Summer 2011 Member e–Newsletter

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Upcoming Meetings of Interest

It's the season for NKF Kidney Walks! Support your local efforts to raise money in the fight against kidney disease. To find a walk in your area, click here.

October 5-7
American Academy of Nurse Practitioners
New Orleans, LA

October 28
2011 Nephrology Academy for Advanced Practitioners
Birmingham, AL
Email for more information

November 8-13
American Society of Nephrology Kidney Week
Philadelphia, PA
Be sure to visit the CAP poster on the 2010 Salary Survey!

May 9–13, 2012
National Kidney Foundation 2012 Spring Clinical Meetings
Gaylord National
Washington, D.C.

NKF- CAP is Now Taking Nominations for the Fall Elections!!!

CAP has grown by leaps and bounds since its inception. We would like YOU to be an important part in leading CAP into the future. There is still so much to be done! Please nominate a fellow CAP member today, or consider taking a leadership role yourself. Serving on an NKF Council is a way to enhance your professional growth and it gives you the ability to positively impact the lives of our kidney patients through advocacy and support (not to mention, it looks great on your resume).

Nominations due: September 15, 2011
Visit the Professional Councils' Elections Site to view open positions and complete the Nominee Biographical Form

Voting online: October 15 - November 15

OPEN POSITION DESCRIPTIONS:

Secretary/Treasurer
The Secretary/Treasurer shall keep minutes of all meetings and transactions of the CAP and of its Executive Committee meetings; shall monitor the expense reports of the CAP Executive Committee and shall communicate with the NKF staff and finance office in this regard; and may also be assigned other responsibilities and duties by the CAP Chairperson and/or Executive Committee from time to time.
The Secretary/Treasurer shall be a CAP member in good standing.
The Secretary/Treasurer shall be elected as set forth herein and shall serve for a two (2) year term in office. This officer may be nominated and re-elected for one (1) additional term of office.

Chairperson-Elect (PA discipline)
The Chairperson-Elect shall become familiar with the duties of the Chairperson and shall, in the absence of the Chairperson, perform such duties and shall also have such other duties and responsibilities as assigned from time to time by the Chairperson and/or the CAP Executive Committee.
The Chairperson-Elect shall hold office for a term of two (2) years and automatically assumes the Chairperson position, a two (2) year term, followed by two (2) years as Immediate Past Chairperson. The Chair-Elect must be a different discipline than the Chair. For 2011, we are seeking a PA candidate.

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Chair’s Corner

Kim Zuber, PA–C, MSPS

"Publish or perish." This quote has taken on new meaning for all of us. Recently, Clinical Advisor printed an article with blatantly incorrect nephrology information. Thanks to the eagle eye of one of our members (thanks, Tricia Howard!), we were able to respond to the article as soon as it was printed, and provide the correct answer. However, that is not good enough. We are in a reactive mode. Instead, we need to be the practitioners writing those answers; we need to be the practitioners giving advice; we need to be the practitioners writing the articles.

I know what you are saying. "I am new, I do not know much." "I have just started. What can I add?" "I don't have time. I can barely get through my rounds and it is blood week!"

I am here to say: "Get out there and make a difference!" Any one of you—from a new grad to the most experienced AP—could have provided a better answer to "When do I use an ACE?" than the answer than was offered in the June edition of Clinical Advisor.

Which goes back to my original comment: "Publish or perish?" This is not only true for the educational AP; it is true for the practicing AP. If we do not step up and teach our new colleagues what we know, we are obsolete. Even the new AP has something to offer. Until you are stretched, you do not know what you know or what you can contribute. Recently, I had a PA student do a nephrology rotation with me. She was not necessarily interested in nephrology; she was simply looking for a rotation in the DC area where her husband was stationed. She was honest about that and I accepted that this was a student who did not want the minutiae of nephrology. However, after four weeks with me, she is now the co-author on an article about Autosomal Dominant Polycystic Kidney Disease (ADPKD), published in the August 2011 Clinician Reviews, and solid in her comprehension of internal medicine.

We can offer a deeper understanding of internal medicine. We have the patients with the physical findings that others have to search for. You can spend an hour rounding on dialysis patients with me and see 1+ to 4+ edema… all on the same shift! If one of my patients complains of shortness of breath or dyspnea on exertion, you better believe it leads to a full on discussion of the causes of congestive heart failure, an MI or sarcoidosis (as one of my patients told a student years ago…"We don't do that sissy asthma stuff here. This is REAL medicine!").

