Case Presentation: A 79-year-old male with vasculopathy, hypertension, diastolic heart failure, and dialysis-dependent end stage renal disease presented after having hypotensive syncopal episodes during initiation of his last 3 outpatient dialysis sessions. Upon dialysis cessation, he quickly awakened fully oriented with a normal hemodynamics. On arrival, physical exam findings were unrevealing, as were a subsequent […]

Case Presentation: A 50-year-old woman with history of ESRD on PD, CHF, and recent invasive pulmonary aspergillosis on posaconazole presents with three days of gradually progressive shortness of breath and right-sided chest pain. The chest pain was associated with coughing and deep breathing, but non-exertional with no hemoptysis. The patient lived with her sister and […]

Case Presentation: A 35-year-old woman with a history of congenital renal dysplasia complicated by end stage renal disease (ESRD) on hemodialysis, chronic macrocytic anemia, and malnutrition with folate, vitamins B12 and A deficiencies, presented with fatigue, dyspnea, and new rash. One week prior to presentation, the patient started experiencing progressive dyspnea on exertion. At her […]

Case Presentation: A previously healthy 29-year-old woman was diagnosed with end-stage renal disease of unknown etiology and initiated on daily peritoneal dialysis. Patient reported poor compliance with this treatment regimen and, five months later, presented to the emergency department with non-productive cough and pleuritic chest pain. She was found to have left upper lobe pneumonia […]

Background: In 2017, Emory University Hospital Midtown (EUHM) instituted fast track dialysis (FTD) which identified low risk patients in the emergency department (ED) in need of hemodialysis (HD) and provided it efficiently. The FTD development team consisted of hospital medicine, emergency medicine, nephrology, dialysis unit nursing, and ED nursing. This program showed a reduction in […]

Background: Missed doses have been associated with adverse outcomes and directly correlate to time off the floor. Pharmacist-assisted administration has decreased omitted doses. At Eskenazi Health, most patients requiring intermittent hemodialysis move to the dialysis unit for hemodialysis which occurs during standard medication administration times. As it relates to antihypertensives, some patients benefit from holding […]

Case Presentation: 47 year-old male with PMH of hypertension, DM, CAD and ESRD on peritoneal dialysis, presented with altered mental status for 1 day. He had developed a vesicular rash in the right upper extremity and was diagnosed with herpes zoster at another facility 2 days prior, for which he was prescribed valacyclovir that was […]

Case Presentation: A 42-year-old female with a past medical history of end stage renal disease from focal segmental glomerulosclerosis on hemodialysis for the past four years, presented to her cardiologist with worsening dyspnea on exertion and a feeling of “increased fluid in her lungs”. An outpatient transthoracic echocardiogram (TTE) was obtained, which showed a normal […]