The next answers will come from Seattle after I get there on Thursday lunchtime, numbed, after having crossed both the dateline (gone back to live the same day all over again) and countless time-zones.
I do love Seattle though. It is my favorite US city … maybe because we lived there for a while or maybe its just that I get to see rain there = something we have in very short supply here!
I only wish the ADC would hold their meeting there every year! At this years’ meeting, I am going to try to persuade those who will listen that there is far more to ‘good dialysis’ than just Kt/V. I have designed what I am calling a ‘good dialysis index’.
My GDI may be a bit too ‘touchy-feely’ and ‘patient-oriented’ for some of the doctors there … it contains a mix of markers that I think matter when assessing the worth and value of good dialysis … but it definitely has a ‘less science and more art’ feel to it than most nephrologists would be used to … it will be certainly be that way for some (maybe most) of my colleagues … but on behalf of you lot out there, the dialysis patients, I am going to have a go at it.
I believe that good dialysis is more than just fitting a mathematical formula … but then, that is for another day. Let’s see if I get out alive first!
I love Seattle too! But I don’t know if it will rain while you’re there. The forecast is for sunny, and Seattle has ALWAYS been sunny when I’ve been there. Even in January. See you soon!
I’ve only been to Seattle once. So I’m looking forward to the conference as well. When I left Chicago this morning there was still snow on the ground, even though it’s been receding. I can already smell Spring in the air. But since Seattle has so much rain, I brought my raincoat.
I’m anxious to hear your talk. Kt/V as a measure for dialysis adequacy has to be challenged. The truth is we shouldn’t be measuring adeqacy at all, but should be looking at optimal dialysis. You go mate, and let the other nephs have it. I’m going to try to do the same in my talk.
A short post-script to the ADC
The ADC was, as usual, a highly successful conference. It is a healthy and useful blend of medical, nursing, industry and consumer flavours and though Richard Berkowitz at the NxStage users site bemoans the lack of exposure of consumer opinion, my own view was that there was both opportunity for and actual contributions from consumers at many levels throughout the conference.
In fact, one of the most spell-binding hours I have spent in many a long time was in a session with the unlikely title of ‘Arranging your life when dialysis comes home: the ‘underwear’ factor!’ … a ‘consumer’ presentation given in tandem by Linda Gromko and Jane McClure. Jane is an interior designer from Seattle and Linda, I think, is an MD who is also the wife of a home dialysis patient (I hope I have that right).
Their session imaginatively showed how easily and cost effectively home haemodialysis and all the storage and ‘stuff’ that goes with it can be sensitively, tastefully and space-consciously built-in to an existing home or apartment using some simple guidelines and thought to design. I think you can find Jane @ http://www.arrange2live.org/ or at http://www.twotheninesdesign.com. She has a book out ‘Arranging your life when dialysis comes home - the Underwear Factor’. It is well worth considering! It deals beautifully with something we often just dont do … or dont do well … and I commend her and her book to you.
There are some nice post-ADC blogs at Bill Peckham’s site … http://www.billpeckham.com/ … for those interested. I would hasten to add that the concept of dialysis-related ‘myocardial stun’ that has so caught the attention of some bloggers at Bill’s site is far from a new concept. There are many known contributors: rapidly changing potassium concentrations: vasoreactive substance release and activation: acute downward changes in coronary artery filling pressures as acute and rapid volume depletion occurs to name a few … and oh, wouldn’t if be beaut if a study could be done in long slow and frequent dialysis regimens to show that ‘stun’ does not occur in this dialysis model - as I suspect it would not - but do not know that it would not …
… but that is likely wishful thinking!
You can also find our webinar with Linda and Jane on the home page (http://www.homedialysis.org)–just scroll down under Webinars.