"Publish or perish?" I say—"Lead or be left behind." It is your choice. We need to share ourselves and our knowledge. Even the newest AP has something to share. CAP needs your help. Our Publications Chair Jane Davis always has ideas in the pipeline and NKF-CAP always needs an AP who can respond to a query, write an article or give a talk to a local group. We, your CAP Executive Committee, are there to help and mentor you. But it is time for you to lead. Step up and take a swing!

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Something Old, Something New – SCM12

No, this is not a wedding announcement. The lineup for the 2012 NKF Spring Clinical Meetings in Washington, D.C., is exciting and something not to miss. Many of the old favorites are back and the new sessions are exciting. Amma Sewaah-Bonsu and Laurie Benton, NKF-CAP CME Chairs, have been at work on the AP program track since they left the 2011 meetings in Las Vegas. If you ever had a question about something renal, more than likely you will find your answer here! Wondered what that thing was you found on your patient's back? Come to the dermatology session. There will be topics for the hospital-based practitioner as well as those in transplant medicine. On the practical side, will be a session on contract negotiations. Remember, too, travel grants are available and applications will be posted on line. Stay tuned to www.nkfclinicalmeetings.org for more information as it becomes available.

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NKF 2011 Spring Clinical Meetings in Las Vegas:
Educational Stipend Recipient Essays

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. A wide variety of APs attended SCM11, as you can see below.

SCM11 From the Perspective of a Non-Nephrology Nurse Practitioner
Christopher E. Hermann, MSN, NP-C

My first SCM was back in the late 1980s when I was a relatively new RN and wanted to supplement my ICU skills. Now as a seasoned RN with ten years as a Nurse Practitioner, I felt I needed a refresher. As a hospitalist, one of my many roles is supporting residents and interns who are new to the VA system, along with serving as a preceptor to NP and PA students. Keeping current with nephrology issues is essential. SCM11 met all my expectations and then some. The take-home messages reinforced my current knowledge base while providing me with a great deal of kidney-saving "pearls."

My program started with the pre-conference Nephrology 201, a great review that reminded me that by the time we see proteinuria, the kidneys are already dying and further intervention is critical. The sessions supplemented each other with recurrent reminders: salt should be listed as a danger to the kidneys, followed closely by NSAIDS. Urinalyses should be a required lab test on every patient regardless of the admitting diagnosis (this is something that I learned from my first preceptor many years ago and pass on to my students. "The UA tells you many things that your patient doesn't…early AKI doesn't hurt."). Take home message #1: do more microscopic examinations on my own. Message #2: we still cannot detect acute kidney injury in a timely fashion. By the time serum creatinine rises, kidney damage is already 24-48 hours old. Hopefully the research using neurtophil gleatinas associated lipocalin (NGAL) will provide us with an early marker for AKI allowing us to intervene earlier.

The session I recommend for every non-nephrology Advance Practitioner is: "The Top Ten Ways to Kill a Kidney." Dr. Feldman reinforced what every practitioner should know. CKD is not always recognized early and early referrals to the experts saves kidneys. Take home messages #3, 4, and 5: watch the overdiuresis, don't stop the ACEI/ARB too soon, and be aggressive in treating hypertension.

I recommend the NKF Spring Clinical Meetings for EVERY Primary Care and Hospitalist Advanced Practitioner at least every 3-5 years. Many of the patients we see have some nephrology issue and renal health closely mirrors cardiovascular health.

SCM11: A Student Perspective
Stephanie Mahooty, MSN, ANP-C, CNN

As a student member of NKF- CAP I was fortunate to receive a travel grant to attend the NKF National Meetings this year in Las Vegas. As a new Advance Practitioner, I found Dr. Charles Foulks' course, "Difficult to Control Hypertension," a great resource. This course offered strategies on how to manage hypertension using different medications and patient case scenarios. I have implemented the information I learned from this course in my current practice. Another course, "Implementing CKD Education," by Dr. Ruth Campbell and Dr. Andrew Narva was particularly useful and offered great information on the Medicare Improvement for Patients and Providers Act (MIPPA) and how to implement CKD education in practice. Dr. Campbell presented spoke of her experience in successfully implementing a CKD education program meeting MIPPA guideline standards. Dr. Narva presented various models to improve collaboration among providers in improving CKD care. National Kidney Disease Education Program (NKDEP) patient and provider educational materials and resources available were also presented.

Lastly, I also enjoyed attending the "Town Hall: Professional Issues" session, which provided a forum for discussion and sharing of valuable information pertaining to patient care and the advance practice role within the nephrology community. This was great learning environment to hear lively dialogue among experienced advanced practitioners on relevant issues within nephrology. I would recommend this session to all advance practitioners who attend SCM12.

