tag:blogger.com,1999:blog-31034567105124553632024-02-29T21:40:08.724-08:00Kidney DiseaseImproving Life for Kidney Patientsdr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.comBlogger102125tag:blogger.com,1999:blog-3103456710512455363.post-32007807749670270592015-11-16T20:44:00.001-08:002017-12-25T13:44:10.596-08:00Home Dialysis Los Angeles<div dir="ltr" style="text-align: left;" trbidi="on">
There are 2 kinds of home dialysis modalities:<br />1. Home hemodialysis<br />2. Home peritoneal dialysis.<br /><br />Home dialysis has several benefits when compared to in-center hemodialysis. In both choices of home dialysis, patients receive more frequent dialysis session than in-center hemodialysis. As such, they have better blood pressure control. This may reduce stress on the heart and blood vessels.<br /><br />Patients on home dialysis and nocturnal dialysis are able to eat more and use fewer medications. In addition, patients can do more of their daily activities and continue working.<br /><br />If you are on home dialysis and planning to travel, you need to talk to your dialysis nurses. They are usually available 24 hours - 7 days of the week. They will arrange for you for either hemodialysis or continuing peritoneal dialysis at your destination. <br /><br />Patients who do home dialysis are more involved in their care, and as such, are more proactive in living healthy and getting better. On the other hand, in-center hemodialysis patients have better support group as they meet with nursing staff and case managers on regular basis.<br /><br />When making a decision about the type of treatment, you should take into consideration that home dialysis is usually a daily process, similar to the working of the kidney and may be more gentle with fluid removal from the body. Both home peritoneal dialysis and home hemodialysis are excellent choices in treatment on end stage renal disease patients. They are both as effective form of dialysis as in-center hemodialysis.<br /><br />There are some people for whom home dialysis may not be appropriate. Home dialysis requires independent patients with good family and social support that can help the patient in this process. Home dialysis is not for everyone. People must receive training and be able to perform correctly each of the steps of the treatment. A trained helper may also be used.<br />
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<br />
<div style="text-align: start;">
Ardavan Mashhadian D.O.</div>
<div style="text-align: start;">
Nephrologist</div>
<div style="text-align: start;">
1400 S Grand Ave Suite 615, Los Angeles, CA 90015</div>
<div style="text-align: start;">
(213) 537-0328</div>
</div>
<div class="blogger-post-footer">
Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>
<br />
Source: blogger posts <br />
<a href="http://losangeleskidneycenter.com/home-dialysis-los-angeles-2/">Home Dialysis Los Angeles</a></div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com1Los Angeles, CA 90015, USA34.0390107 -118.267280134.0126947 -118.30762059999999 34.0653267 -118.2269396tag:blogger.com,1999:blog-3103456710512455363.post-12130923179799422782015-08-15T13:41:00.002-07:002017-12-25T13:44:26.935-08:00Ig A Nephropathy and Bloody Urine<div dir="ltr" style="text-align: left;" trbidi="on">
The most common clinical presentation of Ig A nephropathy is bloody urine provoked by upper respiratory infection. Infectious source with microbial and viral infection is occasionally present. Food particles have also been proposed. Alternatively, Ig A naphropathy may be an autoimmune disease. Ig A Nephropathy is one of the most common causes of kidney disease. In Caucasians, Ig A nephropathy is more common in men with ratio of 3:1 than women. However, in Asians, the ratio approached 1:1. This disease can be transient or progress to chronic kidney disease and possible end stage renal disease requiring dialysis.<br />
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Ig A nephropathy is associated with other diseases such as rheumatoid arthritis, celiac disease, alcohol liver disease, cirrhosis, dermatitis herpetiformis, and HIV/AIDS.<br />
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The clinical presentation may be suggestive of Ig A nephropathy. However, renal biopsy is required for confirmation. Kidney biospay further helps for predicting the course of the disease. That being said, not all patients require to have kidney biopsy.<br />
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<b>Natural Progression</b><br />
Some patient with mild disease have remission. However, the presence of high blood pressure, protein in the urine, and reduced kidney function as well as some findings on kidney biopsy increase progression and poor outcomes.<br />
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<b>Treatment</b><br />
Treatment of Ig A nephropathy depends to clinal presentation, urine studies and kidney biopsy result. Depending to the presentation, the treatment of Ig A nephropathy varies from blood pressure medications to immunosuppresive medications. Close follow up with a nephrologist is crucial.<br />
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Dietary gluten restriction has not been show to preserve kidney function.<br />
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<br />
Ardavan Mashhadian D.O.<br />
Nephrologist<br />
1400 S Grand Ave Suite 615, Los Angeles, CA 90015<br />
(213) 537-0328</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com0Los Angeles, CA 90017, USA34.0543797 -118.267280134.0280677 -118.30762059999999 34.080691699999996 -118.2269396tag:blogger.com,1999:blog-3103456710512455363.post-1077338569815603472015-02-21T09:40:00.002-08:002017-12-25T13:44:52.855-08:00High Blood Pressure - Chronic Kidney Disease, Sodium, and Salt Intake<div dir="ltr" style="text-align: left;" trbidi="on">
In patients with chronic kidney disease, management of high blood pressure is crucial. Uncontrolled blood pressures can have devastating effects on your health (heart attack, stroke, death). It is important to check blood pressure frequently and review the numbers with your kidney doctor (nephrologist). Low salt diet (2 gram per day) is the first step. There are many different medications to help with elevated blood pressure. But if you do not decrease your salt intake, control of blood pressure can be very difficult.<br />
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With high salt (sodium) intake, you will be more thirsty. As such, you will drink more which can lead to swelling and raise your blood pressure. This can damage your kidneys more and make your heart work harder. One of the best things that you can do to stay healthy is to limit how much salt (sodium) you eat.<br />
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To limit sodium in your meal plan:<br />
1. Do not add salt to your food when cooking or eating. One of the first steps in becoming healthy is cooking your own food. With cooking your own food, you will become more health conscious and use healthy ingredients.<br />
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2. Try cooking with fresh herbs, lemon juice or other salt-free spices. To make the food delicious and tasty, you do not have to add salt. Fresh herb and lemon juice can be good alternatives. Make sure you do NOT use potassium supplements though (see below)<br />
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3. Choose fresh or frozen vegetables instead of canned vegetables. If you do use canned vegetables, drain and rinse them to remove extra salt before cooking or eating them.<br />
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4. Avoid processed meats like ham, bacon, sausage and lunch meats. These foods have high salt content. It is much healthier to cook fresh meat.<br />
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5. Eat fresh fruits and vegetables rather than crackers or other salty snacks. As the old saying goes: an apple a day keep the doctor away. Try to have healthy habits during the day. One such habits is eating vegetables.<br />
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6. Avoid canned soups and frozen dinners that are high in sodium. Try to cook your own soup with fresh ingredients. Its more delicious! You can eat more of it and yet not worry about gaining weight.<br />
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7. Avoid pickled foods, like olives and pickled. Substitute it with healthy fruits like avocado.<br />
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8. Limit high-sodium condiments like soy sauce, BBQ sauce and ketchup.<br />
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One important point! Be careful with salt substitutes. Many food with "low salt" advertisements are high in potassium. Too much potassium can be dangerous for someone with kidney disease. Potassium is mainly excreted with kidney. Patient with chronic kidney disease have decreased kidney function and as such have excretion of potassium. Make sure to look at the nutritional facts for the food. Avoid high potassium foods. Work with your kidney doctor (nephrology) or dietitian to find low-sodium foods that are also low in potassium.<br />
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<span style="font-size: x-small;">Sources:</span><br />
<span style="font-size: x-small;">http://www.healthaliciousness.com/articles/what-foods-high-sodium.php</span><br />
<span style="font-size: x-small;">http://www.cdc.gov/salt/</span><br />
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Ardavan Mashhadian D.O.<br />
Nephrologist<br />
1400 S Grand Ave Suite 615, Los Angeles, CA 90015<br />
(213) 537-0328</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com5Huntington Park, CA, USA33.9816812 -118.2250725000000133.929012199999995 -118.30575350000001 34.0343502 -118.14439150000001tag:blogger.com,1999:blog-3103456710512455363.post-79396746759886443642014-11-17T15:12:00.000-08:002020-05-12T16:34:09.459-07:00Kidney Stone Lifestyle Changes <div dir="ltr" style="text-align: left;" trbidi="on">
