Kidney International - Peritoneal dialysis in Mexico

Kidney International - Peritoneal dialysis in Mexico: "- Sent using Google Toolbar"

CKD 2 - Treatment Options: Dialysis

A Great Options Presentation.

Joe Dialyzer on PD

P D an Awesme Option!!!

Are the days of kidney dialysis numbered? | Health Tech - CNET News

Are the days of kidney dialysis numbered? Health Tech - CNET News

Gambro

         Very recently I have made a change in my practice of Dialysis. The organization I am working with now uses predominately Gambro Dailysis equipment. I have in my history used the Gambro CVVH machine.  I will now be using The Phoenix Machine by Gambro in my daily practice and I am excited as it seems to be an excellent machine!

Causes, Growing Organs for people who need them.

Causes

NKF 60 YEARS!!!

http://kidney.informz.net/z/cjUucD9taT04OTIxMTAmcD0xJnU9NzYxMDY4MjY0JmxpPTM2MTUzNDU/index.html

Transplants!!!

                        Very Excited to report THREE Kidney Transplants in my system this past week! Two adults and one small child were the recipients. One of the adults received from a related donor and the others from the transplant list. The child was in need of a Kidney and a Liver and therefore received the liver transplant too! All these transplants done at Strong Memorial Hospital, University of Rochester, Rochester,NY.  Transplant, an awesome option!

One soldier's death helps the lives of 74 - TwinCities.com

One soldier's death helps the lives of 74 - TwinCities.com

How Saving Umbilical Cords Saves Lives

How Saving Umbilical Cords Saves Lives

KDOQI Publishes US Commentary

KDOQI Publishes US Commentary on KDIGO's Guideline for Kidney Transplant Recipients July 2010  The KDOQI US Commentary on the 2009 KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients is now available on American Journal of Kidney Diseases' (AJKD) website. Click here to read the entire Commentary.  Dr Margaret Bia, MD of Yale University School of Medicine and the primary author of the KDOQI commentary, outlined the main messages: 1. In the US, decisions about immunosuoppressive medication such should always be done by or in concert with the transplant center. 2. KDIGO recommendations provide an excellent road map to guide clinicians in the complex care of the kidney transplant recipient but should not be used as the basis of policy because of the paucity of guidelines that are based on a strong level of evidence. 3. The Guideline stresses the need for continued monitoring of recipient's kidney function and drug levels, with frequent use of kidney biopsy to determine causes of graft dysfunction even after the early post-transplant period. 4. Control of risk factors to prevent cardiovascular disease, opportunistic infection and skin cancer, as outlined in the Guideline has now become a major part of good post transplant care.  "KDOQI collected a work group of US transplant nephrologists and surgeons to develop the commentary, which supports many of KDIGO's international recommendations while focusing on implementation and application of guidelines to local practice in the United States. The commentary also serves as an important guide for all clinicians who care for kidney transplant recipients," said Dr Jeffrey Berns of the University of Pennsylvania School of Medicine, Vice Chair of KDOQI Guidelines and Commentaries.  All KDOQI commentaries are published in AJKD and available online at www.ajkd.org and www.kdoqi.org.

Profile Pic

I have had for some time now this combination Pic/awareness banner for my profile Pic on facebook. I just wanted to throw this post up on my blog as an encouragement to others to use this and other awareness symbols in their social networking. I know that many are already doing this and that is fantastic! I just wanted to use this Blog vehicle to promote some more promotion! Below this text I will place the Donate Life banner I use so feel free to copy and paste it into where ever. In a future post I can provide some instruction  on how to combine a pic of your choice with a banner, logo or symbol. Remember use of certain Logos can be an issue.

Transplants!!!

In my Dialysis unit we have had three Patients that have received Kidney transplants in the last 3 months and one that is pending for July! OMG it is the Ultimate option!!! Please Donate Life if you Can!!!!

NKF - Great Story!

A Kidney Transplant Turns the Doctors into Patients

Dr. Andrew Levey, a leading nephrologist at Tufts University in Boston, has thoroughly described for hundreds of patients what to expect following a kidney transplant operation. These days, however, Levey speaks with a different authority–the expertise of one who’s walked in their shoes himself.
Last December, the editor of NKF’s American Journal of Kidney Diseases and leader of the Foundation’s workgroup that created the groundbreaking definition and staging system for chronic kidney disease, became a kidney donor himself. Levey donated a kidney as part of a three-pair “kidney swap” so that his wife, oncologist Dr. Roberta Falke, could receive a kidney.
Levey and Falke, who met as medical residents, knew that ultimately they would face the challenge of kidney failure. Like her father and two of her siblings, Falke suffers from a familial disorder, polycystic kidney disease, and she expected that her own kidneys probably wouldn’t continue functioning past middle age. Falke took meticulous care of her health, regularly visiting the doctor and getting immediate treatment for acute illnesses and infections. Knowing she was doing all she could, she focused on her roles as mother to her son, Isaac, and physician to the cancer patients who relied on her. She was able to banish thoughts of her disease until she developed symptoms related to enlarging kidney and liver cysts, and advanced kidney disease, over the past three years. Although she had to reduce her work hours, she continued to practice until the week before her transplant.
For Levey, though, too much knowledge wasn’t necessarily a good thing. As a kidney specialist, he was all too familiar with every possible complication that could occur. He found it hard to relax, even before Falke showed any symptoms, because he knew what lay ahead. As a husband, he felt duty-bound to help his wife, but he also felt powerless to help restore her health by giving her a kidney, because of incompatible blood type. What he learned throughout this process, though, was that there was a path he hadn’t counted on that could provide hope and ultimately, a solution.
Up until a year or two ago, Levey hadn’t entertained the thought of participating in a paired exchange program, where kidney recipients essentially swap kidneys from willing donors. While medically eligible to donate, each donor has an incompatible blood type or positive cross match test with his or her intended recipient. By agreeing to give kidneys to unknown but compatible recipients, the donors can enable a chain of transplants when previously no transplant would have been possible.
The couple wasn’t sure that paired donor exchange could be a practical reality, so they set about trying to find a donor from among family and friends. But as time wore on, everyone they had considered as a potential donor was eliminated for one reason or another. At the same time, paired donor exchange was becoming more common, and it soon became apparent that this might be the best way for Falke to receive the gift of life.
On December 15, 2009, Levey went under a knife, expertly wielded by his trusted colleagues in his own workplace, Tufts Medical Center. He donated his kidney to Peter Scheibe. Scheibe’s wife Susan donated her kidney to Hai Nguyen, and Nguyen’s wife Vy Yeng donated her kidney to Falke. Lying in the hospital bed, Levey was struck by how different it is to be the doctor who strides into the room to check in and walks right out the door, versus the patient who is laid up in bed.
“Since donating my kidney, I can tell people exactly what to expect every day post-transplant. I always tended to be close to my patients, but now our connection is so much more direct. They feel like I’m one of them. I have done something that they hope their family members will do or already have done, and they know how important it is to them. They really feel in a way like I’m part of their families,” says Levey.
“I have clinic once a week and now when I see patients, we spend the first half of the appointment talking about Roberta and me. Eventually, I have to ask, ‘are we going to discuss your case?’ Usually, they tell me, with a wave of the hand, that we’ll get to that the next visit. They’re far more interested in how the doctor who became a patient is doing.”
Falke too has been moved by the experience. “My cancer patients are so sick themselves, yet they are all concerned about me. They want to take care of me now and to know that I’m going to be okay. I’ve truly been touched by their outpouring of support.”
Falke says that doctors who experience serious illness get a taste of what patients go through. She feels it’s helpful to know where patients are coming from in terms of the fear, vulnerability and actual physical pain. “For now,” Falke smiles, “I’ve had more than my share of experience, but I still maintain that it’s good for doctors to be on the other side every once in awhile.”
Both Falke and Levey say the donation has brought them closer together and given them hope for their own future. They’ve always been involved with the National Kidney Foundation, but now they’re thinking about participating in more of the patient programs, such as the Kidney Walk and possibly even competing in NKF’s Olympic-style U.S. Transplant Games down the road.

