Combined HD/PD course offers basics for practicing nephrologists

The National Kidney Foundation Spring Clinical Meeting has always been popular with practicing nephrologists because of the emphasis on relevant clinical issues in the management of kidney patients. To provide for more focused education, the NKF has scheduled day-long courses in advance of the general meeting. I often was a presenter at the peritoneal dialysis (PD) precourse, but was discomfited by the fact that running parallel to this course was a similar one on maintenance hemodialysis (HD). Because of this, the attendee (similar to our patients) had to choose between PD and HD.

When current NKF president Beth Piraino, MD, asked me to take over the running of the PD precourse, I suggested that we merge the PD and HD courses. All health professionals who manage patients with chronic kidney disease (CKD) would be better served by having a broader base of knowledge of both dialytic therapies. There are many studies that suggest that the over-representation of dialysis patients on HD in the United States is at least in part due to lack of familiarity with PD, especially during nephrology training. In an analogy I have mentioned to attendees of this course, it would be outrageous for a cancer patient to be given the advice “Well, you could do chemotherapy or radiation, but I’m more comfortable with chemotherapy.” However, how often does it transpire that patients are advised to choose, or are preferentially placed, on HD in the United States for the same reason?

There are many issues in the management of dialysis patients that are common to PD and to HD, but need a different approach because of the different therapies. During this course, the physiology of PD (being a biological dialyzing membrane) and the physics of HD are compared and contrasted, particularly with reference to solute and fluid removal. Approaches to adequacy of dialysis are also different between the two (although many still insist on trying to fit the square peg of Kt/V urea into the round hole of PD).

Optimal access, be it a well-functioning PD catheter or an arteriovenous fistula or graft in HD, is discussed by experts in the field. Prevention and treatment of infection, focusing on PD peritonitis and catheter-related bacteremia in HD, are separate lecture. It is becoming clear that attainment of normal volume status is important for the long-term well being of patients on dialysis, and this is discussed from the point of view of both modalities.

Over the years we have solicited feedback on the course from the attendees, and there were requests for a lecture on dialysis in infants and children. In response to this, we added this lecture several years ago by leading pediatric nephrologist Brad Warady, and it remains quite popular. We have intermittently included a talk on home hemodialysis, although given its growing popularity there are now usually several talks about this modality in the main NKF program.

Those dealing with patients with progressive CKD need to be well-versed in both PD and HD in order to provide optimal care and to allow the patient to make a choice of therapy that is best suited for them. The Integrated HD-PD Course should be helpful for that goal. -by Joanne Bargman, MD, FRCPC

This course will be held Wednesday, March 25, from 7:00 am – 5:00 pm.