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1. Drink 2 L of water. Make sure you are measuring this! It is really easy to think you have increased fluid intake with only few glasses of water. I recommend to buy a 1 L bottle of water and measure your water intake. (If you have heart failure, kidney failure or liver disease, discuss this with your doctor first as you can easily accumulate fluid). Drinking water helps you with digestion and prevents constipation. In addition, drinking water helps excreting toxins through your kidney. Try to form a habit of drinking 2 L water per day. This habit will encourage you to live healthy and actually helps with weight loss. Leave the bottle of water at your work and on your table. This way, by seeing the bottle on your table, you slowly form this habit. This is an excellent way of forming healthy habits and avoid kidney stones.<br />
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2. The most common cause of kidney stone is calcium oxalate. Even if you have other kind of kidney stones, calcium oxalate usually complicates the picture. As such, it is highly important to avoid the diet that contains the oxalate! Cola beverages, coffee, and tea should be limited to two cups a day because these fluids contain oxalate. Remember, I said avoid oxalate and not the calcium! One of the common mistakes that I hear from my patients and occasionally from physicians is to decrease calcium intake as well. This is a mistake. You should continue to have normal calcium intake. The normal calcium intake in gut will bind to oxalate and prevents it from absorption from the intestine.<br />
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3. Drinking lemonade made from fresh lemons or lemon juice may help reduce the risk of kidney stone formation. Lemon juice increases the level of citrate in the urine which in turn prevents the formation of kidney stones. Citrate will increase the solubility of the stones in your urine. It helps with preventing new kidney stone formation AND shrinking the previous kidney stones. Remember this is part of life style modification. Depending to the size and kind of your kidney stone, you may need procedures or medications. Do not forget to follow up with your physician closely. Discuss this different life style modifications with your doctor. As a nephrologist and a kidney doctor, I love it when my patients come to clinic prepared to ask questions about their health. This tells me they are proactive.</div>
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4. Decrease salt intake to 2 gram per day. (A tablespoon of salt contains 2,325 mg of salt.) What does salt have to do with kidney stones? The higher salt intake, the more kidney has to excrete the salt. In this process, kidney will also excrete other electrolytes that will make you prone to forming kidney stones. Limiting salt intake has 2 benefits. First, limiting salt intake is important with controlling hypertension. Secondly, by limiting salt intake, you prevent new kidney stone formation or worsening of existing kidney stone. </div>
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5. Eat a healthful amount of calcium. Many people think that if they have kidney stone, they need to decrease their calcium intake. On the contrary, you need healthful amount of calcium. Please read # 2 point above. I explained this in detail. But again, if you have kidney stones, you should not limit calcium intake. Normal calcium intake is highly important. </div>
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6. Moderating consumption of animal protein such as: red meat, poultry, eggs, and seafood. Animal proteins increased uric acid levels in your body. High levels of uric acid will increase your chance of gout and uric acid kidney stones. In addition, a high-protein diet reduces levels of citrate, the chemical in urine that helps prevent stones from forming. Now I don't say do not eat meat. The key is moderation. Limit your daily meat intake to a quantity that is no bigger than a pack of playing cards. This is also a heart-healthy portion.</div>
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7. Decrease consumption of oxalate-rich foods. The highest amounts of oxalate are found in dark-green leafy vegetables such as kale, beet greens, okra, spinach, and swiss chard. Other plants that are rich in oxalate include instant coffee, rhubarb, starfruit, soy nuts, tofu, soy yogurt, soy milk, beets, and sweet potatoes. Limiting consumption of these foods may help prevent calcium oxalate stones from forming. </div>
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8. Discuss the over the counter medications that you are using with your doctor. Over the counter medications do not need FDA approval and some of them contain substances that can damage your kidney or worsen your kidney disease.<br />
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What kind of kidney stone do you have? Were you ever hospitalized? Do you know if you have any kidney damage from the stone?<br />
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<u>Resources</u>:<br />
http://health.usnews.com/health-conditions/urology/kidney-stones/prevention<br />
http://www.health.harvard.edu/blog/5-steps-for-preventing-kidney-stones-201310046721<br />
http://kidney.niddk.nih.gov/KUDiseases/pubs/kidneystonediet/<br />
<br />
Ardavan Mashhadian D.O.<br />
Nephrologist<br />
1400 S Grand Ave Suite 615, Los Angeles, CA 90015<br />
(213) 537-0328<br />
<br /></div>
</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com1Los Angeles, CA, USA34.0522342 -118.243684933.2099567 -119.5345784 34.8945117 -116.95279140000001tag:blogger.com,1999:blog-3103456710512455363.post-54281001624994295282014-11-02T10:47:00.000-08:002017-12-25T13:45:50.572-08:00Living Kidney Donation: Act of Kindness from the Donors but no Incentives from the Government<div dir="ltr" style="text-align: left;" trbidi="on">
When I started my nephrology fellowship training, I was saddened with the quality of life our dialysis patients live. I started this blog with the goal of dedicating time and effort to add some quality to these patients lives.<br />
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Dialysis patients are by far the most complicated patients in medical field. Even with their best adherence to medical therapy, their survival is only 20%. Yet, if they get a living kidney donation, they can live much longer with close to normal quality of life.<br />
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As a society, we have focused for paying medical bills for the dialysis patient but have not looked at how to provide incentives to encourage living kidney donation. I have seen this youtube video and was blow away with the facts this speaker presented. Please look at this video and let me know what do you guys think are possible incentives that might increase living kidney donation.<br />
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<div style="text-align: center;">
<iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/Xy1BBjeU60Q" width="560"></iframe><br />
<br />
<div style="text-align: start;">
Ardavan Mashhadian D.O.</div>
<div style="text-align: start;">
Nephrologist</div>
<div style="text-align: start;">
1400 S Grand Ave Suite 615, Los Angeles, CA 90015</div>
<div style="text-align: start;">
(213) 537-0328</div>
</div>
</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com2Los Angeles, CA, USA34.0522342 -118.243684933.2099567 -119.5345784 34.8945117 -116.95279140000001tag:blogger.com,1999:blog-3103456710512455363.post-20041000011588231052014-10-26T20:11:00.000-07:002017-12-25T13:46:07.323-08:00Home Dialysis Los Angeles<div dir="ltr" style="text-align: left;" trbidi="on">
There are 2 kinds of home dialysis modalities:<br />
1. Home hemodialysis<br />
2. Home peritoneal dialysis.<br />
<br />
Home dialysis has several benefits when compared to in-center hemodialysis. In both choices of home dialysis, patients receive more frequent dialysis session than in-center hemodialysis. As such, they have better blood pressure control. This may reduce stress on the heart and blood vessels.<br />
<br />
Patients on home dialysis and nocturnal dialysis are able to eat more and use fewer medications. In addition, patients can do more of their daily activities and continue working.<br />
<br />
If you are on home dialysis and planning to travel, you need to talk to your dialysis nurses. They are usually available 24 hours - 7 days of the week. They will arrange for you for either hemodialysis or continuing peritoneal dialysis at your destination. <br />
<br />
Patients who do home dialysis are more involved in their care, and as such, are more proactive in living healthy and getting better. On the other hand, in-center hemodialysis patients have better support group as they meet with nursing staff and case managers on regular basis.<br />
<br />
When making a decision about the type of treatment, you should take into consideration that home dialysis is usually a daily process, similar to the working of the kidney and may be more gentle with fluid removal from the body. Both home peritoneal dialysis and home hemodialysis are excellent choices in treatment on end stage renal disease patients. They are both as effective form of dialysis as in-center hemodialysis.<br />
<br />
There are some people for whom home dialysis may not be appropriate. Home dialysis requires independent patients with good family and social support that can help the patient in this process. Home dialysis is not for everyone. People must receive training and be able to perform correctly each of the steps of the treatment. A trained helper may also be used.<br />
<br />
<div style="text-align: center;">
<iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/64OhD_NfwOc" width="560"></iframe>
<br />
<div style="text-align: start;">
Ardavan Mashhadian D.O.</div>
<div style="text-align: start;">
Nephrologist</div>
<div style="text-align: start;">
1400 S Grand Ave Suite 615, Los Angeles, CA 90015</div>
<div style="text-align: start;">
(213) 537-0328</div>
</div>
</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com2Los Angeles, CA, USA34.0522342 -118.243684933.2099567 -119.5345784 34.8945117 -116.95279140000001tag:blogger.com,1999:blog-3103456710512455363.post-25124972865034875202014-06-22T08:25:00.001-07:002020-05-12T16:23:29.205-07:00Peritoneal Dialysis Frequently Asked Questions Part 5<div dir="ltr" style="text-align: left;" trbidi="on">
