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COVID-19 in New Orleans: A Nephrology Clinical and Education Perspective and Lessons Learned

Naljayan, Mihran; Yazdi, Farshid; Struthers, Sarah; Sharshir, Moh'd; Williamson, Amanda; Simon, Eric E
New Orleans' first case of COVID-19 was reported on March 9, 2020 with a subsequent rapid rise in the number of cases throughout the state of Louisiana. Traditional educational efforts were no longer viable with social distancing and stay-at-home orders, therefore virtual didactics were integrated into our curriculum. Due to an exponential increase in the number of patients with acute kidney injury requiring kidney replacement therapy, the nephrology sections at Louisiana State University School of Medicine and Tulane University School of Medicine adapted their clinical workflows to accommodate these increased clinical volumes by utilizing prolonged intermittent kidney replacement therapies and acute peritoneal dialysis as well as other strategies to mitigate nursing burnout and decrease scarce resource utilization. Telehealth was implemented in outpatient clinics and dialysis units to protect vulnerable patients with kidney disease while maintaining access to care. Lessons learned from this pandemic and subsequent response may be utilized for future responses in similar situations.
PMCID:7708233
PMID: 33283183
ISSN: 2590-0595
CID: 4708532

Laparoscopic Sleeve Gastrectomy in a Patient on Peritoneal Dialysis [Case Report]

Nguyen, Anthony Hoan; Naljayan, Mihran; Yazdi, Farshid; Reisin, Efrain
PMCID:7710827
PMID: 33305132
ISSN: 2468-0249
CID: 4709352

First Course DASH, Second Course Mediterranean: Comparing Renal Outcomes for Two "Heart-Healthy" Diets

Yazdi, Farshid; Morreale, Peter; Reisin, Efrain
PURPOSE OF REVIEW/OBJECTIVE:To review studies evaluating renal outcomes based on patient adherence to the Mediterranean diet or to the Dietary Approaches to Stop Hypertension (DASH) diet and to determine which diet is most effective in preventing and managing renal disease. RECENT FINDINGS/RESULTS:Both the DASH and Mediterranean diets have shown many health benefits, including reduced risk for chronic kidney disease (CKD), nephrolithiasis, mortality due to all renal causes and composite outcomes. Both diets have shown a decrease in estimated glomerular filtration rates (eGFR) decline with a concomitant improvement in mortality and dialysis initiation. In summary, both diets resulted in similar magnitudes of risk reduction when comparing equivocal levels of adherence to each diet. Review of evidence for renal outcomes shows strikingly similar effects for both DASH and Mediterranean diets. We hypothesize that these results are due to the overlap in nutritional composition. Both encourage whole foods such as fruits, vegetables, beans/legumes, whole grains, and nuts. Additionally, they restrict animal protein consumption and limit processed and fast foods. Determining a nutritional management intervention for renal impairment is clinically important as approximately 1% of the USA annual budget is spent on end stage renal disease (ESRD) treatment. We believe either diet could be incorporated into a patient's management when considering their renal health. In conclusion, we urge physicians to help patients choose either the DASH diet or Mediterranean diet based on the patient preference.
PMID: 32671570
ISSN: 1534-3111
CID: 4528302

Low-dose gabapentin-induced lower extremity edema in a young peritoneal dialysis patient

Ice, Alissa; Naljayan, Mihran; Yazdi, Farshid; Reisin, Efrain
PMID: 32352370
ISSN: 0301-0430
CID: 4412662

