Improving adequacy of dialysis: using in-series dialyzers.

In larger clients where standard methods of urea removal do not provide adequate dialysis, the increase in surface area of in-series dialyzers has accomplished this goal. Each step that we took imparted to W.T. that our concern was to improve his health. Our objective was to improve the URR in W.T. when his rigorous "standard" treatment did not provide adequate dialysis. An in-series set of dialyzers was designed and configured, necessary supplies were obtained, staff education was performed, and a pilot study was attempted with W.T. An improvement in URR from .52 to .64 occurred during the first month of in-series dialyzers. This resulted in an increased urea reduction of 23%. Once we recognized the usefulness of in-series dialyzers as a tool to improve URR, we applied it to several other patients with similar success rates. The benefits of in-series dialyzers include cost effectiveness (we realized a cost savings of $6 per treatment), higher URR capabilities, the ability to provide adequate dialysis to outliers, improved compliance with treatment times, and a method to maintain a healthy client.

Limitations of ferritin as a marker of anemia in end stage renal disease.

Management of anemia in patients with end stage renal disease (ESRD) requires careful monitoring of iron status. Although serum ferritin is used as an indicator of iron stores, its value is limited because ferritin is an acute-phase reactant; its level increases sharply in the presence of inflammation and infection. This article presents information on the value and limitations of serum ferritin as a marker of storage iron in healthy individuals and in patients with ESRD. It also discusses the need to consider the percentage of transferrin saturation, total iron-binding capacity, and immature reticulocyte fraction as markers of iron storage, particularly in patients with infection and inflammation.