Hemodialysis University offers updates, advances on dialysis care

Hemodialysis University, hosted by the International Society for Hemodialysis, will hold its 2014 update on advances in Hemodialysis Aug. 15–16 in Chicago. This year’s program will focus on home hemodialysis, anemia, complications, outcomes, and other clinically important issues.

NN&I interviewed course co-director John Daugirdas, MD, about important topics at this year’s meeting, which is themed, “Clinical Solutions for Dialysis Care.” Register at http://www.ishd.net/hdu/. For the full program, go to http://www.ishd.net/pdfs/ISHD_HDU_2014_Program.pdf

NN&I: Give us a short history of Hemodialysis University. How are these programs organized and supported?

John Daugirdas, MD:  The ISHD considers education in the field of hemodialysis one of its primary missions. Plus, the society always has had a strong interest in home therapies. Since its inception, the ISHD has been organizing hemodialysis and home hemodialysis "precourses" prior to the Annual Dialysis Conferences organized by the University of Missouri at Columbia. In 2012, the ISHD decided to organize a stand-alone conference in Chicago, and called it "Hemodialysis University" (HDU). The program was a great success, and it has been archived for free access on HDCN.

Since then, the ISHD has organized two additional Hemodialysis Universities, one in Shanghai in 2013 and the other in Hyderabad, India in February 2014. The planned course on Aug 15–16 in Chicago will be the fourth HDU since its inception in 2012. Plans are afoot to hold a HDU on a regular basis in Shanghai starting 2015 onwards.

NN&I: Who do you see as your audience?

Daugirdas: Nephrologists and renal fellows, physician assistants and nurse practitioners as well as nephrology nurses. Many of the programs also might be of interest to dietitians, renal technologists, and pharmacists.

NN&I: Do you see this as more of a review course or one that covers new advances? Is there an emphasis on either approach?

Daugirdas: There is a little bit of both, but the invited speakers have presented a lot of cutting edge material, some of it as yet unpublished. We also strive to keep at least 1/4 to 1/3 of the program linked in some way to home hemodialysis, as the ISHD has from the outset been particularly interested in home therapies.

NN&I: Can you break down the program for our readers into different sections with HD—research, outcomes, etc.?

Daugirdas: We try to present material that is of interest to practicing nephrology providers, primarily. So purely research findings with little foreseeable clinical application are not part of the program. For example, in the area of improving dialysate, Chris McIntyre, MD, of the University of Nottingham, Royal Derby Hospital Centre, Derby, UK, has been looking at the benefits of slightly cooler temperatures. He now shows that this simple maneuver largely eliminates heart stunning and also brain white matter disorganization due to ischemia (the latter linked to depression and cognitive defects).

James Tattersall and Elizabeth Lindley from Leeds in the UK will be presenting how bioimpedance has helped them in their unit optimize postdialysis weight. They find that an important subset of patients is too dry and appear to have high interdialytic weight gain to climb back to their optimum weight. When, based on bioimpedance results, the caregivers increase the patient's postweight to more optimum levels, their interdialytic weight gain is reduced, and several patients had resumption of residual kidney function, to the point that they were able to get off dialysis.

NN&I: What about new technology and pharma?

Daugirdas: Jose Diaz-Buxo is going to talk about sorbents and the new sorbent-based, in-center and home dialysis machines that Fresenius is developing.

Peter Kotanko and Tattersall are going to be talking about new artificial intelligence (AI)-type protocols to minimize AI use, and Dan Coyne, in his overview of anemia treatment will also be discussing the new iron-based phosphate binders, including Velphoro and Zerenex.

NN&I: Home hemodialysis is still a very small slice of the overall HD patient population How will you cover this segment at HD University?

Daugirdas: Lots of home HD stuff as well. Chris Chan and Mark Marshall are completing a home HD Web-based international toolkit, cosponsored by the ISHD, and will be describing this during the meeting. Brent Miller will be talking about home HD, as will Lizzi Lindley. Then Bill Whittier is going to be discussing the NxStage Kidney Care home dialysis center approach and what he is setting up in the Chicago area.

NN&I: Any discussion specific to vascular access?

Daugirdas: There is a very useful section on venous catheters. Ted Clark from Canada discusses their use in an acute setting, and hopefully, will

discuss some work he has done retraining fellows in catheter insertion via simulation training, and Michele Mokrzycki will talk about management options to deal with infected catheters.

NN&I: What should attendees get out of this program?

Daugirdas: I believe that attendees will be very happy with the program, as were those who attended the 2012 Hemodialysis University in Chicago. The information presented regarding use of bioimpedance and dialysis temperature, home hemodialysis, sorbents, venous catheters, and anemia treatment optimization will have direct relevance to their day-to-day practice. Also, those who have been thinking of starting a home hemodialysis program but who have been holding back should find the live program a good source of networking and contacts, where they can discuss practical issues with their peers. The web-based Home HD global toolkit sponsored by the ISHD also should be a great help in this area.