Dizzying Symptoms

Many Dialysis Patients are on Hydralazine.

Dizzying Symptoms

By LISA SANDERS, M.D.

Published: May 31, 2010

“I feel a swimming in my head,” mumbled the voice on the phone. Dr. Stephanie Pouch, a resident in her second year of training, wasn’t sure what to make of this elderly gentleman’s strange complaint. Was he feeling dizzy? He wasn’t sure; all he could say was that his head was “swimming” and that he almost passed out. Uncertain of the cause or even the nature of the complaint, Pouch sent the man to the emergency room. She was on call that day at the University of Chicago Medical Center. She would figure it out when he got there.
Once Pouch found the 68-year-old man in the busy emergency department, a quick glance at his chart explained his vague complaint: his blood pressure was so low it could barely be measured. Whenever he tried to stand, his blood pressure dropped even further, and his head began to swim. A look at the patient himself explained the dangerously low blood pressure: he was severely dehydrated. His eyes were dull and apathetic; his dark skin hung off the bones of his face as if it were a size too large. Beneath a graying, well-trimmed mustache, his lips were dry and cracked, and he passed an equally dry tongue across them frequently.
He was started on intravenous fluids. That would certainly help. But what happened to bring him to this state? The patient was a man of few words. But slowly, with the help of the patient’s wife, Pouch was able to put together his story. For the past several months the patient was plagued by severe diarrhea. He was in the bathroom 5 to 10 times a day. And the pattern repeated itself at night. He couldn’t remember the last time he had an uninterrupted night’s sleep. He had no pain, no fever or chills, just these endless trips to the bathroom.
As the patient spoke, Pouch’s eyes were drawn to his hands. They were covered by strange stripes of dark, thick, rough skin that started at the knuckles and extended all the way down the fingers. She gently turned one of the patient’s hands to look at the palm and found more of the same. He had the rash a long time, he told her, for weeks, maybe months. Pouch found the same rash on his back, chest and feet.
The rash was like nothing Pouch had seen before. Still, it was the diarrhea — not the rash — that brought the patient to the hospital. She forced herself to focus on the problem: what could be causing this persistent and profuse diarrhea? Pouch paged through the patient’s thick chart. He had a lot of medical problems: diabetes, atherosclerotic disease (also known as hardening of the arteries) and, usually, high blood pressure. This combination of diseases could cause diarrhea by limiting the amount of blood that reaches the intestines and starving the tissue. There were many other possible causes of severe diarrhea: infection was one; cancer another. Certain tumors can cause diarrhea by producing too much digestive hormone.
Pouch sent off samples of the patient’s stool to look for evidence of infection and blood for overproduction of hormones. The patient also needed an ultrasound of the blood vessels that feed the gut to see if blood flow was compromised.
The next morning on rounds, Pouch presented the patient to the attending physician, Dr. Vineet Arora. The more experienced Arora was worried about the patient’s prolific diarrhea, but she was also struck by the unusual rash. Could they be part of the same disease process? Patients like this man are the most difficult to assess, Arora later told me, because they have many medical problems, and it’s difficult to distinguish the foreground (the disease) from the background (the complicated and sometimes abnormal base-line state that now represents the patient’s normal condition).
There were some important diseases to consider that could cause diarrhea and a rash. Celiac disease — a sensitivity to a component of wheat known as gluten — can cause both. And the rash in celiac disease, unlike most rashes, can spread to the palms of the hands and soles of the feet. Zinc deficiency could cause both. So could a number of B vitamin deficiencies. Pouch quickly ordered a series of blood tests for these deficiencies.
Over the next several days, the patient improved significantly. His diarrhea slowed, his blood pressure rose and he could sit and stand without the dizziness that took him to the hospital. Meanwhile, test results dribbled in but provided no real answers. The ultrasound confirmed the hardening of the arteries but showed adequate blood flow to his intestines. There was no evidence of infection. He didn’t have celiac disease. It wasn’t zinc deficiency. After nearly a week, the patient was better and was sent home, though the team still didn’t know what made him sick.
A couple of days later, Arora and her team got their answer — or at least part of it. The blood tests they ordered revealed that the patient had a severe deficiency of vitamin B6. Initially, Arora was flummoxed. Vitamin B6 deficiency is rare in this country, and while it can cause pain in the hands and feet, it causes neither a rash nor diarrhea. Finally, she hit pay dirt: deficiencies of this essential nutrient caused the patient to develop a condition known as pellagra. First described by 18th-century European physicians, the name pellagra comes from an Italian description of its most common symptoms: the “rough skin” that Arora and Pouch were first struck by when examining this patient.
For centuries, the disease was thought to be caused by an infection, but we now know that pellagra comes from a deficiency of niacin. If an individual is not ingesting niacin, the body can create it, but it needs vitamin B6 to do so. In medical school we are taught that pellagra is characterized by the four Ds: diarrhea, dermatitis (rash), dementia and death. This patient had two of the four.
If this vitamin B6 deficiency explained the rash and diarrhea, what explained the vitamin B6 deficiency? Again, Arora wasn’t sure. Further reading led to the answer. The patient was taking hydralazine, a blood-pressure medication that had the side effect of eliminating vitamin B6 from the body. Hydralazine was an old blood-pressure medication that slipped from use as newer, easier-to-take medications were developed. But a few years ago a study suggested that hydralazine might be particularly useful in African-Americans. This new information brought the old medication to the current generation of doctors — and African-American patients like this one. That hydralazine can also cause a vitamin deficiency was common knowledge in this medication’s first life but seems to have been forgotten in its reprise.
Now the story was beginning to make sense: the hydralazine caused the vitamin-B6 deficiency, which, in turn, led to the niacin deficiency and pellagra. The patient’s diarrhea caused the low blood pressure. While he was in the hospital, the doctors were not giving him hydralazine because his blood pressure was low. Without the hydralazine the patient was able to absorb vitamin B6 and make niacin. By the time he was discharged, the diarrhea had improved strikingly. Arora contacted Dr. Kevin Thomas, the patient’s primary-care physician, who immediately started him on vitamin B6 supplements. The diarrhea resolved completely within a week; the remarkable rash disappeared over the next two weeks.
Arora and Pouch presented this case to other doctors and found that few of them were aware of this side effect of hydralazine. “Why don’t we know this anymore?” Arora asked me, amazed. “If this medicine is going to be used again, then doctors definitely need to know about this problem.”