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This is Peritoneal Dialysis Frequently Asked Questions Part 5<br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked.html">Click here for Part 1</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_15.html">Click here for Part 2</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_16.html">Click here for Part 3</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_20.html">Click here for Part 4</a><br />
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<b>15. Can I remain sexually active once I begin dialysis?</b><br />
Yes. You are encouraged to maintain a normal lifestyle. Some patients may experience a decrease in sexual drive. If this becomes a problem for you, talk to your doctor. Decrease sexual drive on dialysis is multifactorial. If you are feeling sad or depressed, please make sure to talk to your doctor. Some peritoneal dialysis patients find it difficult to accept a permanent PD catheter. They worry that the catheter may affect their sexual activity and their relationship with their partner. Peritoneal dialysis nurses can help with tips on how to disguise the PD catheter.National Kidney Foundation has a very good and detailed page on sex and dialysis which you can access by <a href="http://www.kidney.org/atoz/content/sexuality.cfm" target="_blank">clicking here</a>.<br />
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<b>16. </b><b>S</b><b>hould I cancel my current Insurance?</b><br />
This is a good question. Most of the patients when they start dialysis have many questions about the insurance and their coverage. Each insurance is different and have different requirement. The social worker will do everything for you. Do not worry about insurance too much. The social worker will be in touch with your insurance and try to arrange everything for you. Do not cancel any insurance policy without discussing your options with your social worker. Being on dialysis will qualify you for medicare. Discuss your options with your dialysis center social worker.<br />
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<b>17. How will I get the supplies I need for peritoneal dialysis?</b><br />
Supplies will be delivered to your home on a regular basis. A nurse will order your first shipment. A customer service representative will call you to set up future deliveries. Make sure to keep the information for you supplier so you can easily reach them. If you ever had any difficulties, call your peritoneal dialysis team. They will help you to get your peritoneal dialysis supplies. Make sure to not wait until the last day to order the new supplies. Also, if you are planning to travel, make sure to talk to your peritoneal dialysis team and supplier in advance so they can arrange the dianeal fluid to be sent to your destination. To access you Baxter account <a href="https://www.ecomm.baxter.com/css/welcome.do" target="_blank">Click Here</a>. If you need to contact Baxter <a href="https://www.ecomm.baxter.com/css/bcontactusjsp.do" target="_blank">Click Here</a>. This is a video of peritoneal dialysis delivery if you would like to watch. <a href="http://youtu.be/pepIWKRTVqE" target="_blank">Video</a><br />
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<b>18. How often will I need peritoneal dialysis? </b><br />
Peritoneal dialysis is done every night. At night time, you or your loved one will connect you to the peritoneal dialysis machine and in the morning, you will get disconnected and can go to work. One of the benefit of the peritoneal dialysis is that because you do dialysis on daily basis, your fluid balance is well controlled and as such your blood pressure will be better controlled. Another benefit of peritoneal dialysis is that it gives the patients much autonomy and ability to continue life and have active life style. Your doctor will determine your exact peritoneal dialysis “prescription.” You can always talk to your doctor about your daily activities and see if he/she can change the prescription to be suitable to your lifestyle. If you are going to travel, make sure to arrange for the peritoneal dialysate (fluid for PD) to be delivered there in advance. You peritoneal dialysis team can help you with that. In addition, if you are going to miss a peritoneal dialysis session, make sure to contact you dialysis team and update them.<br />
<br />
This is Peritoneal Dialysis Frequently Asked Questions Part 5<br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked.html">Click here for Part 1</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_15.html">Click here for Part 2</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_16.html">Click here for Part 3</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_20.html">Click here for Part 4</a><br />
<br />
<div style="text-align: center;">
<iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/kBX4bD10MXM" width="560"></iframe><br />
<br />
<div style="text-align: start;">
Ardavan Mashhadian D.O.</div>
<div style="text-align: start;">
Nephrologist</div>
<div style="text-align: start;">
1400 S Grand Ave Suite 615, Los Angeles, CA 90015</div>
<div style="text-align: start;">
(213) 537-0328</div>
</div>
</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com4Los Angeles, CA 90024, USA34.0631451 -118.4367551000000334.0105301 -118.51743610000003 34.1157601 -118.35607410000003tag:blogger.com,1999:blog-3103456710512455363.post-89479444603417613812014-06-20T09:11:00.001-07:002020-05-12T16:24:02.200-07:00Peritoneal Dialysis Frequently Asked Questions Part 4<div dir="ltr" style="text-align: left;" trbidi="on">
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<div class="separator" style="clear: both; text-align: center;">
</div>
This is Peritoneal Dialysis Frequently Asked Questions Part 4<br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked.html">Click here for Part 1</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_15.html">Click here for Part 2</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_16.html">Click here for Part 3</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_20.html">Click here for Part 4</a><br />
<br />
<b>11. </b><b>How long does a peritoneal dialysis treatment take?</b><br />
Peritoneal dialysis is done every day at night time. The average time is about 8-10 hours, depending on what your doctor prescribes. Some patients may need to have an additional exchange during the day. Since peritoneal dialysis is done every day, patients' blood pressure is much better. In addition, because peritoneal dialysis is done at home, it can be very time saving for patients. If you are going to travel or miss your dialysis, make sure to call your peritoneal dialysis team and let me know.<br />
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<b>12. How long will it take me (or a family member/caregiver) to learn to do the treatment?</b><br />
This is a very good question. The reality is some people may need more time. The important thing is to not rush. In addition, always call your dialysis team if any questions comes up. Remember, asking question is a good sign. It means you care about doing your treatment in best way. And this will make your dialysis team happy. Do not get frustrated. Frustration will not help you. Establish a good relationship with your peritoneal dialysis team especially the nurses. Make sure you have their 24 hours number handy.<br />
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<b>13. What happens to my job? Can I continue to work? </b><br />
The answer to this question depends to your overall wellbeing. In my experience, peritoneal dialysis patients remain more independent compared to hemodialysis patients. Peritoneal dialysis is done mostly at night time. In addition, your doctor can change the prescription so it can fit your schedule better. Many peritoneal dialysis patients continue to work. Sometimes, hours or duties may need to be changes. Continuing to work helps dialysis patients to retain a better quality of life and have higher self satisfaction. Do not take guilt feeling or be shy at work because your kidneys have failed. This was not your fault. Also, ask around at work and see if any of co-workers is interested to participate in a blessing act of kidney donation. Remember, it does not hurt to ask!<br />
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<b>14. Will I qualify for disability?</b><br />
Once you start peritoneal dialysis, your doctor and peritoneal dialysis team will see you on monthly basis. They will evaluate your health and type of work environment to determine if you can continue your job. If you are unable to work, your social worker will help you determine what benefits you are entitled to and how to apply. Do not fall in the trap of taking a sick patient role. Continuing your job and profession can have many positive psychological benefits in addition to financial benefits. One of the distinguishing factors in peritoneal dialysis is that you can continue to work. Now I understand some times, this will not be possible. Talk to your dialysis team. They will try to help you through this. If your dialysis team and you decided not to continue work, the social worker will assist you with different benefit plan. This is noting to be ashamed off. Dialysis team and social worker will assist you to improve your financial shortcomings.<br />
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This is Peritoneal Dialysis Frequently Asked Questions Part 4<br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked.html">Click here for Part 1</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_15.html">Click here for Part 2</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_16.html">Click here for Part 3</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_20.html">Click here for Part 4</a><br />
<br />
<div style="text-align: center;">
<iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/LriX7okbAqU" width="560"></iframe><br />
<br />
<div style="text-align: start;">
Ardavan Mashhadian D.O.</div>
<div style="text-align: start;">
Nephrologist</div>
<div style="text-align: start;">
1400 S Grand Ave Suite 615, Los Angeles, CA 90015</div>
<div style="text-align: start;">
(213) 537-0328</div>
</div>
</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com4tag:blogger.com,1999:blog-3103456710512455363.post-75685801563049117362014-06-16T08:16:00.000-07:002020-05-12T16:25:06.906-07:00Peritoneal Dialysis Frequently Asked Questions Part 3<div dir="ltr" style="text-align: left;" trbidi="on">
