Responding to the needs of patients and families of Renfrew County with chronic kidney disease.

The motto of the newly expanded Regional Nephrology Centre at Renfrew Victoria Hospital says it all.

A large crowd of Renfrew Victoria Hospital officials, dignitaries, staff and guests gathered April 9 for the grand opening of the completed expansion of a program that is vital to Renfrew County residents with chronic kidney disease.

The opening of the new centre means every aspect of a kidney patient’s care - education, clinics, treatment - will be consolidated in the same area of the hospital. And the patients who will directly benefit from the bright new facility were front and centre at the opening, helping to cut the ribbon.

Renfrew-Nipissing-Pembroke MPP John Yakabuski brought greetings on behalf of the province and Ontario Minister of Health and Long Term Care Dr. Eric Hoskins, who officials had earlier hoped was going to be in attendance.

Among the day’s other speakers and dignitaries were Champlain LHIN chair Jean-Pierre Boisclair, medical director of the nephrology program Dr. Nicole Delbrouck and RVH president and CEO Randy Penney.

Chair of the RVH Foundation Jim Lemenchick emceed the ceremony.

“The grand opening is indeed a great achievement for all of us who live and work in Renfrew Country,” said Lemenchick. “It represents the culmination of several years of hard work and co-operation between several organizations within our community and beyond.

He thanked the ministry and various health care organizations and specialists in the field, those involved in the physical planning and construction and also those who worked to fundraise for the project.

RVH is the main site for all nephrology services provided to 100,000 residents of Renfrew County. Designated as a regional program by the Ministry of Health and Long-Term Care (MOHLTC) in 1993, service began with four stations in Renfrew.

Living with chronic kidney disease is a life-long challenge faced by thousands of Renfrew County residents. There are many kinds of kidney disease and many causes. The three main causes in Renfrew County are high blood pressure, diabetes, and an unusually high rate (triple the provincial average) of

polycystic kidney disease.

When a patient reaches 15 per cent or less function of their kidneys, they must either go on life-saving

dialysis treatment or have a kidney transplant, if eligible. Treatment for the incurable disease involves four-hour sessions s three days per week on an ongoing basis.

In August 2011, with the program at full capacity and an ever-increasing need for services, the MOHLTC

announced approval for a $12 million expansion.

“The new 23,000-square-foot addition means we will be able to offer world class nephrology services,” say RVH officials. “For the first time since the program began in 1993, every aspect of a kidney patient’s care - education, clinics, treatment - will be consolidated in the same area of the hospital.”

Prior to the program’s beginning in Renfrew and the establishment of satellite locations in Barry’s

Bay (2001) and Pembroke (2006), patients drove over an hour one way to have a four-hour treatment

three times each week.

The nephrology program grew from 1,000 treatments in 1993 to 16,600 in 2014, with 14 stations in

Renfrew, and provides a full range of chronic kidney disease and pre-dialysis clinics. A Home

Peritoneal Dialysis Program was established in 2006.

Officials are thrilled with the new state-of-the-art facility.

The hemodialysis treatment area has doubled in size from 3,000 to 6,000 square feet and the number of treatment stations increased from 14 to 20, giving RVH the ability to provide an additional 5,616 treatments annually.

Five isolation rooms will improve infection control.

New features will improve the patient and family care experience, say officials.

Large windows will allow natural light and a view, more space will enhance patient privacy and accommodate visitors, and patients will appreciate the comfortable waiting rooms, new treatment chairs with heat and massage and central nursing stations.

The RVH nephrology program consists of two nephrologists, one general practitioner, one social

worker, two dietitians, two hemodialysis technicians, five technical aides, 28 registered nurses, nine

registered practical nurses and three medical secretaries.

The hospital works closely with the Champlain LHIN and Champlain LHIN Regional Renal Steering Committee, participates in Renal Administrative Leaders Network of Ontario (RALNO) and Ontario Renal Network (ORN) working groups and initiatives, and has links with The Ottawa Hospital Renal Program.

...

An extremely premature Polish infant weighing just 820 grammes (1.8 pounds) has become the world's smallest and youngest patient to escape death thanks to an artificial kidney, according to the doctor who oversaw the treatment.

Born 15 weeks early, Kamil nearly died from organ failure a few days later and conventional methods used to keep preterm babies alive proved ineffective.

"He suffered grave edema" or water-retention causing swelling as his kidneys were unable to cope, doctor Wojciech Kowalik, head of the intensive care department of newborns at Legnica hospital in southwest Poland, told AFP Thursday.

Being hooked up to an artificial kidney was his only hope, but the procedure had never been succesful in such an extreme preterm case.

Similar treatment is usually applied to newborns weighing at least three kilogrammes. The treatment only worked for half of the 10 newborns who needed it at the Legnica hospital, according to Kowalik.

In Kamil's case, there was no alternative but to give it a go.

"For a baby weighing just 820 grammes, it's exceptional. We later learnt that he was the smallest in the world to survive thanks to this method. It has already been tried with children as small, but none survived," Kowalik added.

Kowalik said he had found no precedents in medical journals dealing with dialysis used on extremely premature babies.

"It's a miracle," Kamil's father Adam Wawruch told AFP as the five-month-old baby weighed in at four kilogrammes before being released from hospital.

