Alan Kliger

@rheault_m @NephJC 😵😵 #nephjc

@NephJC All of the responsibility. Meetings with dialysis inspectors was the most stressful thing I’ve done in my career. #AskASN

This is a lot. What responsibility does the dialysis facility medical director have for the water system? Who can help me? #AskASN

@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

@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

So what do I do if there's a high level of chloramine? Does the whole unit have to shut down? #AskASN

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

Why do we need all these filters? What are they for? #AskASN

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

@Nephro_Sparks @AlanKliger It is hard not to think this. Is reimbursement in any way affected by infection rates? #AskASN

Ok, but I'd really like to PREVENT those infections in the first place..let's talk prevention. Where do I find guidelines for that? #AskASN

@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

Let's move on to water...after all, without water, you can't make mud! First water question: what the heck is chloramine? #AskASN

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

@AlanKliger @NephJC seems like infection prevention should be higher priority than anemia and bone mineral mumbojumbo... is it because of anemia and phos/ca have big pharma behind it. just sayin #askASN

@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

@NephJC Any data on antibiotic lock for frequent catheter Infections? #AskASN @NephJC

@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

@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

@hswapnil #AskASN

Let's get started with something we all struggle with: Infection prevention! Do national regulations require units to have a designated infection prevention specialist in the facility? #AskASN

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

Hello and welcome to a special NephJC - the crew of @ASNEpc is here with us to talk about dialysis unit safety. Don't forget to tag every tweet @AsnEpc and introduce yourself and any COI. #AskASN

@RobertBlaser1 @blaser_sarah Carrying on the family tradition!!

Here is ⁦@blaser_sarah⁩ introducing speakers at the 2023 Ralph J. Bunche Community Center Annual Black History Brunch. I’m exceptionally proud of her and her community service. #sheshowsup ⁦

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

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

@NephJC I feel like the world is understaffed right now, can’t imagine there are extra hands available to help with infusions at already tight units #nephjc

T1h. What are the major barriers to starting mABs? Let’s chat #NephJC

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

@anuja_java @NephJC @aishaikh @Jwaitz I will repeat my earlier comment. Why isn't anyone leveraging the patient community to counter the #covidiots ? #nephjc

T0c: How should we assess vaccine efficacy among CKD patients? #NephJC 1- Antibody titer 2- Antibody threshold 3- Cellular Response 4-Infection/Hospitalization/Death 5-All

@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

@mattysincs @MDittrichUSRC Not really. Now even a post exposure indication. #NephJC

Are there any patient populations that mAb therapy is not recommended in/contraindicated in? @MDittrichUSRC #nephjc

@hswapnil @NephJC Right #nephjc

@NephJC Though with resistance, Bam not recommended now as monotherapy, right, @AlanKliger #NephJC

T1d. 3 mAbs have been granted FDA EUA for the treatment of COVID-19. Use of these therapies in an outpatient setting can prevent hospitalization. youtube.com/watch?v=JztQGH… #NephJC

@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

@NephJC forbes.com/sites/jemimamc… #nephjc

T1b. Given the recent evidence that high viral loads might contribute to complications of COVID-19, mABs are now being used against COVID-19.

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

@AlanKliger @NephJC Has this sub-population of non-responders been characterized? #nephjc

T0l. If 3 doses are good, can 4 doses in transplant be better? Yes! #NephJC medrxiv.org/content/10.110…