Alan Kliger

Nephrologist, Clinical Professor of Medicine, Yale Medical School. Chair, ASN Nephrologists Transforming Dialysis Safety (NTDS)

[Alan Kliger @AlanKliger]

@rheault_m @NephJC 😵😵 #nephjc

[Alan Kliger @AlanKliger]

@NephJC The medical director has ultimate responsibility for safety and quality. The LDOs and MDOs have water specialists and a team under their direction responding to water needs #nephjc

[Alan Kliger @AlanKliger]

@NephJC There are usually 2 carbon tanks. If the first has chloramine escaping the effluent - - and the 2nd (svrubber) is chloramine-free, you can use the water to make dialysate for hours until the first tank is replaced. If chloramine is detected after 2nd you have ot shut down #nephjc

[Alan Kliger @AlanKliger]

@NephJC The filters remove 96% - 99% of solutes... and also endotoxin and organisms like bacteria and virus. Keep those filters clean!! #nephjc

[Alan Kliger @AlanKliger]

@NephJC @Nephro_Sparks Well.... infected and septic patients in hospitals do not generate reimbursement for facility owners - - nor do dead people....

[Alan Kliger @AlanKliger]

@NephJC Chloramine is produced by chlorine in municipal water. If it is not removed from dialysate before contact with patients, it can cause hemolytic anemia... and can be deadly. The carbon tanks remove the chlkoramine - and must be tested every shift #nephjc

[Alan Kliger @AlanKliger]

@Nephro_Sparks @NephJC Exactly - - - - should bhave higher priority - it surely affects mortality more than bone and mineral metab

[Alan Kliger @AlanKliger]

@docanjuyadav @NephJC Yes, antibacterial and antibiotic devices in the catheter locking caps and on wands attached to these caos ahve been shown to reduce bacterial infections with CVCs. And.... GET THEM OUT ALTOGETHER WHEN WE CAN

[Alan Kliger @AlanKliger]

@NephJC Right. We need to incorporate infection prevention into our usual rounds in the unit, in addition to asking questions about bone disease, anemia, BP etc

[Alan Kliger @AlanKliger]

@NephJC @hswapnil If someone is not tracking infections and bringing them to QAPI, tapping into CDC best practices, then how will this 2nd major cause of dialysis mortality be eliminated? #nephjc

[Alan Kliger @AlanKliger]

@NephJC @AsnEpc Hi. Alan Kliger from New Haven CT here. No COI #nephjc

[Alan Kliger @AlanKliger]

@RobertBlaser1 @blaser_sarah Carrying on the family tradition!!

[Alan Kliger @AlanKliger]

It's STILL worth spending time talking to patients and staff who have not as yet been vaccinated - - just won one over this week! #NephJC

[Alan Kliger @AlanKliger]

@shastriki @NephJC Staffing remains a major problem everywhere. What will vaccine mandates for nurses do for staffing levels?? #nephjc

[Alan Kliger @AlanKliger]

@gratefull080504 @anuja_java @NephJC @aishaikh @Jwaitz Hey Kevin, good idea - - for the Kidney Disease Patient groups?? #NephJC

[Alan Kliger @AlanKliger]

@MaryDittrich5 @mattysincs @MDittrichUSRC I think you'll never get dialysis patients included in a main efficacy trial - - because manufacturers want to show efficacy for their major markets. Ancillary studies of dialysis patients, yes. #nephjc

[Alan Kliger @AlanKliger]

@hswapnil @NephJC Right #nephjc

[Alan Kliger @AlanKliger]

@brian_rifkin @NephJC I believe if you actually read what was said, and not headlines only... that clinicians MAY need to make decisions about who does and who doesn't get treated IF demand outstrips supply... No rationing yet I believe.
#nephjc

[Alan Kliger @AlanKliger]

@anuja_java @NephJC I've only seen that non-responders are much more frequent among transplant patients than dialysis patients. #NephJC