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This is Peritoneal Dialysis Frequently Asked Questions Part 3<br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked.html">Click here for Part 1</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_15.html">Click here for Part 2</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_16.html">Click here for Part 3</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_20.html">Click here for Part 4</a><br />
<br />
<b>8. How will dialysis affect my family?</b><br />
Family and social support is very very important in dialysis patients. As you start peritoneal dialysis, some of the roles in family will change. With peritoneal dialysis, you will be able to remain much more independent than hemodialysis. Remember, you will need your family for support as you begin dialysis, and your family will need your support as well. It is hard to see a loved one starting dialysis. Some patients start becoming frustrated on dialysis and may start blaming themselves or their family members. Try to stay positive. Family members are very important. I can not stress enough on this. Make sure to take your family members to the dialysis unit too. This way, they will see some of the challenges you are facing. In addition, try to make a close friendship with your family members and dialysis team. When you get referral to a transplant center, one of the main things they look at is who is your family members and how much social support you have to help you through transplant. Also remember, family members could be best possible source of kidney donation.<br />
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<b>9. Will I still take the same medications once I start dialysis?</b><br />
This is a good question. I know as a patient with kidney disease, you may have many medications to take. Your nephrologist (kidney doctor) will decide what medications are needed once you begin dialysis. No new medications (over-the-counter or prescriptions from other doctors) should be taken without checking with your nephrologist. If any doctor starts you on new medications, let them know that you are on peritoneal dialysis. Different medications need different dose adjustment once a patient native kidneys fail and start peritoneal dialysis. Always always always have an updated list of your medications and their dosages you are taking and show it to your dialysis team. If the dialysis team wants to change or add new medication write down their name and indications. Remember, try to stay active. It is easy to lose hope and be passive. If you want to get better, you need to stay positive and take role. Be involved.<br />
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<b>10. Will I qualify for Medicare to help pay for the peritoneal dialysis?</b><br />
Yes. In United States all dialysis patients qualify for medicare. Your dialysis unit social worker will assist you with Medicare and other sources that might be available to help pay for dialysis. Each peritoneal dialysis center should have at least one social worker. Try to know the social worker closely. These people can make your life much easier. Talk to them. Let them know about what you do. Tell them your financial and social needs. The dialysis social workers have resources to help you in many ways. Before your monthly peritoneal dialysis check up, take a piece of paper and write down your questions and difficulties you face on peritoneal dialysis. The dialysis team and social worker will try to help you with them.<br />
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This is Peritoneal Dialysis Frequently Asked Questions Part 3<br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked.html">Click here for Part 1</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_15.html">Click here for Part 2</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_16.html">Click here for Part 3</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_20.html">Click here for Part 4</a><br />
<br />
<div style="text-align: center;">
<iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/6R0IPg0g0Rk" width="420"></iframe><br />
<br />
<div style="text-align: start;">
Ardavan Mashhadian D.O.</div>
<div style="text-align: start;">
Nephrologist</div>
<div style="text-align: start;">
1400 S Grand Ave Suite 615, Los Angeles, CA 90015</div>
<div style="text-align: start;">
(213) 537-0328</div>
</div>
</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com2tag:blogger.com,1999:blog-3103456710512455363.post-11812373470421984082014-06-15T08:29:00.003-07:002020-05-12T16:25:39.993-07:00Peritoneal Dialysis Frequently Asked Questions Part 2<div dir="ltr" style="text-align: left;" trbidi="on">
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This is Peritoneal Dialysis Frequently Asked Questions Part 2<br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked.html">Click here for Part 1</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_15.html">Click here for Part 2</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_16.html">Click here for Part 3</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_20.html">Click here for Part 4</a><br />
<br />
<b>4. Is Peritoneal Dialysis a painful therapy?</b><br />
Contrary to hemodialysis, there is no needle involved in peritoneal dialysis. As such it should not be painful. Occasionally, after the dialysis catheter is inserted, abdominal discomfort may occur for one week. If discomfort continues, adjustments can usually be made to your dialysis exchange. Always report pain or discomfort to your doctor or nurse. Pain at the exit site or around it can mean skin infection or even more importantly peritonitis. If you start having pain or abdominal discomfort, you should notify your peritoneal dialysis team. They will obtain culture of abdominal fluid and try to treat you accordingly.<br />
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<b>5. Will my kidneys ever work again?</b><br />
The answer to the question depends to what was the underlying reason for kidney loss. Some patients have had chronic kidney disease for many years, and now, their disease has progressed to end stage renal disease. On the other hand, some patients has had acute kidney injury and may recover some kidney function. Some of the patients on dialysis still make urine. This does not mean that they can come off of dialysis. One of the most important issues is to prevent further deterioration in kidney function. This requires close follow up with dialysis team and avoid any medications that can cause kidney damage such as contrasted imaging.<br />
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<b>6. I still make urine, so why do I need to start dialysis now?</b><br />
Kidney's job is to control your body's fluid status, correct your electrolytes, and get rid of toxins. Making urine is only part of what kidneys do. Dialysis will help you to get rid of extra fluid, balance your electrolytes and more importantly get rid of toxins. Many patients, at first, are hesitant to start dialysis. They associate dialysis with death and pain. However, many of these patients start feeling much better after few sessions of dialysis. This is because dialysis helps to remove many toxins from their body that had been gradually accumulate with decrease in kidney function. In addition, once patients start on dialysis, they start feeling bette, more energetic, and can continue their normal activities. Make sure you ask your dialysis team to refer you to transplant center as soon as possible to be evaluated for kidney transplant. Also make sure to ask around from friends, family members, and church people to see if they like to be a donor.<br />
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<b>7. What will happen if I miss a dialysis treatment?</b><br />
This depends to the patient's residual renal function and whether the patient does hemodialysis or peritoneal dialysis. Missed treatments allow waste products and extra fluid to build up in your body, which often leads to health problems. Peritoneal dialysis patients are on dialysis seven days of the week. As such peritoneal dialysis patients fluid status is much better that hemodialysis patients. Also toxins are removed in continuos manner vs hemodialysis patient that receive dialysis 3 times per week. If you are going to miss a dialysis session you need to inform you dialysis team.<br />
<br />
This is Peritoneal Dialysis Frequently Asked Questions Part 2<br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked.html">Click here for Part 1</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_15.html">Click here for Part 2</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_16.html">Click here for Part 3</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_20.html">Click here for Part 4</a><br />
<br />
<div style="text-align: center;">
<iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/pepIWKRTVqE" width="420"></iframe><br />
<br />
<div style="text-align: start;">
Ardavan Mashhadian D.O.</div>
<div style="text-align: start;">
Nephrologist</div>
<div style="text-align: start;">
1400 S Grand Ave Suite 615, Los Angeles, CA 90015</div>
<div style="text-align: start;">
(213) 537-0328</div>
</div>
</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com1tag:blogger.com,1999:blog-3103456710512455363.post-49748410206578125192014-06-13T11:40:00.002-07:002020-05-12T16:25:52.726-07:00Peritoneal Dialysis Frequently Asked Questions Part 1<div dir="ltr" style="text-align: left;" trbidi="on">
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</div>
This is Peritoneal Dialysis Frequently Asked Questions Part 1<br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked.html">Click here for Part 1</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_15.html">Click here for Part 2</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_16.html">Click here for Part 3</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_20.html">Click here for Part 4</a><br />
<br />
When I see patients in PD clinic, I encounter similar questions. This page should answer many commonly asked questions regarding peritoneal dialysis in different languages. If you have any other questions, please write it on this blog post, and I will try to answer them to the best of my ability.<br />