Lisa Sanders is the author of “Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis.”
If you have a solved case to share with Dr. Sanders, you can e-mail her at lisa.sandersmd@gmail.com. She is unable to respond to all e-mail messages.

By LISA SANDERS, M.D.

Published: May 31, 2010

Renal Caregivers - KDOQI EDUCATION (Survey)

KDOQI EDUCATION PUTTING GUIDELINES INTO PRACTICE Participate in our survey Dear Friend, The National Kidney Foundation's (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI™) is recognized throughout the world for providing evidence-based clinical practice guidelines and transforming the care of patients with kidney disease. KDOQI expanded its scope of work in 2009. In addition to guideline development and commentaries, KDOQI also supports targeted research, advocates public policy positions consistent with KDOQI guideline recommendations and develops implementation and education tools for KDOQI guidelines. In order to help better define future roles for KDOQI education, we would like to hear from you about our programs and how we can improve our resources. Please take a moment to complete our survey. Click here. Your thoughts will be a great asset to NKF and KDOQI. Warm Regards, Michael Choi, MD Vice Chair of KDOQI Education Michael Rocco, MD KDOQI Chair WWW.KDOQI.ORG

Moment of Truth

I am a Nurse working full time in a Home Peritoneal Dialysis program. A large part of of my job is training new patients to do their treatments at home. Also in our system it is often necessary to train a spouse or assistant caregiver to aid the patient or sometimes completely control the treatment process.

There are many aspects to delivering and maintaining continued safe practices inside the realm of Peritoneal Dialysis but I believe the most important thing overall is the actual connection and disconnection of the patient catheter to the Peritoneal Dialysis system. This is what I refer to as "the moment of truth" and I actually use this phrase when training patients.

Infection (Peritonitis) is the number one problem that a Peritoneal Dialysis(PD) patient may encounter while on this modality of treatment. If a patient does develop Peritonitis they may be able to remain on PD with the aid of Antibiotic treatment, they may have to come off of PD temporarily to heal and rest their system or they may not be able to do PD at all again.

There are several ways that the PD patient may contract peritonitis but a very common reason is a touch contamination during connections and disconnections to the system. The patient connection is accomplished in a matter of seconds but must be continually meticulously executed using sterile technique in an attempt to continue on this modality of dialysis.
The mechanics of the connections are quite simple and very user friendly. There are differing brand names of PD equipment but the patient to system connection is very similar across the board. At the moment of truth the patient or caregiver has to remove a sterile cap from the end of their patient line and remove a sterile cap from the PD system line and make a safe quick connection. Once this union is made the circut is closed off to the outside world and the exchange of PD fluid can now occur in a sterile fashion. At the end of the PD fluid exchange the same careful technique is used to disconnect from the PD fluid line and a new sterile cap is placed onto the patient line. These patient to PD system connections are basically the same whether using a manual or automated PD system.

That's all for now on this topic. In one of my future posts I will discuss preparing for the "moment of truth". So to all you PD patients and PD trainers never fall short of that meticulous PD mindset.

