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Perspective
Global Health: Facing a “Slow-Motion Disaster” — The UN Meeting on Noncommunicable Diseases
You might think Linda Ezekiel would always be in a hurry. As the first nephrologist in Tanzania, she started and now runs her country's only public-sector dialysis unit. She is currently spearheading Tanzania's first renal transplantation program. And she manages the postoperative care of 80…
- December 22, 2011
- Rosenbaum L. and Lamas D.
- N Engl J Med 2011; 365:2345-2348
In September, representatives from 192 countries met at a UN conference on noncommunicable diseases, turning international attention from the devastation wrought by well-known epidemics such as those of AIDS and malaria to a quieter, though no less dangerous, threat.
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Case Records of the Massachusetts General Hospital
Case 30-2011 — A 62-Year-Old Woman with Renal Failure
Presentation of Case. Dr. Kyle Staller (Medicine): A 62-year-old woman was admitted to this hospital because of renal failure. The patient had an autoimmune overlap syndrome with polymyositis, treated with prednisone and mycophenolate mofetil, but had been in her usual health until 6 weeks before…
- September 29, 2011
- Cunningham J., Harisinghani M.G., Taheri D.
- N Engl J Med 2011; 365:1233-1243
- CME
A 62-year-old woman with autoimmune overlap syndrome and polymyositis presented to this hospital with anemia, thrombocytopenia, and acute renal failure. Four days before admission, she was found on the floor of her home, confused and minimally conversant.
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Case Records of the Massachusetts General Hospital
Case 29-2011 — A 66-Year-Old Woman with Cardiac and Renal Failure
Presentation of Case. Dr. Jason E. Faris (Medicine): A 66-year-old woman was admitted to this hospital because of cardiac and renal failure. The patient had been well until approximately 6 months earlier, when dyspnea on exertion and leg edema developed. A diagnosis of congestive heart failure was…
- September 22, 2011
- Raje N.S., Steele D.J.R., Lawrimore T.M., Johri A.M., Sohani A.R.
- N Engl J Med 2011; 365:1129-1138
- CME
Cardiac and renal failure developed in a 66-year-old woman. Echocardiography suggested infiltrative cardiomyopathy, lytic bone lesions were seen on imaging, and elevated serum free light chains were detected. A diagnostic procedure was performed.
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Original Article
Long Interdialytic Interval and Mortality among Patients Receiving Hemodialysis
Although some progress has been made in the past two decades, survival rates among patients receiving hemodialysis in the United States remain among the lowest in the world. As in most countries, maintenance hemodialysis in the United States is typically performed three times per week, with two 1…
- September 22, 2011
- Foley R.N., Gilbertson D.T., Murray T., Collins A.J.
- N Engl J Med 2011; 365:1099-1107
- Free Full Text
Patients receiving thrice-weekly hemodialysis have two 1-day intervals and one 2-day interval between treatments. This study shows that the risks of death and cardiovascular events leading to hospital admission are increased during the long (2-day) interdialytic interval.
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Case Records of the Massachusetts General Hospital
Case 26-2011 — A 7-Year-Old Boy with a Complex Cyst in the Kidney
Presentation of Case. A 7-year-old boy was seen in an outpatient clinic at this hospital because of a complex cyst in the kidney. The patient was born by vaginal delivery after an uncomplicated 38-week gestation. His birth weight was 3.04 kg. A diagnosis of tuberous sclerosis complex (TSC) was made…
- August 25, 2011
- Paul E., Thiele E.A., Shailam R., Rosales A.M., Sadow P.M.
- N Engl J Med 2011; 365:743-751
- CME
A 7-year-old boy with tuberous sclerosis complex was seen because of an increasingly complex cyst in the left kidney, seen on serial imaging studies. A diagnostic procedure was performed.
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Original Article
Desensitization in HLA-Incompatible Kidney Recipients and Survival
Renal-replacement therapy can be achieved by means of transplantation or dialysis. Transplantation offers clear benefits in terms of longevity, lifestyle, and savings in health care costs.– However, organs are scarce, and the rate of death among patients on the kidney-transplant waiting list is…
- July 28, 2011
- Montgomery R.A., Lonze B.E., King K.E., et al.
- N Engl J Med 2011; 365:318-326
- Free Full Text
- CME
Investigators used plasmapheresis and low-dose intravenous immune globulin to desensitize HLA-incompatible patients before transplantation and compared their survival rate with that of controls. Live-donor transplantation after desensitization provided a survival benefit.