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<b>1. How often will I have to come in for check ups?</b><br />
Most dialysis centers would like to see their patients at least once a month unless your doctor or nurse instruct you otherwise. If you are not sure, call you PD nurse. There should be a 24 hour nurse available to answer questions. Remember, on each visit, the doctor will go over you lab results and try to optimize your dialysis. Studies show, patients who have good followup with their dialysis team, have good compliance and better outcomes.<br />
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<b>2. Do I need a special place to do my dialysis?</b><br />
One of the most important issues with PD is the setup. Another words, if you dedicate a special place for PD machine and have all the materials ready in one place, it should make it easier for you to connect yourself to the PD machine. Hand hygiene is very important. In addition, the room that you choose to do your dialysis in should be clean and free of clutter, have good lighting and have enough room for all the dialysis supplies.<br />
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<b>3. How long will I need to undergo this therapy?</b><br />
This is a very good question. If you are asking this question, it means you want to get better as soon as possible. With advanced kidney disease, dialysis or kidney transplant is a lifelong therapy. That being said, keep in mind that with other organ failures, such as heart failure and liver failure, there is no such therapy like dialysis to keep patient alive and functioning. In addition, if you have good follow up with your dialysis team and otherwise in good health, you should be referred to a transplant center as soon as possible. Remember, ask around from family members, relatives, friends, and church members to see if they are willing to donate their kidneys. Do NOT be shy. Do NOT be ashamed. Being on dialysis is not your fault. A lot of people would love to be part of such a good act and make a difference.<br />
<br />
This is Peritoneal Dialysis Frequently Asked Questions Part 1<br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked.html">Click here for Part 1</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_15.html">Click here for Part 2</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_16.html">Click here for Part 3</a><br />
<a href="http://www.kidneylosangeles.com/2014/06/peritoneal-dialysis-frequently-asked_20.html">Click here for Part 4</a><br />
<br />
<div style="text-align: center;">
<iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/qKAA4tpr0pU" width="420"></iframe><br />
<br />
<div style="text-align: start;">
Ardavan Mashhadian D.O.</div>
<div style="text-align: start;">
Nephrologist</div>
<div style="text-align: start;">
1400 S Grand Ave Suite 615, Los Angeles, CA 90015</div>
<div style="text-align: start;">
(213) 537-0328</div>
</div>
</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com1tag:blogger.com,1999:blog-3103456710512455363.post-50493620366839584062014-06-12T09:21:00.002-07:002017-12-25T13:48:43.850-08:00How to do Peritoneal Dialysis?<div dir="ltr" style="text-align: left;" trbidi="on">
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<tr><td class="tr-caption" style="text-align: center;"><a href="http://www.pinterest.com/amashhadian/peritoneal-dialysis/">http://www.pinterest.com/amashhadian/peritoneal-dialysis/</a></td></tr>
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There are 2 ways to do dialysis. 1. Hemodialysis and 2. Peritoneal dialysis. When I discuss starting dialysis on my patients, I will talk to them about both.<br />
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However, personally I like peritoneal dialysis more because patient has much mo autonomy. In addition, with peritoneal dialysis, you can control extra fluid more easily, and this may reduce stress on the heart and blood vessels. With peritoneal dialysis you are able to eat more and use fewer medications. You can do more of your daily activities and it is easier to work or travel.<br />
<br />
However, unfortunately, there are some people for whom peritoneal dialysis may not be appropriate. The abdomen or belly of some people, particularly those who are morbidly obese or those with multiple prior abdominal surgeries, may make peritoneal dialysis treatments difficult or impossible. Peritonitis (infection of abdomen) is an occasional complication although should be infrequent with appropriate precautions. When making a decision about the type of treatment, you should take into consideration that peritoneal dialysis is usually a daily process, similar to the working of the kidney and may be more gentle with fluid removal from the body.<br />
<br />
Peritoneal dialysis is an effective form of dialysis, has been proven to be as good as hemodialysis.Peritoneal dialysis is not for everyone. People must receive training and be able to perform correctly each of the steps of the treatment. A trained helper may also be used.<br />
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<div style="text-align: center;">
<iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/dyNjWyF1H8M" width="560"></iframe>
<br />
<div style="text-align: start;">
<br /></div>
<div style="text-align: start;">
Ardavan Mashhadian D.O.</div>
<div style="text-align: start;">
Nephrologist</div>
<div style="text-align: start;">
1400 S Grand Ave Suite 615, Los Angeles, CA 90015</div>
<div style="text-align: start;">
(213) 537-0328</div>
</div>
</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com0tag:blogger.com,1999:blog-3103456710512455363.post-79855868878036288482014-03-19T20:37:00.003-07:002017-12-25T13:50:08.625-08:00Living Donor Outcomes in Kidney Trasnplantation<div dir="ltr" style="text-align: left;" trbidi="on">
A major concern about living donors is the long-term impact of uninephrectomy on risk of hypertension, proteinuria, and chronic kidney disease. One of the more important recent reports regarding the long-term impact of living donation has been provided by Ibrahim and colleagues. This report described almost 3,700 kidney donors who donated kidneys over 44 years. At a mean of 12 years after donation, 85% of a subset of the living donors had a GFR of 60 ml/min or higher, 32.1% had hypertension, and 12.7% had albuminuria. Older age and a higher body mass index, but not a longer time since donation, were associated with both a lower GFR and hypertension. More time from donation was independently associated with albuminuria. Most importantly, the survival of kidney donors was similar to that of controls matched for age, gender, and ethnicity. ESRD developed in 11 donors, a rate of 180 cases per million persons per year, compared with a rate of 268 per million per year in the general population. Most donors had quality-of-life scores that were better than population norms, and the prevalence of coexisting conditions was similar to that among controls from the National Health and Nutrition Examination Survey (NHANES) who were matched for age, sex, race or ethnic<br />
group, and BMI.<br />
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Ibrahim HN, Foley R, Tan L, Rogers T, Bailey RF, Guo H, Gross CR, Matas AJ: Long-term consequences of kidney donation. N Engl J Med 360: 459–469, 2009<br />
<br />
1400 S Grand Ave Suite 615, Los Angeles, CA 90015</div>
</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com0tag:blogger.com,1999:blog-3103456710512455363.post-10297220524208986862014-03-19T06:52:00.000-07:002017-12-25T13:50:23.869-08:00Overall Outcomes for Living Kidney Donors<div dir="ltr" style="text-align: left;" trbidi="on">
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<tr><td class="tr-caption" style="text-align: center;"><a href="http://www.pinterest.com/amashhadian/kidney-donation/" target="_blank">http://www.pinterest.com/amashhadian/kidney-donation/</a></td></tr>
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Accurate information about the effects of donor nephrectomy is important in counseling potential live kidney donors. Issues involve both the short-term risk – the risks of surgery and the immediate peri-operative period – and the long-term risks – overall health and specifically the function of the remaining kidney. Review of peri-operative mortality and long-term survival from registry data in over 80,000 live kidney donors from 1994 through 2009 revealed an overall 90 day mortality rate of 3.1 per 10,000 live donor nephrectomies. Surgical mortality was higher in men than women (5.1 vs. 1.7 per 10,000) and in African American/Hispanic compared with white donors (7.6 vs 2.6 per 10,000). Neither increased donor age, smoking, nor obesity (BMI > 30) was associated with higher surgical mortality. The long-term survival of living kidney donors was no different than that of age- and co-morbidity-matched <span style="font-size: 11pt;">National Health and Nutrition Examination Survey</span> participants for all patients stratifies by age, sex, and race. Obesity is a common issue in potential live donors: a review of the OPTN database of over 5,000 live donors with known BMI data who donated over a 1.5 year period between July 2004 and December 2005 revealed that 40% were overweight, 17.8% were obese (BMI 30-35) and 4.7% were very obese (BMI >35). At baseline and at 6 month follow-up, higher BMI was associated with higher systolic BP, but changes in BP were similar across the groups. There were no apparent differences in decline in GFR or percent change in serum creatinine across these categories of obesity in 6 month follow-up. Others studies have shown that there is no greater decline in renal function in obese patients compared with non-obese patients. Lifetime risk of requiring renal replacement therapy after kidney donation is less than 1%.<br />
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Tavakol, MM, Vincenti, FG, Assadi, H, Frederick, MJ, Tomlanovich, SJ, Roberts, JP, Posselt, AM:<br />
Long-term renal function and cardiovascular disease risk in obese kidney donors. Clin J Am Soc<br />
Nephrol 4:1230-8, 2009<br />
<br />
Nogueira, JM, Weir, MR, Jacobs, S, Breault, D, Klassen, D, Evans, DA, Bartlett, ST, Cooper, M: A study<br />
of renal outcomes in obese living kidney donors. Transplantation 90:993-9, 2010<br />
<br />