Healthcare Reform and Dialysis

Keith Chartier
05/05/2010

HEALTHCARE is a thorny issue, and platoons of pundits have happily weighed in on the left and the right to rile up their bases over the past year. However, on March 23, President Obama signed into law the biggest expansion of federal healthcare guarantees in more than four decades. That doesn’t mean the healthcare debate is over, but the reality is that the U.S. health system must work to adapt to the new rules. And just how will health reform affect the renal community? “The bigger issue for all of dialysis is what’s going to happen with the bundle and how is it going to be implemented,” said Robert Sepucha, senior vice president, government affairs, Fresenius Medicare Care. The bundled payment system was mandated by 2008’s Medicare Improvements for Patients and Providers Act, which will arguably affect dialysis care more than the bill Obama signed into law. “I’m not sure there is anything unique to dialysis or renal care that is going to be impacted by virtue of healthcare reform, save for one exception,” Sepucha said. “But there’s nothing I think people should be overly concerned about.” The one exception for dialysis in the reform bill is a provision that the General Accounting Office (GAO) must do a study on the impact of the inclusion of oral drugs in the dialysis bundle. The deadline for the report is a year from passage, or March 23, 2011. “That’s a good thing, so we can figure out whether or not these things are being adequately priced and if there are any safety concerns,” Sepucha said. Accountable Care Organizations One area of opportunity for the renal community in healthcare reform is accountable care organizations. Right now, Medicare reimburses hospitals through Part A and dialysis through Part B. However, quality advancements in dialysis can lower Part A costs, yet Part B does not share in the savings. “Currently, CKD (chronic kidney disease) is fragmented and not coordinated between PCPs (primary care physicians) and all specialists. Implementing CKD care, disease management, HIT (health information technology), etc. will improve the coordination of quality care,” said Edward R. Jones, MD, president of the Renal Physician Association. “Use of guidelines, setting quality outcomes and instituting P4P (pay-for-performance) models will enhance CKD care. In addition, improved quality of care has demonstrated decreased costs but predominately from Part A services.” ACOs have been officially endorsed by the healthcare reform bill, and the Department of Health and Human Services has been authorized to start reimbursing provider and doctor groups who band together for large cadres of patients. If they are able to improve outcomes and lower costs then those ACOs can potentially share in the savings. “Gainsharing within the ACO will allow sharing of cost savings provided by good quality care,” Jones said. “In addition, ACOs jointly formed by nephrologists, PCPs and other entities will allow for redistribution of cost savings to those providing the improved care.” However, the ACO structures have not been defined, but an example would be dialysis organizations partnering with nephrologists, PCPs and others within kidney care delivery to accept the risks and share in the benefits of the ACO, said Jones. “It would require breaking down on the Part A and B barrier.” In addition to structure, the way ACOs are compensated is still up in the air, but the Medicare Payment Advisory Commission’s June 2009 healthcare reform report to Congress could provide some insight. “In our model, the ACO would consist of primary care physicians, specialists, and at least one hospital,” MedPAC wrote in the report. “The defining characteristic of ACOs is that a set of physicians and hospitals accepts joint responsibility for the quality of care received by the ACO’s panel of patients.” In the MedPAC version of ACOs, which would have at least 5,000 patients to distinguish actual improvement from random variation, providers would still be paid standard fee-for-service Medicare payment rates (such as the dialysis bundle). However, bonuses would be paid if ACOs met certain spending and quality targets. Just how these bonuses are figured out will be up for much debate. In the report, MedPAC acknowledged that geographic consideration needs to be taken into account as some parts of the country use more services that other parts. “The financial incentives would need to be based on changes in spending rather than levels of spending,” MedPAC wrote in the report. “The dialysis community got together to make sure that Congress specifically included dialysis providers and groups as eligible under ACOs,” Sepucha said. “It’s contemplated that we could be part of this overall solution.” Medicare chief medical officer Barry Straube, MD, outlined some areas of interest for ACOs at the Renal Physicians Association’s annual meeting in March. They include physician offices, dialysis clinics and home training programs, fistula maintenance programs, transplant programs, CKD prevention and management programs and end-of-life and palliative care programs. “I think dialysis and renal care are uniquely positioned because of the close relationship we have with CMS,” Sepucha said. “The bundle is a great example. The bundle is the tip of the spear in terms of how CMS and the federal government are going to reimburse providers going forward. People have figured out the fee-for-service doesn’t work in every context and may be sort of a bad way of reimbursing providers,” he added. “That’s what the bundle is, and people realize with global payments you need some sort of shared savings program. That’s what an ACO is. We feel like we’re moving to where people want to end up.” Reform Basics for Patients Although the new healthcare law has little to say specifically about kidney care, its other provisions will have a broader affect on patients and those providing care. Some of the benefits under the new health law take effect in 2010, and many others will be phased in over the next few years in order to allow the healthcare system to adapt to the changes. Starting in 2010, private insurers cannot drop people from their plans if they get sick. In addition, young adults can remain as a dependent on their parents’ private insurance coverage until they reach 26 years old. Another major change is that health insurers can no longer impose lifetime limits on benefits meaning patients’ benefits can no longer run out because of a long or expensive illness. According to the National Kidney Foundation’s Web site, “this could ensure continued access to care and to all treatment options for individuals who have been on dialysis for several years and received two or more kidney transplants.” Under the new law in 2010, children 18 years old and younger can no longer be denied private insurance coverage if they have a preexisting condition. However, adults will have to wait until 2014 until insurers can’t deny them for preexisting conditions. In the meantime, a temporary “high-risk” pool will be established to provide coverage. Also in 2014, all U.S. citizens will be required to obtain health insurance coverage or pay a minor tax penalty. “This is to ensure that everyone is in the insurance pool so no one can get a ‘free ride’ by not having affordable coverage and then going to the emergency room for care,” according to a news release from the American Medical Association. With the greater access to health insurance, one affect of healthcare reform is kidney disease patients receiving preventive care before going on dialysis. “Anyone who understands the renal business knows about the huge transition costs when someone crashes into dialysis,” Sepucha said. “If we can facilitate an orderly transition, we’re able to, not just reduce costs, but dramatically improve health outcomes and reduce mortality and reduce hospitalizations.” Supermarket-like state-based health insurance exchanges will start in 2014. In these, people who don’t have access to employer-based insurance can shop and compare the benefits and costs of private insurance plans. Insurance companies will be required to provide a minimum benefit package, as well as additional coverage options beyond a basic plan. Those who can’t afford the full cost of coverage can access federal subsidies in 2014 through tax credits or vouchers. Medicaid coverage will also be expanded in 2014 to cover those who have incomes at or below 133 percent of the federal poverty level. “From a dialysis perspective, people need to be concerned that large insurance groups aren’t able to dump chronic patients into healthcare exchanges,” Sepucha said. “If suddenly these exchanges are covering chronic patients and they’re woefully underfunded, then the system is destined for failure.” There are also a number of changes for patients enrolled in Medicare and Medicaid. Starting 2011, beneficiaries will no long pay any cost sharing for a number of preventive services. In addition, the new law will start closing the Medicare Part D “donut hole,” which requires patients to pay for their drugs when the costs fall between $2,700 and $6,150. In 2010, Medicare patients will receive a $250 rebate, and during the next 10 years the co-insurance rate will be narrowed in phases until the hole is closed in 2020. Reform Basics for Practices Primary care physicians whose Medicare charges for office, nursing facility and home visits comprise at least 60 percent of their total Medicare charges will be eligible for a 10 percent bonus payment between 2011 and 2016. Also, the new law re-establishes the geographic payment adjustment, also known as the GPCI. In 2010 and 2011, Medicare will reduce the GPCI adjustment for physician practice expenses in rural and low-cost areas. In addition, Medicare quality reporting incentive payments have been extended. Payments of 1 percent in 2011 and 0.5 percent between 2012 and 2014 will continue for voluntary participation in Medicare’s Physician Quality Reporting Initiative (PQRI). Practices or businesses with more than 50 employees will be required to offer health insurance in 2014. However, according to the AMA, the vast majority of physician practices have less than 50 employees and will be exempt from this provision. “People are worried that more coverage is going to change the dynamics of healthcare. That doesn’t play as much into the ESRD population because there is already universal coverage, but in CKD, it changes,” Sepucha said. “It’s one thing to be covered, and another to actually sit down and speak with your doctor. It can only help patients in the sense that if they’re covered they’re more likely to get treatment. That means a primary care doc might refer a patient to a nephrologist that much sooner, and they can get the care sooner.” RBT

Our friend Jim Sloand to the Ways and Means Commitee.