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Perspective
Survivors — Dialysis, Immigration, and U.S. Law
Santiago is in the ER again. He sits in a special row of 20 patients, all of whom are waiting for one result: the potassium. Is it high enough today? Two days ago he was here, and it was only 6 meq per liter. We discharged him. Right now his chest hurts, and he is short of breath. Nothing new, and…
- June 9, 2011
- Raghavan R. and Nuila R.
- N Engl J Med 2011; 364:2183-2185
- Free Full Text
Santiago, one of 6000 undocumented U.S. residents with end-stage renal disease, is in the ER again. He sits among 20 patients, all waiting for one result: the potassium. Will it be high enough today to earn him one of the 12 chairs in the dialysis unit?
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Correspondence
Glycerol Kinase Deficiency in Adult Hypoglycemic Acidemia
To the Editor: A 26-year-old man was admitted to the emergency room with impaired consciousness. The night before he became ill, he had ingested some alcohol, but not an excessive amount. About 24 hours later, he was found unconscious and cold in his bed. In the emergency room, his plasma glucose…
- May 5, 2011
- N Engl J Med 2011; 364:1781-1782
- Free Full Text
A young man presented with inexplicable acidosis and hypoglycemia. He was found to have glycerol kinase deficiency, a rare entity that may be important to consider in the differential diagnosis once intoxication has been ruled out.
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Images in Clinical Medicine
Calcification of the Aorta and Common Iliac Arteries
Figure 1.
- April 14, 2011
- Sudo K. and Harada H.
- N Engl J Med 2011; 364:1449
- Free Full Text
A 59-year-old man presented with paresthesia and weakness in both legs. Plain radiography of the abdomen showed marked calcification of the abdominal aorta, aortic bifurcation, and common iliac arteries. These findings were confirmed on CT of the lower abdomen.
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Perspective
Bundled Payment for ESRD — Including ESAs in Medicare's Dialysis Package
In response to a congressional mandate, Medicare has introduced a more constrained method of paying for services covered by its end-stage renal disease (ESRD) program — a method with benefits and risks for patients and providers alike. In the Medicare Improvements for Patients and Providers Act…
- February 17, 2011
- Iglehart J.K.
- N Engl J Med 2011; 364:593-595
- Free Full Text
Medicare has introduced a more constrained method of paying for services for end-stage renal disease (ESRD) — bundling together most dialysis services and establishing a fixed compensation amount for them, reducing incentives for overuse of drugs such as ESAs.
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Perspective
Special Treatment — The Story of Medicare's ESRD Entitlement
In October 1972, Medicare, which had been enacted for the elderly in 1965, was extended to the disabled by the Social Security Amendments. One provision, added at the last minute, declared that persons with chronic renal disease who required hemodialysis or kidney transplantation "shall be deemed…
- February 17, 2011
- Rettig R.A.
- N Engl J Med 2011; 364:596-598
- Free Full Text
In 1972, through a last-minute provision of the Social Security Amendments, Medicare coverage was extended specifically to people with end-stage renal disease requiring hemodialysis or kidney transplantation — an entitlement that has had significant consequences.
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Original Article
Prevention of Dialysis Catheter Malfunction with Recombinant Tissue Plasminogen Activator
Central venous catheters are used for vascular access in the majority of patients undergoing hemodialysis.– The major complications of catheters include thrombosis and infection. Approximately 50% of hemodialysis catheters fail within 1 year; up to two thirds of the failures are due to thrombosis.…
- January 27, 2011
- Hemmelgarn B.R., Moist L.M., Lok C.E., et al.
- N Engl J Med 2011; 364:303-312
- Free Full Text
- CME
Long-term hemodialysis patients with a newly inserted central venous catheter received heparin three times a week or recombinant tissue plasminogen activator (rt-PA) instead of heparin at the midweek session. The use of rt-PA reduced the incidence of catheter malfunction and bacteremia.
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Editorial
Tackling the Achilles' Heel of Hemodialysis
More than 375,000 patients undergo long-term hemodialysis treatment in the United States, but the outcomes have remained abysmal, with the rate of death during the first year of hemodialysis therapy exceeding 20%. Although the development half a century ago of techniques for sustainable vascular…
- January 27, 2011
- Winkelmayer W.C.
- N Engl J Med 2011; 364:372-374
More than 375,000 patients undergo long-term hemodialysis treatment in the United States, but the outcomes have remained abysmal, with the rate of death during the first year of hemodialysis therapy exceeding 20%. Although the development half a century ...
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Editorial
“Daily” Dialysis — Lessons from a Randomized, Controlled Trial
The frequency of dialysis was established at three times a week in 1965, and this frequency has been used in most centers around the world. Soon after the establishment of this dialysis schedule, an analogue simulation concluded that daily (also known as quotidian) short dialysis sessions would be…
- December 9, 2010
- Twardowski Z.J. and Misra M.