Reese, PP, Feldman, HI, Asch, DA, Thomasson, A, Shults, J, Bloom, RD: Short-term outcomes for<br />
obese live kidney donors and their recipients. Transplantation 88:662-71, 2009<br />
<br />
Axelrod, DA, McCullough, KP, Brewer, ED, Becker, BN, Segev, DL & Rao, PS: Kidney and pancreas<br />
transplantation in the United States, 1999-2008: the changing face of living donation. Am J Transplant<br />
10:987-1002, 2010<br />
<br />
Davis, CL, Cooper, M: The state of U.S. living kidney donors. Clin J Am Soc Nephrol 5:1873-80, 2010<br />
<br />
Segev, DL, Muzaale, AD, Caffo, BS, Mehta, SH, Singer, AL, Taranto, SE, McBride, MA, Montgomery,<br />
RA: Perioperative mortality and long-term survival following live kidney donation. JAMA 303:959-66, 2010<br />
<br />
Lentine, KL, Schnitzler, MA, Xiao, H, Saab, G, Salvalaggio, PR, Axelrod, D, Davis, CL, Abbott, KC,<br />
Brennan, DC: Racial variation in medical outcomes among living kidney donors. N Engl J Med<br />
363:724-32, 2010<br />
<br />
<br />
Ardavan Mashhadian D.O.<br />
Nephrologist<br />
1400 S Grand Ave Suite 615, Los Angeles, CA 90015<br />
(213) 537-0328<br />
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<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com0tag:blogger.com,1999:blog-3103456710512455363.post-28541878855002361062014-01-31T10:54:00.001-08:002017-12-25T13:50:38.775-08:00Future of Human Kidney Transplant<div dir="ltr" style="text-align: left;" trbidi="on">
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<tr><td class="tr-caption" style="text-align: center;"><a href="http://www.pinterest.com/amashhadian/regenerative-nephrology/"><span style="font-family: "times" , "times new roman" , serif; font-size: small;">http://www.pinterest.com/amashhadian/regenerative-nephrology/</span></a></td></tr>
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<span style="color: #222222; font-family: "times" , "times new roman" , serif; line-height: normal;">Since starting my training in the field of nephrology, my biggest dream has been to see my patients independent of dialysis and having a normal life. Kidney represents the human organ in highest demand among 120,000 U.S. patients waiting for organ donations. </span></div>
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<span style="color: #222222; font-family: "times" , "times new roman" , serif; line-height: normal;">The usual and most frequent source of kidneys for transplantation has been donation before cardiac death, formerly known as the heart-beating cadaveric donor. The increasing worldwide discrepancy between the availability and need for renal allografts has led to the increasing use of alternative sources of organs, including donation after cardiac death and live donors. </span></div>
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<span style="color: #222222; line-height: normal;"><span style="font-family: "times" , "times new roman" , serif;">Approximately 18 people die every day waiting for an organ transplant. But that may change someday sooner than you think -- thanks to 3D printing.</span></span></div>
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<span style="color: #222222; font-family: "times" , "times new roman" , serif; line-height: normal;">Over a year ago, I started this blog when I saw printing human kidney shown on TED.com.</span><span style="color: #222222; font-family: "times" , "times new roman" , serif; line-height: normal;"> </span><span style="font-family: "times" , "times new roman" , serif;"><span style="color: #222222; line-height: normal;">L</span><span style="color: #222222; line-height: normal;">ike other forms of 3D printing, bio-printing lays down layer after layer of live cells to form a solid human tissue. The major stumbling block in creating tissue continues to be manufacturing the vascular system needed to provide it with life-sustaining oxygen and nutrients.</span></span></div>
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<span style="font-family: "times" , "times new roman" , serif;"><span style="color: #222222; line-height: normal;">Researchers hope that new generations of 3D printers can use living human cells to build replacement organs — especially organs such as livers, hearts and kidneys.</span><br style="color: #222222; line-height: normal;" /><br style="color: #222222; line-height: normal;" /><span style="color: #222222; line-height: normal;">A 3D-printed kidney, like other 3D-printed replacement organs, likely won't become a reality within the next 10 or 15 years, researchers say. But they plan to use the simplified, miniature versions of 3D-printed organs created so far as guinea pigs for pharmaceutical drug testing — an idea that could help scientists to discover drugs suitable for humans more efficiently and ethically than animal testing.</span></span></div>
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<span style="color: #222222; line-height: normal;"><span style="font-family: "times" , "times new roman" , serif;">Currently, there are about 120,000 people on the organ waiting list in the U.S., and even those who receive a donated organ face the prospect of ongoing medical challenges because of organ rejection issues. However, if a patient's own stem cells could be used to regenerate a living organ, rejection would become moot.</span></span></div>
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<span style="font-family: "times" , "times new roman" , serif;"><span style="color: #222222; line-height: normal;">To date, the researchers have been able to create a piece of tissue the size of a thumbnail and keep it alive for two weeks.</span></span></div>
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<span style="font-family: "times" , "times new roman" , serif;"><span style="color: #222222;"><span style="color: #666666;">What do you guys think about this technology? Could this be a reality or a </span>science<span style="color: #666666;"> fiction?</span></span>
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Ardavan Mashhadian D.O.<br />
Nephrologist<br />
1400 S Grand Ave Suite 615, Los Angeles, CA 90015<br />
(213) 537-0328<br />
<br /></div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com0tag:blogger.com,1999:blog-3103456710512455363.post-10415240128531920492013-11-10T09:21:00.004-08:002020-05-12T16:28:15.102-07:00Is antioxidant therapy beneficial for people with chronic kidney disease?<div dir="ltr" style="text-align: left;" trbidi="on">
People with chronic kidney disease (CKD) have high risk of developing heart disease and dying prematurely. Although heart disease has many causes, damage caused by poor oxygen exchange in the body’scells (oxidative stress) is thought to be a major problem.<br />
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People withCKD often have evidence of oxidative stress and this is positively associated with the rate of kidney disease progression. A cochrane systemic review assessed how antioxidant therapy influenced outcomes for patients with CKD. Overall, we found that antioxidant therapy did not reduce the risk of heart disease or death in people with CKD, but that this could vary depending on CKD stage.<br />
<br />
There was some evidence to suggest that people on dialysis may benefit from antioxidant treatment, and that these therapies could reduce the risk of kidney disease becoming worse. However, these results are based on very limited evidence and further studies are needed to confirm if antioxidant therapy could be of benefit for people with CKD.<br />
<br />
Ardavan Mashhadian D.O.<br />
Nephrologist<br />
1400 S Grand Ave Suite 615, Los Angeles, CA 90015<br />
(213) 537-0328<br />
<div>
<br /></div>
</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com2tag:blogger.com,1999:blog-3103456710512455363.post-22605379204874777972013-07-04T08:35:00.002-07:002017-12-25T13:51:02.398-08:00Dialysis Introduction<div dir="ltr" style="text-align: left;" trbidi="on">
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<br />
Ardavan Mashhadian D.O.<br />
Nephrologist<br />
1400 S Grand Ave Suite 615, Los Angeles, CA 90015<br />
(213) 537-0328</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com0tag:blogger.com,1999:blog-3103456710512455363.post-73150940459324683552013-06-21T11:47:00.001-07:002017-12-25T13:51:14.580-08:00Chronic Kidney Disease & High Blood Pressure<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="color: black; font-family: "arial";">Control of hypertension is the single most important intervention to delay progression of chronic kidney disease (CKD). Extracellular fluid volume expansion is one of the most important factors leading to persistent hypertension in patients with CKD. Older individuals and black patients are more likely to be salt-sensitive and exhibit an antihypertensive response to sodium restriction or diuretic therapy. <br /><br />If hypertension and proteinuria persist despite sodium restriction, the addition of a diuretic may be beneficial. Thiazide diuretics, if not used as a first-choice antihypertensive drug, are almost always indicated as an additional drug in patients with incompletely controlled hypertension, because these agents augment most other agents used as monotherapy. <br /><br />Most hypertensive patients will require more than one antihypertensive drug to lower BP below target levels. The combination of diuretics with renin-angiotensin system (RAS) antagonists offers several advantages to include additive BP-lowering efficacy and enhanced reductions in urinary protein excretion. Thiazide diuretics are associated with metabolic complications that are particularly evident when used in high doses. When used in combination with RAS blockade, metabolic complications such as hypokalemia are minimized. The avoidance of hypokalemia has been linked to less thiazide-induced glucose intolerance. Patient persistence on therapy is dependent on well tolerated drug combinations.</span><br />
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Ardavan Mashhadian D.O.<br />
Nephrologist<br />
1400 S Grand Ave Suite 615, Los Angeles, CA 90015<br />
(213) 537-0328</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com0tag:blogger.com,1999:blog-3103456710512455363.post-34341957872589554192013-06-21T07:53:00.001-07:002020-05-12T16:28:46.458-07:00Resistant Hypertension<div dir="ltr" style="text-align: left;" trbidi="on">
