In March 2017, articles on staffing requirements, consolidation in the dialysis market, and an unusual application of an automobile manufacturing technique were the most read posts on our site. Our Facebook followers were particularly intrigued by a story of a dialysis patient removed from the transplant waiting list for smoking medical marijuana, a case study on hemodiafiltration, and the stories of two home dialysis patients.

Dialysis providers, union take sides in California over staffing ratios

‘“It’s like a factory. We put them on and take them off.’ That complaint has been heard from nurses and patient care technicians before in the dialysis field,” wrote Mark Neumann in his article about a bill in California that would create mandatory staffing ratios, establish a minimum transition time, and increase the frequency of inspections. “There is little time to spend with the patient sitting 3 ½ to four hours in the dialysis chair. Turnaround between shifts is tight.”

Since Mark’s article was posted, the bill has passed committee in California.

The kidney care community appears to be torn on the subject. Dialysis providers are clearly against the bill, but some nurses and patients have expressed support.

“Absent from prior considerations about ways to reduce hospital admissions among dialysis patients has been the role of evidence-based clinic staffing standards,” wrote William A. Wolfe, MSW, in his July 2016 article, Is it possible to reduce hospital admissions through evidence-based clinic staffing? “There is already preliminary evidence on clinic staffing which can serve as a basis for additional research and the eventual establishment such standards.”

This bill, and the controversy surrounding it, supports his argument that there is a need for more research on clinic staffing and dialysis patient outcomes.

FTC: DaVita must divest 7 clinics as a condition of acquiring Renal Ventures

The Federal Trade Commission is requiring DaVita Kidney Care to divest its ownership interest in seven dialysis clinics as a condition of acquiring Renal Ventures Management LLC. The divestiture of the clinics, five in New Jersey and its suburbs and two in the Dallas area, would resolve charges that the acquisition is anticompetitive.

It’s no surprise that the dialysis industry has continued the consolidation trend, and requiring clinic divestitures after mergers and acquisitions is fairly common. Renal Ventures Management was the 8th largest dialysis provider in 2015, operating 36 dialysis clinics in six states.

Applying Lean principles to dialysis clinic operations, part 1 

Can a production technique used by Japanese car makers be adapted for health care clinics and hospitals? One nephrology group in Poland thinks so.

“Consider that in both cases there are work processes that use operating resources that interact to create added value,” Katarzyna Zlotowska and Douglas C. Wood wrote in their article Applying Lean principles to dialysis clinic operations, part 1, published in the march issue of NN&I.

“In both cases there is a ‘medication’ that can increase added value and reduce waste and non-value added time along with expenses. The philosophy of lean management using the appropriate methods to eliminate unnecessary activities and losses (time, money, resources) will also increase the quality, safety and efficiency of processes. Lean takes note of quality indicators, patient and employee expectations, and patient flows in processes. Lean uses clearer communication with an appropriate system of information signaling and creates overall smoother process flow.”

Part 2 covers activities and costs relating to the investments, monitoring, and waste. You can read it here.

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Kidney patient taken off transplant list for using medical marijuana

The most popular post in March on NN&I’s Facebook page concerned medical marijuana and the transplant list. According to a WGME CBS 13 news article, Garry Godfrey, a dialysis patient in Augusta Maine was taken off the kidney transplant list for using medical marijuana. Godfrey has Alport syndrome and said the legal marijuana helped him deal with the pain, nausea, and anxiety the disease caused.

A spokesperson for the transplant center said “Our drug use policy currently prohibits transplant candidates from using marijuana, due to the risk of an invasive fungal infection known as Aspergillosis.”

Many states are legalizing marijuana, both medicinal and recreational use.  But the kidney care community does not have universal regulations to handle its use among dialysis patients and transplant recipients.

“Areas of concern [for transplant patients who smoke marijuana] include susceptibility to fungal infections, possible interaction with the metabolism of immunosuppressants and co-existing behavioral disturbances,” Madhusudan Vijayan, MBBS and Ajay K Singh, MBBS, FRCP, MBA, wrote in the article Recreational use of marijuana: Current experience and information for nephrologists, published in the April issue of NN&I.

“Previously, marijuana users were commonly denied kidney transplants, but physician attitudes towards this have been changing. Now experts have begun emphasizing behavioral assessment of these patients to rule out any negative influence of smoking marijuana on their socio-economic conditions. Seven states have disallowed physicians from rejecting potential transplant recipients solely on the basis of the use of medical marijuana. Transplant centers usually ask kidney donors to stop smoking tobacco and marijuana for 6-12 weeks prior to organ donation.”

Commenters on NN&I’s Facebook page expressed a mix of outrage over Godfrey being removed from the list and support for the transplant center, and suggested that he look into getting on multiple lists to increase his chance of transplantation.

The ROI on ultrapure water for dialysis: A case study

“While U.S. dialysis providers say achieving ultrapure water is expensive, one Canadian program that cares for pediatric patients has made the investment and sees the rewards as part of a new hemodiafiltration clinic,” Mark Neumann wrote in his article published in the March issue of NN&I.

The Dialysis and Apheresis team at The Hospital for Sick Children in Toronto (SickKids) is the first in North America to use HDF for pediatric care.

“We have found that patients have more energy, live with fewer diet and fluid restrictions, and have closer to normal development,” said Christoph Licht, MD, the Medical Director of Nephrology at SickKids. who first looked at outcomes for hemodiafiltration overseas before starting the SickKids program. Licht’s team is now doing research to compare patient outcomes after transitioning from hemodialysis to hemodiafiltration.

Chronic Kidney Disease: The long-term battle

“When I see the daily battle my patients endure to lead a full and normal life, I am reminded of the story in Greek Mythology of Sisyphus, the founder and king of Corinth,” wrote Leslie Spry, M.D., FACP, in his article, Chronic Kidney Disease: The long-term battle, published March 22 in The Huffington Post.

Spry interviewed two individuals who have been performing frequent home hemodialysis treatments for more than 10 years. Both patients started dialysis before they turned 18, and have worked hard to lead normal lives, despite their chronic illness.