Testimony By James Sloand, M.D., Statement

Statement of James Sloand, M.D., Medical Affairs U.S., Baxter Healthcare

My name is James Sloand, M.D. and I direct medical affairs for renal services at Baxter Healthcare for the U.S.  I have also been a practicing physician for over 30 years. Baxter’s renal business has long served the needs of people with end stage renal disease (ESRD). ESRD is the most serious form of kidney disease and occurs when the kidneys lose approximately 85-90 percent of their natural function.  Kidney disease is life threatening and requires treatment in order to remove toxins from the bloodstream.  In 1956, the company introduced the first commercially available and disposable dialyzer to act as an artificial kidney in hemodialysis.  Nearly 20 years later, Baxter pioneered peritoneal dialysis a primarily home-based treatment for ESRD patients that is used all over the world.
The development of kidney dialysis therapy and the many improvements made to it over the past several decades have vastly improved survival for patients with end-stage renal disease.  Improvements in the care of patients with kidney disease, for example, have meant that more individuals are undergoing dialysis therapy for longer periods.[1]  As such, total costs will continue to rise as the prevalence of patients on dialysis increases, (estimated to increase by 62% by 2020.[2] )
Finding a way to delay entry into dialysis and to lower the costs of car­ing by preventing hospitalizations for people with chronic kidney disease (CKD) is critical to reducing health care spending.  Patients can play an important role preventing deterioration in health once they have been diagnosed with a chronic condition. Building in patient self-management and empowerment through provider reimbursement policies may be key to reducing costs.[3]
A patient with end stage renal disease has  two different options for renal replacement therapy (dialysis) if a pre-emptive renal transplant is not available: treatment at home with either peritoneal or home hemodialysis  or by in-facility hemodialysis.  Home peritoneal dialysis is underutilized in the U.S. compared with (for example) Canada (7.6% in U.S. versus 37% in Canada in 2005).  A recent study of nephrologists indicated that if maximizing survival, wellness and quality of life were the most important factors in deciding mode for dialysis, 33% should be on PD.[4]  The underutilization of PD in the U.S. may thus have a negative impact on quality of life for patients that might otherwise use this modality and the data show that this deficiency increases costs to the Medicare program:

• MedPAC said in a recent report "Home dialysis offers several advantages related to quality of life and satisfaction to those patients who are able to dialyze at home.”[5]  
• The Centers for Medicare and Medicaid Services states that, "If 5 percent additional patients were to opt for home peritoneal dialysis, which provides added health and quality of life benefits….the potential savings for these 5 percent additional patients could be as much as $295 million."  (Page 20471 Final Regulation on the Medicare Conditions of Coverage for End-stage Renal Disease Patients).  [Note: these savings are through reduced hospitalizations and improved outcomes and over 10 years would result in at least $3 billion in savings.]

A lack of education about different modalities has been one of the significant reasons for underutilization in the U.S.  In fact, only 25% of patients on hemodialysis ever remember receiving information about peritoneal dialysis as an option.[6]  The provision of information to patients is also associated with greater willingness to adhere to therapies[7] and may include delayed progression to ESRD.[8]
 In 2008, the Congress added an education benefit to the Medicare program to educate patients in the final stages of kidney diseases to delay the onset of dialysis and to increase the information on dialysis options for care.  The benefit allows up to six educational sessions for Stage 4 kidney disease patients including instruction on the management of co-morbidities, with the goal of delaying the need for dialysis.  The educational sessions are also required to include a discussion of the treatment options available to patients.  The Centers for Medicare and Medicaid Services (CMS) now has responsibility for implementing this important benefit.  It is my hope that they recognize the need for a collaborative model between the physician and his staff where both contribute to the process to ensure that the therapy is as the law requires: individualized and aiding the patient in managing complications and co-morbidities of kidney failure.
I recommend that Congress further improve the management of kidney disease within the Medicare program by recognizing the direct link with the initial coverage under the Medicaid program for the low-income.  However, almost one-third of all new starts in dialysis begin in Medicaid and then transition after three months to Medicare.   Data show that Medicaid patients are less likely to have access to nephrologists and to critical information on diet.[9]  Increasing information to empower patients on how to manage their co-morbidities and significant metabolic issues-- prior to kidney failure-- is both equitable (increasing patient satisfaction) and, by reducing avoidable hospitalizations during the months immediately preceding and following the initiation of dialysis, it reduces costs for Medicaid program. 
Therefore Congress should specify that Stage 4 CKD patients should be part of targeted Medicaid case management services.[10]  In this instance, the case manager (a nurse or social worker) could ensure through community outreach that Medicaid eligibles with Stage 4 CKD have access to information on kidney disease, to kidney care providers, and they evaluate whether patients are receiving the appropriate information.  Further, similar to the recently enacted Medicare physician and practitioner model for renal education, the case manager would refer the Medicaid eligible to a physician for training on managing their co-morbidities, diet and metabolic issues, as well as the modalities of care and preparing for the appropriate access for dialysis.  It could also be a required case management activity for Medicaid managed care plans, through a case manager and through separate payments to physicians. 
In addition, prevention should be a cornerstone of all aspects of the health care system rather than an afterthought. This shift requires a fundamental change in the way providers are reimbursed in the system to reward those that are increasing the value of the health care services and reducing preventable admissions.  The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requirement on pay for performance was an important step, as discussed further in my testimony as follows on vaccines for patients with end-stage kidney disease. Dialysis patients have long been recognized as a vulnerable and an underserved population that would benefit from immunizations.  Since 1995, hospitalization rates for dialysis patients for infection have risen 19 percent overall, and 28% for African Americans. The rates of death due to infection are also highest among African Americans.  Studies show that vaccination will result in reduced risk of hospitalization and death from infections.  As a result, the CDC has recommended that all dialysis patients and staff be immunized to improve anti-microbial resistance. 
Patients with ESRD are under immunized (60% in 2002 and no significant improvement in the reported data since then [11]), with an even lower rate for the dual eligible population.  A CMS objective is to increase the annual ESRD patient influenza vaccination rate to 90% by 2010.  Vaccines are cost effective overall for the population over 65, reducing costs by $117 per person.[12]  Specifically, vaccinations reduce the risk of any hospitalization for hemodialysis patients by 7% (see chart below.)

Influenza vaccine delivery and effectiveness[13]
Hospitalization	Reduction in Risk
-Any cause -Influenza -Bacteremia -Respiratory infection	-7%
	-16%
	-24%
	-12%

Mr. Chairman, I request that your Committee urge CMS to include a measure concerning the percentage of vaccines, which is a national Quality Forum, for use in the pay for performance system that is required under the new dialysis payment system, effective January 2011.  The statute provides for flexibility in the measures to be used for dialysis pay for performance, but does not specifically require vaccination for influenza as a measure.  Given that spending on hospital services for patients undergoing dialysis was $7.05 billion a year in 2006, the estimated savings for an increase up to the CMS influenza vaccine target would be $150 million a year, or roughly $800 million over 5 years.  This could be a key part of aligning incentives for excellence of care for providers in the Medicare program and also for reducing disparities for vulnerable kidney patients.
Thank you for this opportunity to submit testimony for the record on health care reform and reforming the delivery system.