Resistant hypertension is defined as blood pressure that remains above goal despite treatment with the optimal dosage of three antihypertensive agents, including a diuretic.<br />
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Patient characteristics more likely to be associated with resistant hypertension include:<br />
1. Older age<br />
2. BMI above 30<br />
3. Higher baseline blood pressure<br />
4. Diabetes mellitus<br />
5. Black race.<br />
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Excessive consumption of dietary salt and alcohol contributes to resistant hypertension. Many patients with resistant hypertension have secondary hypertension caused by primary aldosteronism or renovascular hypertension, and these conditions should be excluded.<br />
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Treatment of resistant hypertension should include appropriate lifestyle modifications, discontinuation of agents that may increase blood pressure such as NSAIDs, and correction of secondary causes of hypertension. Mineralocorticoid receptor antagonists are particularly effective in treating resistant hypertension even in the absence of hyperaldosteronism. The Anglo-Scandinavian Cardiac Outcomes Trial evaluated the efficacy of spironolactone among 1411 participants with an average age of 63 years who received this medication mainly as a fourth-line antihypertensive agent for uncontrolled blood pressure. After 1 year of treatment, blood pressure in these patients decreased by approximately 21.9/9.5 mm Hg.<br />
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Ardavan Mashhadian D.O.<br />
Nephrologist<br />
1400 S Grand Ave Suite 615, Los Angeles, CA 90015<br />
(213) 537-0328</div>
</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com0tag:blogger.com,1999:blog-3103456710512455363.post-10105155354628397602013-06-20T07:49:00.000-07:002020-05-12T16:29:30.290-07:00Managing High Blood Pressure<div dir="ltr" style="text-align: left;" trbidi="on">
Lifestyle modifications are recommended for all patients with hypertension, including prehypertension. The Dietary Approaches to Stop Hypertension (DASH) study showed that 8 weeks of a diet of fruits, vegetables, low-fat dairy products, whole grains, poultry, fish, and nuts, along with a reduction in fats, red meat, and sweets, caused an 11.4-mm Hg decrease in systolic pressure and a 5.5-mm Hg decrease in diastolic pressure. In addition, patients using the DASH diet who consumed less than 100 mmol/d of sodium had a systolic pressure 3 mm Hg and a diastolic pressure 1.6 mm Hg less than those who consumed high amounts of sodium.<br />
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Weight reduction in a patient whose weight is 10% above ideal body weight lowers blood pressure by an average of 5 to 7 mm Hg. Alcohol consumption should be limited to two drinks daily for men and one for women, because excess amounts of alcohol may contribute to hypertension and resistance to antihypertensive medications. Regular aerobic exercise also modestly decreases blood pressure. In addition, patients should be counseled about smoking cessation.<br />
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The goal of treatment of hypertension is to reduce cardiovascular morbidity and mortality by lowering blood pressure. Lowering blood pressure has definitively been shown to reduce stroke, myocardial infarction, heart failure, and overall cardiovascular mortality. Evidence obtained from clinical trials suggests that the goal of antihypertensive treatment is to reduce blood pressure to below 140/90 mm Hg in the general population. The American Heart Association recommends a blood pressure target of 130/80 mm Hg for those with coronary artery disease, carotid artery disease, peripheral artery disease, abdominal aortic aneurysm, and a Framingham 10-year risk score of 10% or greater. However, data clearly demonstrate a linear, progressive increased risk of ischemic heart disease and stroke in patients with blood pressures higher than 115/75 mm Hg, which suggests that these targets may be too high. Clinical trials addressing lower blood pressure targets are currently being planned.</div>
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Ardavan Mashhadian D.O.<br />
Nephrologist<br />
1400 S Grand Ave Suite 615, Los Angeles, CA 90015<br />
(213) 537-0328<br />
<br /></div>
</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com4tag:blogger.com,1999:blog-3103456710512455363.post-43742211000873296752013-04-13T14:49:00.000-07:002017-12-25T13:51:38.525-08:00Code Status<div dir="ltr" style="text-align: left;" trbidi="on">
Few days ago, I saw a perfectly healthy nurse in emergency department as a patient. He was worried that he had been exposed to carbon monoxide. He had a patient in hospital for a long time that had brain injury from exposure to carbon monoxide. Now he was worried for similar outcomes. I checked his blood gas, reassured him and sent him home. <br />
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Few days later, I saw Mr. M a 35 year old man with history of kidney stones transferred from nursing home to hospital for evaluation of decrease mentation. As soon as he arrived, emergency physicians rushed to him, placed a large line on him and started fluid and antibiotics. Mr. M was cold, clammy and unable to provide any history. So I called his parents.<br />
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His mother picked up the phone and in a calm tone told me that she was aware that he was in hospital again. Mr. M had suffered anoxic brain injury at age 19 when he was working on his car and got exposed to carbon monoxide. Since then, he has developed mental retardation and has become bed bound.<br />
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I looked at Mr. M vitals. He was very sick and unstable. After the first round of resuscitation, I call his mother again. As I was dialing the numbers, I was thinking to myself how to update the family and respectfully ask them about his code status at 2 o'clock in the morning. I thought to myself, over a decade had passed from the accident. During this time, his parent must have seen many different physicians and spent many hours in emergency department and hospitals. The nursing staff told me, Mr. M had been hospitalized many times and family requested full code during the previous admissions.<br />
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I knew Mr. M only for few minutes, and I was not sure how to approach the family about the code status. After thinking about this for few minutes, I decided to actually share my dilema with the mother. After updating her, I told her how difficult it was for me to bring this subject. I told her about my feelings. This time, she started to cry.<br />
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My shift was almost over. As I was preparing my documents for sign-off, the ICU resident came to bedside and told me Mr. M parents had decided to change his code status to DNR (Do Not Resuscitate).<br />
<br />
Ardavan Mashhadian D.O.<br />
Nephrologist<br />
1400 S Grand Ave Suite 615, Los Angeles, CA 90015<br />
(213) 537-0328</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com0tag:blogger.com,1999:blog-3103456710512455363.post-70992155541781044782013-03-09T20:38:00.002-08:002017-12-25T13:51:55.742-08:00Dialysis Access<div dir="ltr" style="text-align: left;" trbidi="on">
Dialysis patients have many comorbidities. This ranges from heart disease all the way to vision problems. One of the biggest comorbidites with dialysis patients is the management of dialysis access. Unfotunately, I see a lot of hospital admissions for acute dialysis. Due to lack of access, hospital doctors are forced to place a central-line in the neck or groin and start dialysis as soon as possible. The central line placement and management is much more difficult than managing AV fistula. In additon, it exposes the patients to higher risk of infection, bacteremia, and infective endocarditis. <br />
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Chronic kidney patients need to stablish care with a caring nephrologist and start being prepared for dialysis in stage 4-5. A close follow up is required to make sure volume status and electrolytes are monitored. This prevents such patients present to emergency room in need of acute dialysis with no prepration. <br />
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The best dialysis access is AV fistula which takes 4-6 months before it is ready to be used. Unfortunately many patients start dialysis with temporarly access line in hospital, and then switched to tunneled cath dialysis access. Finally if they have good followup, the AV fistula access is placed. And even then, some the fistulas fail before they are ready to be used or take 6 months to mature. <br />
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As you see, the process gets longer and longer and meanwhile patient is exposed to high risk of blood borne infections. In fact, it is not uncommon to find some patients to be dependent on these central-lines for a longtime before they present to hospital for severe infection.<br />
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The treatment of temporarly dialysis central line is a nightmare. Why? Because most of the times, the treatment requires the removal of these lines and leave patient with no access for dialysis. Even worse is when the temporarly dialysis line has been in the body for such a long time that blood clots have formed around it. <br />
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The management of line infection in dialysis patients requires close cordination between nephrologist, cardiologists, hopital physicians, surgeons, and Interventional radiologist. As you see, the process becomes more and more difficult. Prolong hospitalization of such patients exposes them to more infections and complications. <br />
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It is very important to stablish care with nephrologist early in the process. This way, many complications can be avoided. AV fistula placement before need of acute dialysis decreases morbidity and mortality.<br />
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What access did you or your loved one used for dialysis for the first time?<br />
<br />
Ardavan Mashhadian D.O.<br />
Nephrologist<br />