Using manual exchanges for an urgent-start peritoneal dialysis program

Naljayan, Mihran V; Yazdi, Farshid; Reisin, Efrain
Background/UNASSIGNED:Urgent-start peritoneal dialysis (USPD) was designed to avoid temporary hemodialysis initiation with a hemodialysis catheter. In these patients, PD is initiated within 2 weeks of catheter placement, but typically these prescriptions utilize automated peritoneal dialysis (APD) with a cycler. Manual exchanges have not been reported previously for USPD. We hypothesize that using multiple, low-volume manual exchanges, patients will have similar rates of peritonitis, exit-site infection (ESI), pericatheter leaks and discontinuation of PD in the first 3 months after initiation. Methods/UNASSIGNED:used 1000 mL dwell volumes during the first 7 days. Dwell times were 2-2.5 h for two to three exchanges per day. After 7 days of successful therapy, the dwell volumes were doubled. All patients were maintained on furosemide 160 mg twice daily. Results/UNASSIGNED:There were 20 patients enrolled in our USPD program. Our rates of peritonitis, ESI, pericatheter leak and discontinuation of PD were 5%, 0%, 5% and 5%, respectively. Conclusions/UNASSIGNED:Manual exchange during USPD is a viable modality with similar results as APD. Using manual exchanges allows patients to be more ambulatory during the day when they are not dwelling, allows nurses to evaluate the amount of ultrafiltration and effluent characteristics and allows for training in manual exchanges as well.
PMID: 30288268
ISSN: 2048-8505
CID: 3328412

Bariatric Surgery and Hypertension

Owen, Jonathan G; Yazdi, Farshid; Reisin, Efrain
Obesity continues to increase in prevalence worldwide. Hypertension has long been associated with obesity, and weight loss continues to be a first-line therapy in the treatment of hypertension. Lifestyle modification and pharmacologic therapy, however, often meet with treatment failure. Bariatric surgery continues to be the most successful approach to sustained weight loss. This review focuses on the underlying physiologic mechanisms of obesity-hypertension, and the impact of bariatric surgery on the treatment of hypertension. Current available literature on the physiologic mechanisms of obesity-hypertension, and the major trials, meta-analyses and systematic reviews of the impact of bariatric surgery procedures on hypertension are reviewed. Evidence suggests significant improvement in obesity-hypertension in patients who undergo surgical weight-reduction procedures. Malabsorptive techniques such as the Roux-en-Y gastric bypass or surgical resection techniques such as laparoscopic sleeve gastrectomy appear to offer superior results in regards to hypertension control over restrictive techniques such as Gastric Banding. Though long-term control of hypertension following surgery remains a concern, available follow-up post-operative data of up to 10 years suggests a sustained, if lessened, effect on hypertension control over time.
PMID: 28985287
ISSN: 1941-7225
CID: 3067522

MPGN and mixed cryoglobulinemia in a patient with hepatitis C - new treatment implications and renal outcomes

Palombo, Shannon B; Wendel, Eric C; Kidd, Laura R; Yazdi, Farshid; Naljayan, Mihran V
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PMCID:5663211
PMID: 29098140
ISSN: 2196-5293
CID: 3064502

Complications of liver resection: laparoscopic versus open procedures

Slakey, Douglas P; Simms, Eric; Drew, Barbara; Yazdi, Farshid; Roberts, Brett
BACKGROUND AND OBJECTIVE: Minimally invasive surgery for liver resection remains controversial. This study was designed to compare open versus laparoscopic surgical approaches to liver resection. METHODS: We performed a single-center retrospective chart review. RESULTS: We compared 45 laparoscopic liver resections with 17 open cases having equivalent resections based on anatomy and diagnosis. The overall complication rate was 25.8%. More open resection patients had complications (52.9% vs 15.5%, P < .008). The conversion rate was 11.1%. The mean blood loss was 667.1 +/- 1450 mL in open cases versus 47.8 +/- 89 mL in laparoscopic cases (P < .0001). Measures of intravenous narcotic use, intensive care unit length of stay, and hospital length of stay all favored the laparoscopic group. Patients were more likely to have complications or morbidity in the open resection group than in the laparoscopic group for both the anterolateral (P < .085) and posterosuperior (P < .002) resection subgroups. CONCLUSION: In this series comparing laparoscopic and open liver resections, there were fewer complications, more rapid recovery, and lower morbidity in the laparoscopic group, even for those resections involving the posterosuperior segments of the liver.
PMCID:3662744
PMID: 23743371
ISSN: 1086-8089
CID: 967742