---

[1] “Technological Change and the Growth of the Health Care System”, Congressional Budget Office, January 2008.
[2] Gilbertson and Collins, USRDS (the NIH US Renal Data System).
[3] “The Healthcare Delivery System: A Blueprint for Reform, from Chapter 5, Second Generation Consumerism: Increasing Consumer Activation to Improve Health Outcomes and Lower Costs for Patients with Chronic Disease by Judith Hibbard, and Katherine Hayes, J.D., Center for American Progress
[4] Mendelssohn et al, 2001
[5] MedPAC
[6] Golper, 2001 
[7] Swatz, Robinson, Davy and Poltoski, 1999
[8] Golper, 2001
[9] Solid, Collins, USRDS, Minneapolis, Medical Research Foundation, 2007
[10] Case management is not the direct provision of medical and related services, but rather is assistance to help beneficiaries receive care by identifying needed services, finding providers, and monitoring and evaluating the services delivered.1 Targeted case management (TCM) refers to case management that is restricted to specific beneficiary groups. Targeted beneficiary groups can be defined by disease or medical
condition, or by geographic regions, such as a county or a city within a state. Targeted populations, for example, may include individuals with chronic physical or mental illness, developmental disabilities, or other groups identified by a state and approved by the Centers for Medicare and Medicaid (CMS). TCM and case management are optional services that states may elect to cover, but which must be approved by CMS through state plan amendment (SPAs).  CRS Report to Congress: Medicaid Targeted Case Management Benefits, March 27, 2008
[11] One large chain recently reported an 85% vaccination rate.
[12] The Efficacy and Cost Effectiveness of Vaccination against Influenza among Elderly Persons Living in the Community, Nichol et al, NEJM September 1994).
[13] Odds ratios for the impact of vaccinations on mortality and morbidity in hemodialysis patients during the period 1998-1999 from  “Influenza vaccine delivery and effectiveness in end stage renal disease”, Gilbertson et al, Kidney International, 2003

25 Facts About Organ Donation and Transplantation. NKF.

The success rates of transplant surgery have improved remarkably, but growing shortages exist in the supply of organs and tissues available for transplantation. Many Americans who need transplants cannot get them because of these shortages. The result: some of these people die while waiting for that "Gift of Life."
Each year, the National Kidney Foundation develops special public education programs aimed at increasing public awareness of the need for organ and tissue donation. Learning more about organ and tissue donation will help every American to make an informed decision about this important issue. Here are some facts everyone should know:

1. 104,748 U.S. patients are currently waiting for an organ transplant; more than 4,000 new patients are added to the waiting list each month.
2. Every day, 18 people die while waiting for a transplant of a vital organ, such as a heart, liver, kidney, pancreas, lung or bone marrow.
3. Because of the lack of available donors in this country, 4,573 kidney patients, 1,506 liver patients, 371 heart patients and 234 lung patients died in 2008 while waiting for life-saving organ transplants.
4. Nearly 10 percent of the patients currently waiting for heart transplants are young people under 18 years of age.
5. Acceptable organ donors can range in age from newborn to 65 years or more. People who are 65 years of age or older may be acceptable donors, particularly of corneas, skin, bone and for total body donation.
6. An estimated 12,000 people who die each year meet the criteria for organ donation, but less than half of that number become actual organ donors.
7. Donor organs are matched to waiting recipients by a national computer registry, called the National Organ Procurement and Transplantation Network (OPTN). This computer registry is operated by an organization known as the United Network for Organ Sharing (UNOS), which is located in Richmond, Virginia.
8. Currently there are 58 organ procurement organizations (OPOs) across the country, which provide organ procurement services to 250 transplant centers.
9. All hospitals are required by law to have a "Required Referral" system in place. Under this system, the hospital must notify the local Organ Procurement Organization (OPO) of all patient deaths. If the OPO determines that organ and/or tissue donation is appropriate in a particular case, they will have a representative contact the deceased patient’s family to offer them the option of donating their loved one’s organs and tissues.
10. By signing a Uniform Donor Card, an individual indicates his or her wish to be a donor. However, at the time of death, the person's next-of-kin will still be asked to sign a consent form for donation. It is important for people who wish to be organ and tissue donors to tell their family about this decision so that their wishes will be honored at the time of death.
11. All costs related to the donation of organs and tissues are paid for by the donor program. A family who receives a bill by mistake should contact the hospital or procurement agency immediately.
12. Tissue donation can enhance the lives of more than 50 people. Donated heart valves, bone, skin, corneas and connective tissues can be used in vital medical procedures such as heart valve replacements, limb reconstruction following tumor surgery, hip and knee joint reconstruction and in correcting curvature of the spine.
13. In 2008, a total of 14,208 organ donors were recovered in the U.S. Of these, 7,990 were cadaveric donors, which represented a decrease over the total of 8,019 in 2006. Living donors decreased from 6,732 in 2006 to 6,218 in 2008.
14. Donor organs and tissues are removed surgically, and the donor’s body is closed, as in any surgery. There are no outward signs of organ donation and open casket funerals are still possible.
15. Acceptable organ donors are those who are "brain dead" (whose brain function has ceased permanently) but whose heart and lungs continue to function with the use of ventilators. Brain dead is a legal definition of death.
16. Organ transplant recipients are selected on the basis of medical urgency, as well as compatibility of body size and blood chemistries, and not race, sex or creed.
17. Advances in surgical technique and organ preservation and the development of more effective drugs to prevent rejection have improved the success rates of all types of organ and tissue transplants.
18. About 94.4 percent of the kidneys transplanted from cadavers (persons who died recently) are still functioning well at one year after surgery.
19. The results are even better for kidneys transplanted from living donors. One year after surgery, 97.96 percent of these kidneys were still functioning well.
20. Following are one-year patient and organ graft survival rates:

Organ		Patient Survival Rate		Graft Survival Rate
Kidney (cadaveric) Kidney (live donor) Liver		94.4% 97.9% 90.1%		89.0% 95.1% 82.0%

21. Following is a comparison of the numbers of organ transplants done in 2008 and the numbers of individuals who are on the national waiting list as of November 2009.

Organ		Number of Transplants in 2008		Number of Patients on Waiting List* (of November 2009)
Kidney Kidney/Pancreas Pancreas Liver Heart Heart/lung Lung Intestine Total:		16,520 837 436 6,319 2,163 27 1,478 185 27,965		82,364 2,220 1,488 15,915 2,884 83 1,863 229 107,046

22. Of the 13,156 single kidney transplants performed in 2008, 5,968 were from living donors and the rest were from cadaveric donors. In addition, 837 kidneys were transplanted in combination with pancreas transplants.
23. Over 2,500 bone marrow transplants were performed in the U.S. in 2004. Marrow is collected from a pelvic bone using a special needle while the volunteer donor is under anesthesia. The majority of bone marrow transplants are done for leukemia.
24. In the United States fewer than 2.5% of patients with end-stage kidney disease undergo transplantation as their first treatment or therapy. The National Kidney Foundation is dedicated to educating kidney patients about the benefits of pre-emptive transplantation - when a person is able to go straight to transplant without dialysis they usually have good health outcomes.
25. 2008 was the first time in 20 years that there was a decline in the number of deceased donors used for transplants. Living donors in 2008 were at their lowest numbers since 2001.
26. Virtually all religious denominations approve of organ and tissue donation as representing the highest humanitarian ideals and the ultimate charitable act.