1400 S Grand Ave Suite 615, Los Angeles, CA 90015<br />
(213) 537-0328<br />
<br />
<br /></div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com1tag:blogger.com,1999:blog-3103456710512455363.post-68733442685260443372013-02-05T11:32:00.003-08:002017-12-25T13:52:03.030-08:00Peritoneal Dialysis Complications<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><u><br class="Apple-interchange-newline" />Complications</u></b><br />
1. Peritonitis and Catheter-Related Infections: Peritonitis is thought to occur most often by touch contamination, but may also occur in the setting of a catheter exit site or tunnel infection. Patients with peritonitis usually present with cloudy peritoneal fluid and abdominal pain. Infections due to gram-positive cocci (Staphylococcus epidermidis and Staphylococcus aureus) tend to be most common (60–70% episodes) compared to infections with gram-negative bacteria (15–25%) or fungi (2–3%). Treatment should be continued for a total of 2 weeks, while more severe infections due to S aureus, pseudomonas, or multiple gram-negative organisms should be treated for 3 weeks. Patients should be taught to perform routine exitsite care in order to prevent catheter infections. Daily cleansing with antibacterial soap and water is recommended by most centers. The daily application of mupirocin or gentamicin cream to the exit site has been shown to be effective in reducing catheter infections and related peritonitis.<br />
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2. Mechanical Complications such as hernia, scrotal or labial edema.<br />
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3. Encapsulating Peritoneal Sclerosis: a rare but serious condition characterized by extensive intraperitoneal fibrosis and encasement of bowel loops.<br />
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4. Ultrafiltration Failure<br />
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5. Metabolic Complications<br />
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<u><b>Indications for peritoneal dialysis catheter removal:</b></u><br />
1. Refractory peritonitis: failure to respond to appropriate antibiotics within 5 days<br />
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2. Fungal peritonitis<br />
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3. Relapsing peritonitis<br />
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4. Peritonitis in the setting of severe exit site or tunnel infection<br />
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5. Peritonitis due to multiple enteric organisms in the setting of a surgical abdomen<br />
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<b><u>Dietary modifications:</u></b><br />
A protein intake of at least 1.2 g/kg is recommended for PD patients.<br />
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National Kidney Foundation has great handbook. To view please <a href="http://www.kidney.org/atoz/pdf/peritonealdialysis.pdf" target="_blank">Click Here</a><br />
For information on nutrition and peritoneal dialysis please <a href="http://www.kidney.org/atoz/pdf/nutri_pd.pdf" target="_blank">Click Here</a><br />
<br />
Ardavan Mashhadian D.O.<br />
Nephrologist<br />
1400 S Grand Ave Suite 615, Los Angeles, CA 90015<br />
(213) 537-0328<br />
<br />
<br /></div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com3tag:blogger.com,1999:blog-3103456710512455363.post-69139976564653255352013-02-05T11:30:00.001-08:002017-12-25T13:52:12.400-08:00Types of Peritoneal Dialysis<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><u>Types of Peritoneal Dialysis</u></b><br />
1. Continuous Ambulatory Peritoneal Dialysis: In CAPD dialysis solution is constantly present in the abdomen, typically being exchanged four to fives times per day, 7 days per week. The dialysis fluid is exchanged manually by the patient using the force of gravity to drain and fill the abdomen.<br />
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2. Automated Peritoneal Dialysis: In APD a cycler machine automatically exchanges fluid into and out of the abdomen for the patient. The cycler draws dialysis solution from larger bags (usually 5 L), which it warms to the desired temperature. The patient usually spends between 8 and 10 hours a night on the cycler, disconnects from the cycler in the morning after a final fill is delivered, and then is free to go about daily activities.<br />
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3. Intermittent Peritoneal Dialysis: IPD is a form of PD that is usually performed in a hospital or in a dialysis center. It is usually reserved for patients with acute renal failure or end-stage renal failure and sometimes for patients immediately after catheter placement who are uremic and need more urgent dialysis.<br />
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Not all patients' peritoneal membranes transport solute at the same rate. In clinical practice, a patient's peritoneal membrane transport characteristics can be determined by measuring the creatinine equilibration curve and the glucose absorption curve during a standardized peritoneal equilibration test (PET). Patients are classified principally into one of four transport categories: high, high-average, low-average, and low. High transporters tend to do better on regimens that have frequent, short duration dwells, such as APD, whereas low transporters tend to do better on regimens with longer duration dwells, such as CAPD. Average transporters are generally able to do well on a variety of PD regimens.<br />
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National Kidney Foundation has great handbook. To view please <a href="http://www.kidney.org/atoz/pdf/peritonealdialysis.pdf" target="_blank">Click Here</a><br />
For information on nutrition and peritoneal dialysis please <a href="http://www.kidney.org/atoz/pdf/nutri_pd.pdf" target="_blank">Click Here</a><br />
<br />
Ardavan Mashhadian D.O.<br />
Nephrologist<br />
1400 S Grand Ave Suite 615, Los Angeles, CA 90015<br />
(213) 537-0328</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com0tag:blogger.com,1999:blog-3103456710512455363.post-17210038528413486872013-02-05T11:19:00.003-08:002017-12-25T13:52:18.926-08:00Peritoneal Dialysis Indications and Contraindications<div dir="ltr" style="text-align: left;" trbidi="on">
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<tr><td class="tr-caption" style="text-align: center;"><a href="http://pinterest.com/amashhadian/peritoneal-dialysis/" target="_blank">http://pinterest.com/amashhadian/peritoneal-dialysis/</a></td></tr>
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Peritoneal dialysis (PD) PD is a form of dialysis in which a dialysis solution is instilled in the peritoneal cavity, periodically drained, and exchanged with fresh solution through a single, indwelling peritoneal catheter. It is a established form of renal replacement <span style="text-align: center;">therapy that is used around the world. United States Renal Data System (USRDS) data </span><span style="text-align: center;">from 1998 to 2002 indicate that the prevalent PD population decreased by 3.5% per year, </span>with only 8% of prevalent dialysis patients being treated with PD in 2002. In contrast to the experience in the United States, the prevalent number of patients with end-stage renal disease receiving PD has exceeded 60% in other countries, such as in Mexico and Hong Kong. The cause for these differences is likely multifactorial and is related to access to PD, physician expertise, patient mix, and reimbursement.<br />
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<b><u>Indications:</u></b><br />
1. PD continues to be the preferred dialysis modality for infants and young children<br />
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2. Patients with severe hemodynamic instability on hemodialysis<br />
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3. Patients with difficult vascular access<br />
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<b><u>Contraindications:</u></b><br />
1. The one absolute contraindication to chronic PD is an unsuitable peritoneum due to the presence of extensive adhesions, fibrosis, or malignancy.<br />
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2. Abdominal hernias<br />
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3. Presence of colostomy, ileostomy, nephrostomy, or ileal conduit<br />
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4. Recurrent chronic backache with preexisting disc disease<br />
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5. Severe psychological and social problems<br />
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6. Severe diverticular disease of the colon<br />
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7. Severe neurologic disease, movement disorder, or severe arthritis preventing self care. (caregivers can be trained to perform the peritoneal dialysis)<br />
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8. Severe chronic obstructive pulmonary disease<br />
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9. Malnutrition<br />
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Studies investigating differences in patient mortality between PD and hemodialysis (HD) have been conflicting. Most reports have shown no significant difference in survival between PD and non-diabetic HD patients.<br />
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<iframe allowfullscreen="" frameborder="0" height="315" src="http://www.youtube.com/embed/IQKQ4eoKfTg" width="560"></iframe>
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National Kidney Foundation has great handbook. To view please <a href="http://www.kidney.org/atoz/pdf/peritonealdialysis.pdf" target="_blank">Click Here</a><br />
For information on nutrition and peritoneal dialysis please <a href="http://www.kidney.org/atoz/pdf/nutri_pd.pdf" target="_blank">Click Here</a><br />
<br />
Ardavan Mashhadian D.O.<br />
Nephrologist<br />
1400 S Grand Ave Suite 615, Los Angeles, CA 90015<br />
(213) 537-0328</div>
<div class="blogger-post-footer">Please sign-up for my KIDNEY DISEASE blog. This is free and help to spread quality improvement measures for life of patients with chronic kidney disease. </div>dr.mashhadianhttp://www.blogger.com/profile/06119161841465431798noreply@blogger.com0