Background: Many end stage renal disease (ESRD) patients present with complaints related to missed or incomplete hemodialysis (HD). Inpatient HD units often are not credentialed for outpatient use which results in extra cost and consumes additional resources for a standard outpatient procedure. Delays in patient throughput in emergency departments (ED) can cause boarding in the [...]

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 [...]

Background: Venous excess ultrasound score (VExUS) is an emerging point-of-care volume assessment tool that utilizes inferior vena cava diameter and doppler waveforms within the hepatic, portal, and renal veins to predict venous congestion. High VExUS grades have previously been validated against elevated filling pressures during right heart catheterization in patients with steady-state fluid balance; however, [...]

Background: Transcatheter aortic valve implantation (TAVI) has become the main treatment for symptomatic severe aortic stenosis but patients on dialysis have been excluded from major randomized controlled trials. Our aim was to compare outcomes after TAVI of patients with end-stage renal disease (ESRD) on dialysis versus those without. Methods: EMBASE and MEDLINE were searched through [...]

Background: Rhabdomyolysis is a condition of rapid muscle breakdown resulting in myalgia, enzyme elevations, electrolyte imbalance. Released heme pigment may lead to tubular obstruction, vasoconstriction, and tubular epithelial cell injury, causing acute kidney injury (AKI) as a severe complication. Especially with predisposing conditions such as volume depletion. Early and aggressive fluid resuscitation is an essential [...]

Background: The global impact of the COVID-19 pandemic has been profound, with significant disparities in infection and mortality rates, particularly in high-risk populations. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that complicates patient management in the context of COVID-19, given the increased risk of infections and limited guidance on pharmacological management. Methods: This [...]

Background: Peripherally inserted central catheters (PICCs) are associated with central vein stenosis and failure to establish a functioning arteriovenous fistula. Thus, guidelines recommend avoiding PICC placement when patients with chronic kidney disease (CKD) are likely to require hemodialysis. We sought to describe the current practice of PICC placement in hospitalized patients with an estimated glomerular [...]

Background: At our 583-bed tertiary care nonprofit teaching hospital serving the greater metropolitan New York area, ESRD (End-Stage Renal Disease) patients on hemodialysis presenting with complaints like chest pain, shortness of breath, hypertensive urgency, pulmonary edema, would sometimes wait for more than 6 hours to get dialysis started. While they were “waiting” to get admitted [...]

Background: Our region has the lowest hospital bed per capita of any metropolitan area in the United States. Additionally, during the COVID-19 pandemic there have been outpatient dialysis chair shortages due to workforce staffing issues. This has led to many patients waiting weeks or even months in the hospital to secure a new chair for [...]

Case Presentation: A 49 year-old woman with end stage renal disease on peritoneal dialysis (PD) for the past year, presented with progressively worsening abdominal pain, fevers, and nausea. This was her second presentation as she had been treated with antibiotics for presumed culture-negative PD-catheter-associated bacterial peritonitis three weeks earlier without improvement. Admission vital signs and [...]