A Gamble in Vegas with Clinical Nephrology for a Sub-Specialist
Ashley Heath Seawright, DNP

As a first time attendee, I was not exactly sure what to expect of this particular conference, but I soon found the listing of session options did not do the experience justice. Most of the transplant meetings I routinely attend are heavy in scientific content and immunology, as they pertain to current trends in transplantation. However, I was pleasantly surprised by the variety of sessions available for general knowledge as well as general nephrology. While the transplant sessions seemed to focus on some basic contents, the curriculum was appropriate considering the majority of the audience are general nephrology practitioners not transplant specialists.

My trip started with a full day of the pre-conference session, "Long-Term Care of the Kidney Transplant Recipient." The content of this particular presentation provided a very useful review for transplant providers. Coming from a small center, allograft outcomes have a direct impact on our program. The discussions on the role of monitoring of alloantibodies and protocol biopsies by Dr. Milagros Samienago was an excellent topic to bring home to further evaluate how well we evaluate graft failure. It also carried over nicely into the next day's panel focusing on transplantation of the sensitized patient. Various infections in the transplanted kidney pose a real risk and challenge for the provider. Having an open discussion about monitoring trends and pre-emptive treatment options utilized in other centers is of use in forcing a self evaluation of your own management tactics. Furthermore, basic health maintenance is not enough in this patient population. Going deeper with vaccinations, as well as bone and skin evaluation, is a necessity.

No time for the betting tables because day two started early with a basic review of the urinalysis. I can honestly say that as an acute care provider I assumed this session would be too basic. However, sometimes as specialists, we skip over pieces of our lab (like "fatty casts," the hallmark of nephritic syndrome) and just jump into the treatment plan. Not only was interpretation highlighted, but treatment trends in proteinuria patient populations were also discussed. Several reference articles were provided which I have brought back to my team in hopes of revising some of our protocols for patient evaluation.

"Transplantation of the Sensitized Patient" provided a jolt of excitement. I learned not only the generally accepted protocols for desensitization, but who should do it and who shouldn't. Before capping off the evening, I attended the drug prescribing in kidney disease session. There was a very interesting discussion of volume of distribution and the effects of albumin as it pertains to Acute Kidney Injury and medications that tend to be protein-bound. The day concluded with hanging my poster in the Exhibit Hall and attending the poster session.

Day three was entertaining, with (false) fire alarms interrupting the electrolyte session! Despite the distraction, the speakers remained calm as they polled the audience on hyponatremia evaluations and treatments. Osmotic demyelnation syndrome was discussed along with Barter's syndrome. The palliative care session sparked many heated debates. My final stop was to the Exhibit Hall to see the rest of the posters and visit with some newly-made professional friends.

Vegas still a gamble? Not a gamble at all. The reason we travel to these meetings isn't just to gain knowledge. We can read that online or in a journal. We travel to meet new people and discuss how others manage with the resources they have. While we have many differences in patient populations across this country, there is something to be said for sitting down with someone who is more than 1,000 miles away (whether you consider them a mentor or a new colleague) to share protocols, patient issues, or reimbursement concerns, and bring new knowledge back home to our practices. No need to re-invent the (Roulette) wheel!

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NKF CARES, the National Kidney Foundation's Patient Information Hotline, is now available! A toll-free phone line has been set up at 855.NKF.CARES (855.653.2273) for those at risk, people with kidney disease, transplant recipients, family, caregivers, potential living donors, and other people who have questions, to speak with a trained professional who will answer questions and provide support. NKF Cares has been created so we can meet the needs of all our constituents in a comprehensive way. Please encourage people to call!

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Sydney the Kidney Update: Florida Edition

In April, Sydney left sunny southeast Florida for the 2011 NKF Spring Clinical Meetings in Las Vegas. He had a great time meeting everyone there and hopes to visit many of the Advanced Practitioners who attended the meeting. He came back to Florida for the inaugural Orlando Kidney Walk at the University of Central Florida. He was accompanied by APNs Amma Sewaah-Bonsu and Debra Hain as a member of their facility's team. The walk was challenging because it was so hot, but Sydney endured in an effort to meet his goal of promoting awareness of kidney disease. He met some wonderful people along the way.

He was very thirsty so he made a pit stop at the Florida Hospital Transplant table where they were kind enough to make sure he was adequately hydrated. After the NKF Kidney Walk, Sydney left Florida and headed across the U.S. to continue his mission, arriving safely to Advanced Practitioner Mary Jansma in Kelso, WA. Please stay tuned for more exciting news from the Northwest!

In the meantime Sydney is looking for more places to go, so if you are interested in having Sydney come visit you, please contact his travel agent, Deb Hain.

You can now "friend" Sydney on Facebook! Click here to view his profile.

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