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NKF-CAP annually awards educational stipends of up to $500 to its members to help defray the costs of attending the NKF Spring Clinical Meetings. As part of the stipend requirement, awardees submit an essay on their experience.
20th Anniversary of the NKF Spring Clinical Meetings:
What I Learned My First Year
Erica Hammes, MMS, PA–C
It was easy to spot attendees of the conference as you walked through the casino and around the grounds of the MGM Grand. We were not swimsuit clad or carrying cocktails. No, we were the badge–wearing, tote–carrying kind who looked as happy to be debating phosphate binders as we were to stand in line for an hour at the hotel Starbucks. After all, that coffee is what got us through the 6am sessions. Six AM! (The timing also provided us the best take on last night's casino winners and losers as their day was ending and ours was beginning.)
As a Physician Assistant in Kidney Transplant at Advocate Christ Medical Center in Chicago, IL, I attended the NKF Spring Clinical Meetings for the first time in Las Vegas. For those of you who have been, it is obvious why this conference is so well–attended by professionals in all areas of nephrology care—it represents what the multi–disciplinary approach to patient–centered care is all about! Every attendee has the option to attend lectures in the advanced practice, physician, allied health, social work, nursing, or dietitian track. Not interested in peritoneal dialysis management? Try sessions on vascular access updates, depression screening, or re–evaluation of the kidney transplant recipient. Not to mention a great sneak peak at the new KDIGO guidelines for managing acute kidney injury (AKI), anemia, and blood pressure.
So what did we all really learn? Many sessions were a great solidification of concepts; others provided new information directly applicable to clinical practice. “Diagnostic Urinalysis” reminded us that in order to decrease microalbuminuria in our patients (which we know to be a marker of increased CV risks) we must decrease systolic pressures. New in this treatment approach is the ability to ablate sympathetic activity in the renal artery to decrease blood pressure. Be on the lookout. Also, it is important to remember that some of our patients are more salt–sensitive than others–a high salt diet in a salt–sensitive hypertensive will absolutely undermine the efficacy of an ACE– African Americans tend to be more salt–sensitive than their Caucasian counterparts; if a patient cannot adhere to a strictly low salt diet, consider switching to a diuretic to tighten blood pressure control.
“Top 10 Ways to Kill a Kidney” discussed the role of aggressive diuretic use, especially in a CKD patient with an episode of congestive heart failure. Perhaps the most appropriate time to cut back can be determined by monitoring NGAL (neurtophil gleatinas associated lipocalin) and BUN and cutting the diuretic when NGAL>BUN. Since a rise in NGAL will precede a rise in serum creatinine by more than 24 hours, adjusting a diuretic based on this marker may prevent an episode of acute kidney injury. Additionally, it might be that we are causing harm by discontinuing ACEis/ARBs prematurely. We all know that the serum creatinine will rise, but early termination can accelerate the decline in renal function despite a normal bump in serum creatinine. Expect a 20–30% increase in serum creatinine from baseline; anything more should prompt some intervention.
“Red Flag Medications” described prolonged sedation with morphine’s active metabolites in our patients with decreased renal function. Switch to dilaudid, which is not renally eliminated, to avoid this problem. And by all means, avoid FLEET bowel preps to prevent acute phosphate nephropathy; polyethylene glycol is a better alternative! Additionally, keep in mind that our B–lactam antibiotics (think penicillins and cephalosporins) must be renally adjusted (except ceftriaxone) to prevent interstitial nephritis. They also induce the p450 enzyme system and must be avoided in certain transplant recipients. Electrolyte imbalances stemming from inaccurate dosing may induce seizures, so dose with caution.
The 2011 Spring Clinical Meetings were the best attended in its 20 year history–proof that word continues to spread about the foundation and the knowledge that NKF imparts to all segments of nephrology practitioners. If you won the office straw–draw to attend the conference in Vegas, share your knowledge with all colleagues and consider joining one of the NKF Councils; impart to the social workers and dietitians that it is as important for them to attend as the physicians, PAs and NPs. After all, it is the multi–disciplinary team that improves patient outcomes. Thank you NKF–we will see you next year!
What I Learned in Vegas
Catherine Wells, DNP, ACNP-BC, CNN-NP
I was honored to be invited to work with an amazing group of Advanced Practice researchers to present "Strut Your Stuff" at the NKF 2011 Spring Clinical Meeting. The primary goal of this session was to encourage Advanced Practitioners to participate in research by providing education on research design, implementation of project ideas, and dissemination of past projects. The session was opened by Beth Adams, PA-C, with an overview of the research process. Understanding the ideal process for research enables Advanced Providers (AP) not only to participate in active research, but also to critically assess the validity of research outcomes. Subsequent speakers, as detailed below, provided examples using the research process and its outcomes to directly improve the lives of patients.
Deborah Hain, DNS, APRN, GNP-BC, described her use of Story Theory to engage and empower patients by learning their story, then matching her education and treatments to the individual needs of each patient. This middle-range nursing theory was the subject of her research in the past, and is now positively impacting care of her patients by improving communication and patient engagement. Deb exemplifies the process for evaluating a concept via research, and implementing the research conclusion into daily patient care.
Stephanie McIntyre, PT, DPT, RD, and Jane Davis, DNP, CRNP, exemplify a passion for improving the lives of dialysis patients through implementation of evidence based practice; they provided education on incorporating exercise into dialysis treatments. Exercise is safe for dialysis patients when the program is designed properly, and there is a growing body of evidence regarding implementation of exercise programs, making this an ideal topic for research and quality improvement projects.
