failure

To me, he seemed invincible; the real life “superhero. But this allusion was soon shattered, and I was in for a rude awakening of the transient nature of life when I heard the doctor’s prognosis. It is heartbreaking to see how he, a man of tough spirit and stubborn temper, struggles to hide his symptoms as the disease slowly consumes him. Watching his daily fight against this vicious disease, it’s not hard to imagine the millions of lives kidney diseases destroy across the globe each year. Yet despite being one of the fastest growing chronic diseases in the world, the clinical researches regarding kidney disease treatments are relatively outdated. It’s hard to imagine that currently there is still no clear evaluation of the prognostic implication of slow kidney allograft function despite thousands of kidney transplant procedures being performed each

The National Kidney Foundation information is provided in a question and answer format with one or two sentence simple answers provided. The Merck Manual site utilizes headers with information ranging between one to three paragraphs. Links available on the National Kidney Foundation Website keep the reader on the site and frequently take them back to the donation page. The Website provides a section for “Professional” users, however, the majority of the area is again written for the general public. One area reviewed provides an “Education and Research” option that takes the professional reader to more technical writing sources contained within the National Kidney Foundation Website. The Merck Manual links allow the reader to visit other Websites for additional subject information. The National Kidney Foundation Website offers additional educational opportunities via Webinars and seminars. No such offerings were noted on the Merck Manual site.

Chronic kidney disease (CKD) is a worldwide problem that is currently three times higher for African Americans, Hispanics, Pacific Islanders, American Indians and seniors (The National Kidney Foundation, 2013). CKD occurs when the kidneys are damaged by a pathogen or injury and they can no longer adequately maintain proper levels of regulated chemicals in the bloodstream. There are many risk associated with CKD. According to the National Kidney Foundation, two of the major risks are Chronic Renal Failure (CRF) and Cardiovascular Disease. Currently twenty million American adults have CKD and millions of others are at increased risk. Age has no barrier on getting CKD. People with pre-existing health issues, and a part of certain population

Through the passage of time mankind has always been on the quest for knowledge to understand themselves and the universe. One such discovery was the discovery of the kidney and its functions. The kidneys are responsible for filtering blood and producing urine as waste from your body to the bladder. But there are instances of kidneys losing their functionality, this is called either acute kidney disease were kidneys lose function for less than 3 months or chronic kidney disease(chronic kidney failure) for persistent loss of functions. So what happens when the kidneys lose function? this causes uremic syndrome liquids and waste build up in the body which can reach dangerous levels and cause death without a transplant or dialysis treatment. (Longo,

RAI is a provider of dialysis services that combines the latest communications and electronic technologies to provide dialysis services that are many steps beyond what most individuals still think of the process of dialysis. Dialysis undoubtedly save lives. As Power, Duncan, & Goodlad reported in 2009, there is a significant

The wait times of dialysis patients before and after hemodialysis treatments have been an area of concern. In a typical morning at an outpatient dialysis clinic, all the patients for the first shift will begin to gather in a waiting room just prior to a specific time. I will use the start time of 7:00 a.m. for example. The nurses and patient care staff will arrive a considerable amount of time earlier to prepare for the oncoming shift of patients. At 7:00 a.m., the nurse in charge will begin calling each patient in one at a time. An assessment is done. The patient is weighed. His/her lungs are listened to. Many specific questions are asked. A treatment goal is determined based on protocols. Then, the assessment data is entered into a networked computer system, which is retrieved at a specific station for a particular patient. This process continues until every station in the clinic is full. Typically, a clinic will hold anywhere from 12 to 30 stations. For this example, I will use a 20-station clinic.

DaVita is a kidney care company that services people by supplying dialysis treatments to patients that have serious “chronic kidney failure and people that are going through end stage renal disease”. “DaVita’s website states that “as of December 31, 2013, DaVita operated and also provided administrative services at 2,074 of its outpatient dialysis centers located in the United States, they served nearly 168,000 patients in that aspect as well as provided services at 73 outpatient dialysis centers that are located in 10 separate countries.” (DaVita Health Care Partners). Retrieved April 18, 2014 from http://davitahealthcarepartners.com/.

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Front-line employees, such as nephrologists, nurses, and dietician, work day-to-day with all the systems and processes in the Dialysis Center. They have a tremendous responsibility to act on any problems and strive to find improvements in the work they perform. Quality reporting in Hemodialysis Center is done on a monthly, quarterly and annual basis. All nurses are responsible for identifying, monitoring and reporting improvement activities using the Plan – Do – Check - Act quality philosophy. Summaries are presented to doctors, medical director and nurse manager for review and dissemination to all staff nurses through staff meetings and

Figure 1: Cardiovascular disease mortality by age, race, and gender in the general population and in dialysis patients. Cardiovascular mortality is defined as death due to arrhythmias, cardiomyopathy, cardiac arrest, myocardial infarction, atherosclerotic heart disease, and pulmonary oedema. Data from the general population are from the National Centre for Health Statistics multiple cause of mortality files 1993. Data from dialysis patients include haemodialysis and peritoneal dialysis combined from USRDS 1994-1996. Reprinted with permission from Am J Kidney Dis 32[Suppl 3]: S115, 1998.

Hypotension that occurs during hemodialysis primarily results from rapid removal of vascular volume (hypovolemia), decreased cardiac output, and decreased systemic vascular resistance (Lewis, 2014, pp. 1122-1123). The patient may experience a drop in blood pressure during dialysis process. As a result of cardiac ischemia the patient may also exhibit symptoms of light- headedness, nausea, vomiting, seizures, vision changes, and chest pain. To combat these complications of hypotension the volume of fluid being removed is decreased and administering 0.9% saline solution through IV therapy (Lewis, 2014, pp. 1122-1123).

We used clinical and biochemical data derived from the DaVita database. The study population (N=420,255) included subjects undergoing hemodialysis in DaVita facilities across the US during the period of 2004 to 2011.

Chronic kidney disease (CKD) is an irreversible condition that progresses causing kidney dysfunction and then to kidney failure. It is classified by a GFR of <60mL/min for longer than 3 months. There are five stages of CKD: Stage 1 has kidney damage but has a GFR ≥ 90. Stage 2 has mild damage and a GFR of 60-89. Stage 3 has moderate damage and a GFR of 30-59. Stage 4 has severe damage and a GFR of 15-29. Stage 5 is also known as end stage renal disease (ESRD), this is kidney failure with a GFR of ≤ 15 and theses patients are typically on dialysis or in need of an immediate transplant. The leading cause of CKD is diabetes. Hypertension is also a major cause. Since most DM patients have HTN,

The physician may adjust the hemodialysis intensity and frequency based on the test results. These labs are crucial and must be checked monthly while being on dialysis.

Srinivasa R. Raghavan et al [10]. Briefly reviews the literature on clinical decision support system, debates some of the difficulties faced by practitioners in managing chronic kidney failure patients, and sets out the decision provision techniques used in developing a dialysis decision support