Spouses of Dialysis Patients Have Reduced Kidney Function

Spouses of Dialysis Patients Have Reduced Kidney Function

Married couples share a bed, a life, children, but chronic illness? A new study, reported in the May issue of American Journal of Kidney Diseases, suggests that a shared home environment and health habits can contribute to the development of chronic kidney disease (CKD) in the spouses of dialysis patients.

“We were surprised to find that the risk of developing chronic kidney disease for spouses of hemodialysis patients is just about as high as it is for blood relatives of these patients,” said study author Dr. Hung-Chun Chen of the Division of Nephrology at Kaohsiung Medical University Hospital in Taiwan.

To see how environmental factors might contribute to the development of CKD, researchers examined prevalence of chronic kidney disease in 95 spouses and 196 first- and second-degree relatives of 178 hemodialysis patients, who had been undergoing dialysis for between three months and 21 years.

The prevalence of CKD was found to be significantly higher in spouses and relatives of hemodialysis patients, than in a matched control group who were not related or married to patients. Both types of relatives were found to have a noticeably lower estimated glomerular filtration rate (eGFR), a measure of kidney function, and a high rate of albuminuria, or protein in the urine, an early sign of kidney disease.

The spouses had higher rates of habitual smoking, use of herbal medicines and analgesics and high blood pressure than their control group. Additionally, diabetes, which can be caused by obesity and poor health habits, was found to be a significant risk factor for CKD in spouses of dialysis patients.

“In light of these findings, it is critically important that spouses of dialysis patients receive careful screening for chronic kidney disease, in addition to first degree relatives,” said Dr. Kerry Willis, Senior Vice President for Scientific Activities, National Kidney Foundation. “Education about the role of environmental factors and health habits in increasing the risk of developing CKD is essential, as well.”

The National Kidney Foundation offers free screenings to those at risk of chronic kidney disease—anyone with high blood pressure, diabetes or a family history of chronic kidney disease, through its Kidney Early Evaluation Program.

Shad Ireland Ever Inspiring

I have seen this presentation before and wanted to share it as this man is so motivating!

Nocturnal programs continue to grow!

Nighttime dialysis launched in Tennessee FMCNA successfully launched a nighttime dialysis program at the facility in Smyrna, Tenn. The service allows patients to receive treatments in the clinic for eight hours at night while sleeping or resting, three times a week. Laura Beach, RN, in photo, heads the Nocturnal program.

Michael Peoples used to receive life-sustaining dialysis treatments for four hours, three days a week.

Fresenius Medical Care North America, operator of the nation’s leading network of dialysis facilities, has launched a night-time dialysis program at Fresenius Medical Care Smyrna, according to a press release. The service allows patients to receive treatments in the clinic for eight hours at night while sleeping or resting, three times a week.

Dialysis is a process that cleans waste products from the blood, removes extra fluids, and controls the body’s chemistry when a person’s kidneys fail. Patients typically require treatment on an ongoing basis unless they receive a kidney transplant.
In addition to having their days free for other activities, patients often report having more energy and better dialysis results.

“Since I began dialyzing at night, I feel better and have more energy during the day,” said Peoples. “I love nighttime dialysis because when I wake up in the morning it doesn’t feel like I have had a dialysis treatment, I’m full of energy. The treatment is also spaced over a longer period of time, so it's easier on me physically.”

Clinical Manager Shannon McCurry said nocturnal dialysis can improve a patient’s overall quality of life.

“During the day, they may be able to work, spend more time with their families or enjoy their favorite hobbies,” she said.

For Peoples, that means being able to focus more on producing his own music.

'JumpStart' uses retired Rochester officer's story to highlight kidney disease

(CARLOS ORTIZ staff photographer)

Jon Hand • Staff writer • April 29, 2010  JHAND@DemocratandChronicle.com

The current story line of the comic strip JumpStart has been pulled from the real-life health problems of retired Rochester police Officer Greg Raggi, a dialysis patient who has been in line for a life-saving kidney transplant for 3 ½ years.
Artist Robb Armstrong's strip, which is printed daily in the Democrat and Chronicle, features the lives of a fictional police officer, Joe, and his wife, Marcy, a nurse.
Since April 12, the strip has focused on Joe's "cop lifestyle" of eating fast fatty foods, working long hours and dealing with high stress. In the past few days, Joe and Marcy have discussed how that lifestyle can lead to diabetes and renal failure. In a subplot of the comic, Joe's partner, Crunchy, has left the fictional world of JumpStart to give his brother, Stanley (also a police officer), a kidney because Stanley has diabetes.
Armstrong said he developed the story line after a phone call from Mike Mazzeo, a friend and longtime partner of Raggi's in the narcotics unit of the Rochester Police Department.
Mazzeo, who is also the president of the Locust Club, the city police officer's union, first met Armstrong last year during a dust-up over a strip by Armstrong depicting a police shooting. The strip ran about the same time two city officers were shot and some in the community criticized Armstrong and the newspaper for being insensitive.
Mazzeo disagreed and publicly came to Armstrong's defense.
A bond was formed and the next time Mazzeo talked to Armstrong, he was asking him to help his friend, Raggi, and bring awareness to a problem many officers are concerned about.
"It's something that has affected many of us," said Mazzeo, who spent many hours taking his own father to dialysis treatments.
At least one other retired Rochester officer, Stan Prewasnick, is on dialysis and a third, Lt. Lou Genovese, died this past year after spending a year on dialysis, Mazzeo said.
Armstrong said he loved the idea right away.
"I have people walking up to me all the time saying, 'This is so funny, you have to write about it in JumpStart,'" Armstrong said from his home in Pasadena, Calif. "Mike came up to me and told me about something that wasn't funny but was so important. I said: 'Wow, this isn't just good for JumpStart, this is perfect.'"
Dr. Carlos Marroquin, a transplant surgeon from Strong Memorial Hospital, said no studies have been done to calculate whether police officers have a higher incidence of renal failure compared to other professions. But it's clear, Marroquin said, poor diet and stress can be a harmful combination.
"Clearly it is an issue, given the lifestyle, the stress, the dietary habits of a police officer," said Marroquin, who, at Mazzeo's invitation, spoke to union members in March to discuss kidney health and the safety of becoming "live donors." Donna Dixon, education director for the local chapter of the National Kidney Foundation, also spoke to the officers.
For his part, Raggi acknowledges that many of his old habits as an officer likely "caught up with him."
"I'm sure, eating the way I did, sleeping the way I did, middle shifts, night shifts, waking up early for court, it all took a toll on me," he said. "I'm not complaining. I loved it. But I wish I'd known better."
He retired in 1993 after 20 years in the department, and was diagnosed with Type 2 diabetes in 1995. The symptoms became more prevalent following a heart attack in 2004 and he went on the donor list in 2006.
He began peritoneal dialysis about 18 months ago, which requires Raggi to attach a tube leading from a suitcase-sized machine to a permanent tube in his abdomen each night for about nine hours while he sleeps. The process takes the place of the natural function of Raggi's kidneys, to filter toxins from his blood.
"I feel OK. I have good days and bad days; my doctor tells me to hang in there," said Raggi.
Doctors told him to expect it to take four to five years to find a donor kidney from the date he was placed on the list.
That surgery would change his life, he said. He's been looking forward to one thing, in particular.
"We never travel anymore because of the dialysis," he said. "I'd like to take a trip with my wife."
JHAND@DemocratandChronicle.com

Nasal mupirocin prevents Staphylococcus aureus

If you are a Peritoneal Dialysis patient or a PD Nurse you may want to mention this study in your clinic and ask for the opinion of the professionals in the office. 
J Am Soc Nephrol. 1996 Nov;7(11):2403-8.