- N Engl J Med 2010; 363:2363-2364
The frequency of dialysis was established at three times a week in 1965,¹ and this frequency has been used in most centers around the world. Soon after the establishment of this dialysis schedule, an analogue simulation concluded that daily (also known as ...
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Original Article
In-Center Hemodialysis Six Times per Week versus Three Times per Week
When 90% or more of usual kidney function is lost, either kidney transplantation or dialysis is required to sustain life. Nearly 400,000 persons in the United States and 2 million worldwide are dependent on dialysis; of these, approximately 90% in the United States and 70% in Canada undergo…
- December 9, 2010
- The FHN Trial Group
- N Engl J Med 2010; 363:2287-2300
- Free Full Text
Frequent hemodialysis and conventional hemodialysis were compared for 12 months. Frequent hemodialysis was associated with improvement in primary outcomes (death or change in LV mass and death or change in physical health), but more interventions related to vascular access were required.
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Review Article
Medical Progress: Hemodialysis
Fifty years ago, Belding Scribner and his colleagues at the University of Washington developed a blood-access device using Teflon-coated plastic tubes, which facilitated the use of repeated hemodialysis as a life-sustaining treatment for patients with uremia. The introduction of the Scribner shunt,…
- November 4, 2010
- Himmelfarb J. and Ikizler T.A.
- N Engl J Med 2010; 363:1833-1845
- CME
The expansion of dialysis into a form of long-term renal-replacement therapy has transformed nephrology and created a new area of science: the physiology of the artificial kidney. This review describes the medical, social, and economic evolution of hemodialysis therapy.
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Original Article
A Randomized, Controlled Trial of Early versus Late Initiation of Dialysis
The worldwide prevalence of long-term dialysis continues to rise,, driven in part by strong trends toward the initiation of dialysis earlier in the natural history of chronic kidney disease than was the practice previously.– Traditionally, the indicators for starting dialysis were the presence of…
- August 12, 2010
- Cooper B.A., Branley P., Bulfone L., et al.
- N Engl J Med 2010; 363:609-619
- Free Full Text
- CME
In this study, adults with progressive chronic kidney disease and an estimated glomerular filtration rate between 10 and 15 ml per minute per 1.73 m² (stage V chronic kidney disease) were randomly assigned to early or late initiation of dialysis. Early initiation of dialysis was not associated with an improvement in survival or clinical outcomes.
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Editorial
The Initiation of Renal-Replacement Therapy — Just-in-Time Delivery
Renal-replacement therapy for patients with end-stage renal disease was introduced approximately 50 years ago, yet the optimal timing for the initiation of dialysis is still debated. In recent years there has been a trend toward initiating dialysis at a relatively high estimated glomerular…
- August 12, 2010
- Lameire N. and Van Biesen W.
- N Engl J Med 2010; 363:678-680
Renal-replacement therapy for patients with end-stage renal disease was introduced approximately 50 years ago, yet the optimal timing for the initiation of dialysis is still debated. In recent years there has been a trend toward initiating dialysis at a ...
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Original Article
Stent Graft versus Balloon Angioplasty for Failing Dialysis-Access Grafts
By 2008, more than 341,000 patients in the United States were undergoing hemodialysis for treatment of their end-stage renal disease. The National Kidney Foundation Kidney Disease Outcomes Quality Initiative seeks to increase the use of autogenous fistulas, yet many patients continue to undergo…
- February 11, 2010
- Haskal Z.J., Trerotola S., Dolmatch B., et al.
- N Engl J Med 2010; 362:494-503
- Free Full Text
In this randomized, multicenter trial, patients with a venous anastomotic stenosis who were undergoing hemodialysis were assigned to undergo balloon angioplasty or placement of a stent graft. Primary end points included patency of the treatment area and patency of the entire vascular access circuit. Percutaneous revision was improved with the use of a stent graft, which appeared to provide durable and superior patency and freedom from repeat interventions.
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Editorial
Fistula First, Stent Graft Second
A growing number of patients in the United States undergo efficient hemodialysis through autogenous arteriovenous fistulas or prosthetic arteriovenous grafts. Unfortunately, these vascular conduits are fraught with complications, and failing access remains the leading cause of hospitalization for…
- February 11, 2010
- Kerlan R.K. and LaBerge J.M.
- N Engl J Med 2010; 362:550-552
A growing number of patients in the United States undergo efficient hemodialysis through autogenous arteriovenous fistulas or prosthetic arteriovenous grafts. Unfortunately, these vascular conduits are fraught with complications, and failing access ...
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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