In order to understand why pregnancy in the setting of renal replacement therapy constitutes a significant medical event, it helps to understand how pregnancy affects women with normal kidney function. During pregnancy blood vessels become dilated leading to lowered blood pressure.

On May 9, 2007, the U.S. Food and Drug Administratio issued a public health advisory outlining new safety information about ESAs . This included a new black box warning advising physicians to adjust the ESA dose to maintain the lowest hemoglobin level needed to avoid the need for a blood transfusion.

Remember the Waltons, from the 1970’s TV show Walton’s Mountain? Four generations were living together in the same home: grandparents, parents, seven children, and eventually the children’s children. The family members operated as a team, full of collective wisdom and insight.

As if a diagnosis of end stage renal disease (ESRD) is not enough, according to the United States Renal Data System (USRDS) one-third of people with ESRD get hit with a double whammy… a cancer diagnosis. ESRD patients are already dealing with a difficult disease, which impacts quality of life on many levels.

Answer: The overriding factor is patient safety. To assure a safe treatment, staff may not be able to satisfy all patient comfort requests, such as keeping the access site covered.

A correlation between method of administration and clinical result achieved has been known for erythropoietin use in dialysis patients for a decade (NEJM). Application of this knowledge has not been the usual practice, however.

Answer: In projecting how long an individual is likely to survive after the onset of what is called end-stage renal disease (ESRD), the key factors are: 1. Patient age and gender, 2. Cause of kidney failure, and 3. Method of treatment.

Dear Doctor: My 16-year old son was admitted to the hospital in kidney failure three weeks ago. He just got out two days ago and during his stay started hemodialysis. While in the hospital doctors inserted a peritoneal line so we can transition to peritoneal dialysis (PD) in the next couple weeks.

It seems like every time I bump into something, I bruise. What’s causing me to bruise so easily and is there something I can do to stop it? Bruising, also called ecchymosis, is caused by extravasation or leaking of blood into the skin. The bleeding is the result of a complex process and begins with our largest organ-the skin.

Three days a week dialysis and a healthy fear of the open seas kept Shakur Bolden from taking that dream vacation. He had seen the brochures in his dialysis unit and on the tables in his doctor’s office. “Exciting vacation opportunities…”, “From Barcelona to Bermuda, there’s a cruise that’s going your way.