Seminars in dialysis
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Seminars in dialysis · Jan 2011
Case ReportsAbdominal catastrophe in a 43-year-old female with end stage renal disease.
A 43-year-old female with end-stage renal disease secondary to focal segmental glomerulosclerosis was admitted to the hospital for shortness of breath after missing hemodialysis. On admission, the patient was noted to have painful skin lesions consistent with calciphylaxis on biopsy. While undergoing aggressive wound care, she developed altered mental status and was found to be septic and started empirically on broad-spectrum antibiotics. ⋯ The patient expired on day 26 of admission. An autopsy revealed calciphylaxis within the gut wall and within the dura of the central nervous system. While typically a disorder of subcutaneous tissue, calciphylaxis can affect internal organs, which in this case resulted in a catastrophic outcome.
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Seminars in dialysis · Jan 2011
EditorialCherry picking in ESRD: an ethical challenge in the era of pay for performance.
In poorly designed pay-for-performance schemes in which case mix adjustments are not adequate, self-interest could lead nephrologists toward cherry picking dialysis patients. Cherry picking, however, is morally problematic. ⋯ Second, it involves shifting the burden of caring for sicker (and less financially attractive) patients to other nephrologists and dialysis units that do not practice cherry picking, creating injustices in the health care system. Finally, it treats patients as mere means through which nephrologists achieve reimbursement instead of as persons possessing dignity and deserving of respect.