Hospitals need more ‘energy, focus’ on urgent-start dialysis programs in emergency rooms
Similar to how emergency departments have teams ready to treat patients after cardiac arrest or stroke, a speaker argued it is equally necessary to have interventional teams for patients who develop rapid kidney failure.
“[We] have brain intervention teams when a patient hits the emergency room [after stroke],” Martin Schreiber, MD, chief medical officer for DaVita Kidney Care’s home modalities, said during his virtual presentation at the Annual Dialysis Conference. “[Likewise,] we are focused on preserving cardiac function and therefore, when a patient comes into the ER with an apparent myocardial injury or ischemic event, we get the team on that patient because we want to preserve the heart muscle.
We need that same energy, that same focus and that same purpose to characterize people that come into the ER that have residual renal function, because that's extremely important. And so, just like we have a brain team and a heart team, I think we also need to have a kidney team.”
Schreiber stressed that urgent-start peritoneal dialysis programs must focus on organ preservation or maintaining residual kidney function. To ensure focus on this goal, he suggested the term “urgent start” be thought of differently; rather than centering solely on the therapy to be used in the short term, he advocated for thinking of how best to support the patient in continuing PD after discharge instead of initiating hemodialysis.
“The primary goal is [determining] the form of therapy to utilize to preserve functioning renal mass, because that's where the urgency is,” he said. “The urgency is to [ensure the patient is not] placed on a modality that will lead to significant acceleration in renal functional loss. [Decide if] there is a way the patient can be placed on peritoneal dialysis to improve residual renal function, both now in the short term, as well as in the long term.”
According to Schreiber, too much emphasis is placed on vascular access decisions (ie, whether the patient has a catheter or graft placed) or whether a patient should start on hemodialysis instead of PD. If the primary focus is on preserving kidney function, he argued, it is critical to activate a “preservation team” that is multidisciplinary and that ensures “rapid placement” of the PD catheter within 24 to 48 hours.
“It’s not the individual nephrologist that should be championing urgent start,” Schreiber said. “It should be everybody in the hospital that’s aware of preserving kidney function.
“We spend our whole careers trying to preserve residual renal function; I'm amazed that when we get to the point of dialysis, people forget about it. No, we need to continue the quest to preserve residual renal function even when a patient is starting dialysis.”
This may be achieved, according to Schreiber, through the creation of a “kidney team” that begins in the ER.