Nephrology nursing journal : journal of the American Nephrology Nurses' Association
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Sepsis is the second leading cause of death in patients with end stage renal disease (ESRD) on hemodialysis (HD). The average cost to the healthcare system for catheter-related infections (CRI) ranges from $4000 to $80,235 for each occurrence. CRI is a significant health problem leading to increased hospitalizations, morbidity, mortality, and a financial burden to the healthcare system. ⋯ The projected annual savings in one dialysis unit was $141,606 using the project hospital's data and $179,010 using national data. CRI in patients on HD are preventable. The analysis revealed a significant reduction in CRI by implementing published guidelines with a significant cost savings to the healthcare system.
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Erythropoiesis stimulating agents (ESAs) have revolutionized the management of anemia of chronic kidney disease (CKD). Peginesatide is an investigational pegylated, peptide-based, once-monthly ESA for increasing and maintaining hemoglobin (Hb). In phase 2 studies, peginesatide increases and maintains target Hb levels in patients with CKD, both those on hemodialysis and those not on hemodialysis; phase 3 trials have recently been completed. This article discusses unmet needs in the management of anemia of CKD, presents peginesatide attributes, reviews the results of select peginesatide clinical studies, and discusses the potential value of peginesatide as an alternative anemia management option.
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The occurrence of a hypercoagulable state and decreasing concentration of ADAMTS 13 in late pregnancy and during the postpartum period increases the risk for a woman to develop life-threatening thrombotic thrombocytopenic purpura (TTP). This is also the time of great risk for the more common obstetric complications of preeclampsia; eclampsia; and hemolysis, elevated liver functions tests, low platelets (HELLP) syndrome. These conditions are associated with high maternal and perinatal mortality. ⋯ Management of microangiopathic disorders encountered during pregnancy differ; therefore, an accurate diagnosis is required. Outcomes of TTP without plasma exchange therapy (TPE) are almost uniformly fatal. Early recognition and management of symptoms with prompt and aggressive TPE is essential when TTP is suspected.
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Globally, critical care environments within health care organizations strive to provide optimal quality renal replacement therapy (RRT), an artificial replacement for lost kidney function. Examination of RRT delivery model literature and a case study review of the multidisciplinary-mixed RRT delivery model utilized within a closed medical surgical intensive care unit illustrates the organizational and clinical management of specialized resource and multidisciplinary roles. The successful utilization of a specific RRT delivery model is dependent upon resource availability.