Michael F Michelis
Lenox Hill Hospital, USA
Title: Update on management issues in patients with advanced renal disease
Biography
Biography: Michael F Michelis
Abstract
As patients with advanced renal disease become more complicated with time, due to factors such as complex associated conditions, aging, increasing numbers of available pharmacologic agents and improvement in renal replacement therapies, decision making has become more challenging. Subjects to be evaluated will include proper approaches to blood pressure therapy in patients with pre, inter or intra dialysis blood pressure abnormalities. Medication characteristics will be outlined and the effects of various drugs as they relate to the dialysis procedure will be described. Also metabolic issues such as approaches to hyperuricemia and hyperphophatemia will be reviewed and discussed. New agents and their benefits and limitations will be noted and present goals of therapy will be reviewed. Furthermore the effects of increased body mass and glucose intolerance on survival as well as possible corrective measures will be elucidated. Recent concerns regarding enzymatic predispositions to obesity will be described and possible solutions to these newly recognized abnormalities will be offered. Finally, current approaches to renal replacement therapy will be reviewed and the importance of the timing of interventions and the choice of access and modality will receive consideration. These issues apply particularly to patients of advanced age. Current standards as proposed by various nephrologic entities may not be appropriate for particular age groups with serious comorbidities. Factors influencing such decisions will be presented and critically evaluated.