2. Zuragen® Lock (an investigational device)
Sodium Citrate 7%, Methylene Blue 0.050%, and 0.165% parabens.
Density same as blood,
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.

3. 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.

4. 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

5. 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

6. 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

7. Avoid IV Catheters in Arms

9. 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.

10. Evaluate Fistula Function in the Office

11. 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.

12. Peritoneal Dialysis Catheters are More Successful than Tunneled CVC for HemoDialysis

13. 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.

14. 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.

15. 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.

16. 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

17. Outcomes over 5 years are similar for hemodialysis and peritoneal dialysis

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

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

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

26. 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)

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

28. 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.

29. Thanks for the attention….