Zuragen® Lock (an investigational device) Sodium Citrate 7%, Methylene Blue 0.050%, and 0.165% parabens. Density same as blood, 1.040. To be used as routine catheter lock instead of heparin. In vitro data showing eradication of all planktonic and biofilm bacteria in one hour. Similar solution (methylene blue/4% citrate) has been used for catheter salvage for 5 years in our practice, acceptable results.

And physically eliminates biofilm from plastic surfaces Figure 4- Scanning Electron Microscopy (SEM) of P. aeruginosa biofilm on polycarbonate coupons before (left) and after (right) one hour of ZuragenTM treatment.

AZEPTIC™ Analysis: Time to CRBSI Events Definite and Concordant CRBSI Events Zuragen Heparin Kaplan-Meier survival curves reinforce the statistically significant (p=0.0290) efficacy ZuragenTM Solution has in the prevention of CRBSI vs. heparin. 4

AZEPTIC™ Analysis: Time to Patency Failure Heparin Kaplan-Meier survival curves reinforce the significant (p=0.0423) difference of ZuragenTM Solution in preventing catheter patency failures. 5

Primary Care Physicians Assure Patients obtain Fistulas for Dialysis Preserve arm veins for hemodialysis access Expect and support access procedures at stage 4-5 (GFR<20 ml/min/1.73M2) Avoid damage to fistula or graft in arm Monitor graft and fistula function, report abnormalities Make sure dialysis catheter if present is accessed only for dialysis procedures

Avoid IV Catheters in Arms

Avoid Venipunctures and Blood Pressure Measurements in Arm with Fistula or Graft If patient has seen a nephrologist, ask if they have a fistula or graft Roll up sleeve and look for scar and feel for “thrill” at the scar site Use hand veins if possible.

Evaluate Fistula Function in the Office

If there is no thrill or pulsation in fistula or graft, it is clotted If there is no thrill or pulsation in fistula or graft, it is clotted. Contact Nephrologist or Dialysis Unit.

Peritoneal Dialysis Catheters are More Successful than Tunneled CVC for HemoDialysis

Kaplan-Meier plot of Tenckhoff catheter survival according to the technique of placement, peritoneoscopic versus surgery. Gadallah et al. Am J Kidney Dis 33:120, 1999.

Kaplan-Meier curves for catheter survival of peritoneoscopically (Scope) and surgically (Surgery) placed peritoneal dialysis catheters in patients receiving their first PD catheter. Pastan, et al. Trans Am Soc Artif Intern Organs, 1991.

Tenckhoff catheters placed by dissection also do very well Ortiz et al. Outcome of peritoneal dialysis: Tenckhoff catheter survival in a prospective study. , Adv Perit Dial. 2004;20:145-9.

8. Choice of Therapy-What about Peritoneal Dialysis 8. Choice of Therapy-What about Peritoneal Dialysis? -use in the US is flat but may soon increase -most home dialysis patients are on PD however 2010

Outcomes over 5 years are similar for hemodialysis and peritoneal dialysis

How about in the hospital, how do we choose continuous therapy versus hemodialysis for acute renal failure patients?

NxStage Therapy System-Used in Lafayette for Continuous Dialysis in the Hospital

Choice often is based on practicalities and risks rather than clinical benefit

New Approaches to Making Dialysis Simpler to Implement in Homes Wearable hemodialysis systems Sorbent regeneration of peritoneal dialysate Flow-through PD systems Sorbent regeneration of dialysate (6 liters tap water used rather than over 100 liters purified water)

Allient™ Sorbent Dialysis System FDA Approved, New Version Being Constructed

Finally, thanks for the help in care of these very complicated patients Nephrologists will become the primary care physician for patients on dialysis or after transplant But we really appreciate the care of many medical problems by Family Practice and Internal Medicine primary care physicians.

Thanks for the attention….