Recent work focuses on delivery of renal replacement therapy (RRT) and on outcome in acute renal failure (ARF), and on psychosocial issues for patients and staff in the acute and chronic renal failure settings. The mortality of ARF has decreased from 60% in 1995-96 to 53% in 2000-01, and data strongly suggest that continuous RRT is better in all patients but especially in the sickest patients. New paradigms for continuous RRT employ predominantly slow dialysis and modest ultrafiltration, with extracorporeal citrate anticoagulation that avoids systemic bleeding risk and prolongs dialysis filter longevity. Further analysis of factors predicting survival and recovery of renal function are in progress. Finally, new data show that severe ARF requiring RRT in the critical care setting nearly doubles the likelihood that these very ill patients will be withdrawn from life support - important information to have when talking to families. In the chronic dialysis setting, prior publications show that talking to patients and families about advance directives can improve the reconciliation about death by facilitating ongoing discussion. More recent survey work shows that the character of interpersonal interactions in the chronic dialysis setting impacts patients (depression, well being and adherence) and staff (work stress, burnout, job satisfaction, job meaning) alike, pushing the borders of "professionalism" back and suggesting the importance of letting our "humanness" show. Other recent work with peer mentors (patients trained to talk with patients) demonstrates their influence in areas such as talking about advance directives, and further work in dietary adherence and in choosing a modality for chronic dialysis is in progress.
Link to PubMed Citations
Swartz RD, Bustami RT, Daley, JM, Gillespie BW, Port FK. Estimating the Impact of Renal Replacement Therapy Choice on Outcome in Severe Acute Renal Failure. (Clinical Nephrology 63:335-345, 2005).
Perry E, Swartz J, Brown, S, Smith D, Kelly G, Swartz RD. Peer Mentoring: A Culturally Sensitive Approach to End-of-Life Planning for Chronic Dialysis Patients. (American Journal of Kidney Disease 46(1):111-119, 2005).
Sekkarie, MA, Swartz, RD. Symptoms of renal disease: the treatment and palliation of symptoms due to comorbidity in end-stage renal disease. Supportive Care for the Renal Patient. Oxford University Press, 2004, pp 95-104.
Swartz RD , Perry E, Daley J. The Frequency of Withdrawal From Acute Care Is Impacted By Severe Acute Renal Failure. (J. Palliative Med 7:676, 2004).
Swartz R, Pasko D, O’Toole J, Starmann B. Improving the delivery of Continuous Renal Replacement Therapy using regional citrate anticoagulation. (Clin Nehprol 61:134-143, 2004).
Weitzel WF, Segal JH, Leavey SF, Saran R, Swartz, RD, Messana, JM. Effect of Time on Sensitivity and Specificity of Access Flaw in Predicting Thrombosis. (Seminar in Dial 16:498-501, 2003).
Swartz RD. Nephropathic Fibrosing Dermopathy: a Novel Cutaneous Fibrosing Disorder In Patients with Renal Failure. (Am J Med, 114:563-72, 2003).
Mason NA, Neudeck BL, Welage LS, Elhasan NS , Wong A, Patel JA, Swartz RD. Comparison of Three Vancomycin Dosage Regimens Hemodialysis with Cellulose Triacetate Dialyzers: Post-Dialysis Versus Intradialytic Administration. (Clin Nephol 60:96-104, 2003).
Mohamed S, Swartz R. Co-morbidity in ESRD: Treating the symptoms and palliating the discomfort. In Supportive Care for the Renal Patients, Germain M, Chambers J. (eds.), Oxford University Press, Oxford, UK, 2002.
Martin C, Saran R, Leavey S, Swartz R. Using Risk Stratification Models to Predict the Outcome of Renal Replacement Therapy in Severe Acute Renal Failure. (ASAIO, 48:640-644, 2002).
Messana J, Block G, Swartz R. Injury to the inferior epigastric artery complicating percutaneous peritoneal dialysis catheter insertion. Perit Dial Int, 21 (3): 313-315, 2001.
Swartz R, Perry E. “Medical Family”. A new view of the relationship between chronic dialysis patients and staff arising from discussions about advance directives. J Women's Health & Gender Based Medicine, Vol 8, No 9, 2000.