Amma Sewaah-Bonsu, DNP, NP-C, used an evidence-based device in a new way to improve blood pressure outcomes fewer medications. Blood volume monitors decrease complications associated with fluid removal during dialysis, and are available in many dialysis clinics. Amma expanded this concept, and used the monitors to improve blood pressure management in her population. Research and quality improvement projects do not have to be cumbersome or expensiveâ€”there is so much we can do with existing technology and systems.
Finally, I presented a quality improvement project using the evidence-based protocols of KDOQI which successfully decreased the incidence of infections in an inpatient dialysis unit. KDOQI is designed primarily to guide outpatient care, but when properly implemented, these concepts can be applied to the hospital setting as well.
In conclusion, APs must constantly seek to expand the available evidence to improve healthcare outcomes and quality of life for our patients. Complacency in our dialysis and CKD systems will lead to a deterioration of quality; conversely, ongoing pursuit of research and quality improvement will improve the care of our patients. In conclusion, remember these guiding principles for success:
Kim Zuber, PA–C, MSPS
The April showers have brought May flowers and your Executive Committee has returned from an exhilarating (and exhausting) NKF Spring Clinical Meetings in Las Vegas. To all those new friends—it was great to meet you. To all those old friends—it is always wonderful to catch up. It seems like the conference is over and before we know it…we are planning for the next one.
The rest of 2011 and 2012 are going to bring big changes for CAP. We will have our first turnover of the Executive Committee at the Washington, D.C. conference. When CAP was founded in 2008, NKF appointed the Executive Committee from the steering group that had written the CAP bylaws. In 2009, the appointed Executive Committee members ran for their positions and were elected (for a total of 2 years appointed, 2 years elected). The upcoming elections this fall will thus be the first turnover of Executive Committee leadership. We are looking for CAP members to run for Secretary and Chair–Elect. Our bylaws state that the Chair and Chair–Elect must be different disciplines AND previously served on the Executive Committee. We are also appointing a Member–at–Large, who will be responsible for one special project per year. The Secretary and Chair–Elect positions are funded to attend SCM12, although Member–at–Large is not. All positions require participation in the monthly conference calls and designate you as an Executive Committee member; thus, you would be eligible to run for Chair–Elect in the 2013 elections. Barbara Weis–Malone, who is presently Chair–Elect, will take over as CAP Chair in spring 2012. The more people we have involved, the more input we have within the organization, and the better CAP will be. Consider getting involved as a Member–at–Large if you are nervous about jumping in feet first!
Our other big project for 2011–12 is an online nephrology ‘residency–type’ program. 2012’s Transplant Essentials, the third in our series of educational programs on our website (and free to members), concludes the ‘basic’ training programs that we are offering to members. The Essentials programs were written for the new practitioner or the practitioner new to nephrology. Now we are starting a multi–year, multi–author online program for the ‘seasoned’ practitioner and we are putting out a call for writers. If you, your supervising physician, or any writer you know is interested in helping, please contact Lisa Farris as soon as possible. We have already begun selecting topics and now need writers. This is your chance to get involved… and see your name on an NKF program.
I want to thank my entire committee for their incredible work over the last year. All of us have full–time, demanding jobs, families and many other local projects that pull at us. My committee members still make time for all the fantastic work that they do, on a volunteer basis, for NKF and I truly appreciate it. As is often said that “Behind every successful man is an incredible woman”…well I have incredible men and women behind me and I know I could not have done the CAP Chair job without them.
Got eight minutes and want a laugh? Watch Seymour Jones and the Temple of CKD, brought to you by the Renal Support Network (RSN). If there is a light side to kidney disease, this is it. Not only is it entertaining, but it’s a great teaching tool.
CAP member Mandy Trolinger of Denver has worked with RSN on several projects, and was kind enough to coordinate getting copies of the video to those who request them. If you are interested, please send your mailing address to firstname.lastname@example.org.
The Renal Support Network also mails out a quarterly newsletter called Live & Give, and they are always looking for writers (both patients and providers). For more information, and to see the current newsletter, visit the RSN online.
The National Kidney Foundation's new Patient Information Hotline, also known as NKF Cares, was launched in March. A dedicated telephone line has been set up at 855.NKF.CARES (653.2273) for people with kidney disease and those at risk for kidney disease, transplant recipients, family, caregivers, potential living donors, and other people who have questions about kidney ailments to call and speak with a trained Social Worker. NKF Cares has been created so we can meet the needs of all our constituents in a comprehensive way.
Visit Sydney the Kidney’s Facebook page and “friend” him. The new and improved Sydney the Third made his debut in Las Vegas at Spring Clinical meetings and he was a hit. If you want Sydney to visit, contact his travel agent, Deb Hain. Rumor has it he has a shot at leading the Disney parade when Spring Meetings come to Orlando.
While many of us were enjoying clear blue skies in Las Vegas, Alabama was pounded by multiple tornadoes with resulting loss of life and destruction and devastation. Attendees donated their canvas tote bags to the relief effort and were used by food banks and aid agencies to carry food, water and other necessities. Many thanks to the more than 100 people who donated the bags and to Southwest Airline which transported the bags with a smile.
Since inception, CAP has never stood still. Dialysis Essentials, an on line CE–CEU program, will be available soon. Created by CAP members, it will be a valuable tool to the nephrology practitioner and will join Nephrology Essentials as a CAP benefit. Transplant Essentials will complete the trilogy next year.
Look for Nephrology Q&A in Clinician Reviews. In our every–other–month column (alternating with endocrinology), CAP members will answer questions for the practitioner in primary or specialty practices. If you have any suggestions, please send them on.
Nephrology News and Issues has also asked for a quarterly column for Advanced Practitioners. The first installment is a composite of many member’s comments and suggestions.