With public spending on healthcare in Poland still low by Western standards, not all Polish hospitals have dialysis machines. Kamil had the good fortune to be born in one that did, thanks to funds raised by a popular annual telethon.

Founded in 1993, the Great Orchestra for Christmas Charity (WOSP) has raised $160 million (150 million euros) for medical equipment to treat children. It paid for the dialysis machine used to save Kamil.

Known for his colourful outfits and outgoing personality, former TV journalist Jurek Owsiak is the force behind the telethon's success.

He visited the Legnica hospital to congratulate the doctors responsible for saving Kamil.

"Even if he were in New York, London or Paris instead of Legnica, Kamil would still be a patient at risk. Everyone would wonder whether they would have the courage to embark on this kind of therapy," Owsiak told AFP.

...

The Clinical Standards Group in the CMS Center for Clinical Standards and Quality asked the ESRD community to provide suggestions for changes to the Conditions for Coverage, which was last revised in 2008.

Beloware excerpts from comments submitted by renal groups. This list is not exhaustive, and the full comments are available for download.

Common concerns included dialysis patients not being properly informed of treatment choices, patients' rights, and a lack of alignment between other quality programs related to ESRD facilities.  

American Association of Kidney Patients

The AAKP suggested that each dialysis facility survey should provide evidence that patients have been fully informed on all options available to them for their treatment.

"An AAKP survey published in the March 2011 issue of the Clinical Journal of the American Society of Nephrology showed the majority of patients with ESRD would like to receive more comprehensive information about the various treatment alternatives available. Nearly 1,000 ESRD patients and their caregivers responded to the survey, which asked for their perspectives on dialysis education and therapy. More than 30 percent of the patients felt that the different options for treatment—in-center hemodialysis, peritoneal dialysis, home hemodialysis, and kidney transplantation—were not "equally or fairly presented to them." Only about a third of end-stage renal disease patients indicated that they were given sufficient information about home hemodialysis - a therapy option that offers some key advantages over in-center dialysis. AAKP believes the facility survey should provide evidence that patients have been fully informed on all options available to them for their treatment. This should be signed and witnessed before each individual patient."

Download full comments

National Kidney Foundation

NKF has concerns that despite the comprehensive statements surrounding patients’ rights there remains evidence that the majority of patients continue to be unaware of these rights. The foiundation urged CMS to incorporate the following recommendation from a  2013 report from the Office of Inspector General.

(1) define “grievance” for facilities, (2) require that facilities report grievances regularly to their respective networks, (3) provide guidance to facilities on what constitutes a robust process for anonymous grievances, (4) work with the Agency for Healthcare Research and Quality to add a question to the standardized satisfaction survey to assess ESRD beneficiaries’ fear of reprisal, and (5) provide networks with better technical support for their grievance database.

Download full comments

National Renal Administrators Association

The NRAA urged CMS to better align the varos quality programs related to dialysis facilities.

"As CMS considers updates to the Conditions for Coverage, we urge the agency to create more alignment among its quality programs. The goals of the Conditions for Coverage, as well as the ESRD Quality Incentive Program (QIP) and the Five Star Program, are to ensure the best possible outcomes for ESRD patients. When various quality programs across CMS do not align, it can create confusion for dialysis facilities and impede their progress toward that overall goal, especially since dialysis facilities are operating within different quality programs and regulations simultaneously. For example, the calcium measurement in the Conditions for Coverage differs from the one used in the QIP. In the Conditions for Coverage, facilities are advised to follow the standards established in the Measures Assessment Tool (MAT). The MAT uses corrected calcium levels of greater than 10.2 while the QIP requires use of uncorrected calcium levels. As a result, facilities are trying to adhere to the QIP measure and not to the Core Survey process."

Download full comments

Renal Physician's Association

The RPA noted that the lack of uniformity in the training and education of the surveyors from state to created variability in the program's effectiveness.

"RPA recognizes that that the Clinical Standards Group seeks input on the ESRD Conditions for Coverage and not on the dialysis facility survey process per se, however, given that the Conditions form the foundation for performing the surveys, we would be remiss to not note that  the current system for surveying dialysis facilities often results in the quality of the surveys being compromised.  While the dialysis facility certification process in some states is a positive and educational exercise that fosters the development of effective processes of patient care at the institution, in other states facility surveys can be arbitrary and punitive, and contrary to the needs of the local kidney patient population.  Lack of uniformity in the training and education of the surveyors causes significant variability in the caliber of inspections from state to state.  Some dialysis facility medical directors have noted that surveyors unfamiliar with renal care processes will often focus on issues peripheral or even unrelated to the delivery of safe dialysis while ignoring the more critical elements of ESRD services, or will cite the facility for “violations” that do not reflect deviation from the Conditions or from state regulations governing ESRD facilities"

Download full comments

...

A baby weighing 1lb 12oz is believed to be the world’s youngest, and smallest, child to survive dialysis treatment after being born 15 weeks prematurely.

Kamil Wawruch, from Poland, nearly died from organ failure a few days after birth when conventional methods used to keep pre-term babies alive proved ineffective.

He suffered water retention leading to swelling because his kidneys were unable to cope, said Wojciech Kowalik, head of the intensive care department for newborn children at Legnica provincial hospital in southwest Poland.

The procedure was described as extremely difficult and hugely risky, and involved placing a catheter into the

...