Nasal mupirocin prevents Staphylococcus aureus exit-site infection during peritoneal dialysis. Mupirocin Study Group.

[No authors listed]

Abstract

A total of 1144 patients receiving continuous ambulatory peritoneal dialysis in nine European centers was screened for nasal carriage of Staphylococcus aureus. Two hundred sixty-seven subjects were defined as carriers of S. aureus by having had at least two positive swab results from samples taken on separate occasions, and were randomly allocated to treatment or control groups. Members of each group used a nasal ointment twice daily for 5 consecutive days every 4 wk. The treatment group used calcium mupirocin 2% (Bactroban nasal; SmithKline Beecham, Welwyn Garden City, United Kingdom) and the control group used placebo ointment. Patients were followed-up for a maximum period of 18 months. There were 134 individuals in the mupirocin group, and 133 individuals acted as control subjects. There were no differences in demographic data, cause of renal failure, type of catheter, system used, or method of exit-site care between the groups. Similarly, there were no differences in patient outcome or incidence of adverse events between both groups. Nasal carriage fell to 10% in those subjects who received active treatment and 48% in those who used the placebo ointment. There were 55 exit-site infections in 1236 patient-months in the control group and 33 in 1390 patient-months in the treatment group (not significant). S. aureus caused 14 episodes of exit-site infection in the mupirocin group and 44 in the control group (P = 0.006, mixed effects Poisson regression model). There were no differences in the rate of tunnel infection or peritonitis. There was no evidence of a progressive increase in resistance to mupirocin with time. Regular use of nasal mupirocin in continuous ambulatory peritoneal dialysis patients who are nasal carriers of S. aureus significantly reduces the rate of exit-site infections that occurs because of this organism.

PMID: 8959632 [PubMed - indexed for MEDLINE]

See Social Networking can be Very Good!

Conn. mayor donates kidney to Facebook friend

AP – Kidney recipient Carlos Sanchez poses for a photograph at his home in East Haven, Conn., Wednesday, April …

By STEPHANIE REITZ, Associated Press Writer Stephanie Reitz, Associated Press Writer – Wed Apr 21, 7:32 pm ET

HARTFORD, Conn. – Politicians long ago discovered the uses of Facebook. East Haven Mayor April Capone Almon found something else there: a constituent who needed her kidney. Capone Almon, 35, had more than 1,600 "friends" on Facebook last year when she saw one of them, Carlos Sanchez, post a status update saying his friends and relatives had all been tested and couldn't donate a kidney. She knew him casually through activities and friends in the New Haven suburb of East Haven, but they weren't so close that she had heard he was ill. Sanchez, a 44-year-old father whose kidneys were failing because of diabetes, sent out the request on Facebook only hesitantly and on his doctor's suggestion. He worried people might pity him — and certainly hadn't pinned his hopes on finding a donor that way. He didn't have long to wait. Capone Almon was the first person to respond. "I sent him a private message and just said, 'Hey, I'll try. I'll get tested,'" Capone Almon said Wednesday. "I really felt from the very beginning that I was going to be a match and a donor. I don't know why, but I just knew it." Sanchez had no such certainty. "I thought she was joking. The mayor of East Haven would offer me her kidney?" said Sanchez, an office administrator. "She responded back and said, 'I am serious, I am willing to get tested.' "I wasn't putting too much faith in it," he said. "I didn't want to get my hopes high. But at a point she made me feel so comfortable that I started feeling maybe this was meant to be." Capone Almon, a Democrat, was running for second term as mayor at the time but kept the details of her medical plans a secret. She won the election as they awaited word on when she could donate the kidney, saying they grew as close as family during the lull. "I know he voted for me, too," she joked. The operation was set only after Capone Almon passed a battery of tests and was given a long explanation of the process, which involved three small incisions near her ribcage and a scar similar to that of a cesarean section. "What the doctors said to me is, 'Your recipient is already sick and we're not going to make you sick to make him somewhat better,'" she said. "They do not compromise the donor's health in any way, shape or form." Their tenuous connection was cemented into a lasting bond April 8, when doctors at Yale-New Haven Hospital removed Capone Almon's left kidney and transplanted it into Sanchez. They were released from the hospital in less than a week and are expected to make full recoveries. His insurance paid for both their surgeries, and the mayor is back on the job in this middle-class city of about 30,000. Capone Almon said that she fields questions almost daily from people asking whether she's worried her one remaining kidney might someday fail, but that she's confident enough in modern medicine and her own health — especially after the numerous tests — that she barely gives it a thought. "I don't want people to see this as something larger than life," she said. "There's nothing special about me. Anybody can try to do this, and if it's meant to be, you'll be a match and a donor and you can really help someone." Michael Lawlor, an East Haven attorney and longtime friend of Capone Almon's, said she kept the details of her plans private for a long time, even as he and others quizzed her to ensure she recognized the serious nature of the donation. "I remember saying, 'Wow, that's really something. I wonder if she's really thought through the fact that it might actually be a match,'" said Lawlor, the area's state representative to the General Assembly. "Almost everybody says the same thing: I don't know if I would do that if it wasn't a relative ... but she said, 'No problem,'" he said. "When she found out she was a match, she was genuinely happy and truly excited to do it."

Transplant!!!!!

Many of you may remember Keith Barr from our 2010 Geneseo Kidney Walk - his outgoing personality and creative advertising caught all of our attentions!!

We are very excited to announce that Mr. Barr received notice last Wednesday that a kidney was available to him - and he received his transplant on Thursday. I spoke with Keith today and he said he is feeling great! We want to send a congratulations to him and his family - we are all so excited for you and wish you the best!

Keith promised to attend the Geneseo Kidney Walk next year with a sign that says "Received My Kidney 1 year ago!"

We are all very excited to see Keith and the rest of our great kidney walkers next year!

Thanks, 
 http://organdonor.gov/

Michelle Castrogiovanni

Division Special Events Manager

National Kidney Foundation

Serving Upstate New York