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DIALYSIS TIMESNEWS & VIEWS FROM RRI
Volume 10, No. 5 November 2005
Inside…PRESORTEDSTANDARD
U.S. POSTAGE
PAIDLANSING, MI
PERMIT NO. 224
Dialysis for ARF in Developing Countries:Theory and Practice ...................................................1-2
New Evidence-Based Medicine Journal ...........................2
Global Transplant Conference to Lay Groundwork for New Clinical Practice Guideline................................3
2006 Conference On Dialysis Information/Program ....4-5
Renal-Friendly Holiday Eating ........................................6
CKD On Capitol Hill........................................................7
Renal Research Institute Update ...................................7
Renal Research Institute’s purpose is to improve outcomes in Dialysis patients through col-laborative research. This paper presents views of events in the Dialysis community from avariety of sources and information about our programs. We welcome your input.
To search past issues online, register to receive future issues, or submit articles or letters forpublication, visit www.renalresearch.com or e-mail dialysistimes@rriny.com.
Dr. M. K. Mani, Chief Nephrologist,Apollo Hospital, Chennai, India
Institutions treating ARF in India fallinto two major categories: the private sector,in which the patient pays all the expensesincurred upon him, and government hospi-tals, in which the state pays. In the privatesector, patients are managed more or less asin developed countries. Intermittent peri-toneal dialysis (IPD) is no longer in vogue.Most patients are maintained on haemodial-ysis (HD) till they recover. Some with unsta-ble circulation are kept on continuous renalreplacement therapies (CRRT). CAPD isused for some with long drawn out ARF inwhom it is felt that HD might further delayrecovery. Most government hospitals arestarved for funds. Places on HD are kept forpatients who have CRF and have relateddonors for transplantation, so that they willnot occupy the unit for long. Patients withCRF who are being investigated or who arewaiting for a donor to come forward fromwithin the family are kept on IPD until theirprogress to transplantation is assured. Theavailability of HD for ARF depends on the
number of CRF patients on HD awaitingtransplantation. If slots are available, ARF maybe treated on HD, but otherwise IPD is used.
Institutions in small towns may not haveprogrammes for CRF, and therefore maynot need to invest in artificial kidneys. ARFis treated with IPD in such centres. Thereare no reliable figures, but the sale of IPDcatheters in Tamil Nadu (population 65 mil-lion) is 1650 per month. Many of thesecatheters must be used for ARF. The mostfrequent causes of ARF in Tamil Nadu arevasomotor nephropathy secondary to gas-troenteritis, acute glomerulonephritis, anddrug induced ARF. The prospects for recov-ery are therefore excellent, and in my unitonly 28% of patients needed dialysis.Mortality was just 12%, and 79% of all ARFmade a smooth and complete recovery.Apollo has a very active cardiothoracic surgicalunit, and one can assume that the proportioncaused by these simple causes will be evenmore in secondary care hospitals, with bettersurvival and even less need for dialysis.When dialysing for ARF, the goal is just tokeep the patient alive until his kidneys recover.
A study from Tirunelveli demonstrated that,in 40 patients with vasomotor nephropathysecondary to diarrhoea allocated at randomto either IPD or HD (20 in each limb), olig-uria lasted three and a half days in patientson IPD against six days on HD, and recoveryfrom renal failure occurred in 16 days onIPD against 20 days on HD. The absence ofHD does not adversely affect the outcome inthe majority of ARF in India outside ametropolis.
Our aim is to make dialysis as cheap aspossible without compromising efficiency. Afew studies have demonstrated that the effi-ciency of IPD can be increased by the addi-tion of sodium nitroprusside to the dialysate,to dilate peritoneal vessels. For some reasonthis has not caught on, though sodium nitro-prusside is available.
Studies in my own unit have establishedthat one hour one litre cycles are the mosteconomical for IPD, and that is now thenorm in most parts of the country. one hourone liter cycles achieve the same urearemoval as half hour cycles with one, oneand a half or two litre exchanges using 70%
Dialysis for ARF in Developing Countries: Theory and Practice
RRI Newsletter 10/21/05 2:16 PM Page 1
DIALYSIS TIMESPage 2
as much dialysis f luid, and as one hour twolitre cycles using 75% as much. We have alsoshown that ARF with severe acidosis can betackled by adding 7.5% NaHCO3 to theIPD f luid. This is a useful addition to thearmamentarium of a unit that lacks facilitiesfor HD. Patients with ARF and acidosis(mean arterial pH 7.265, SD 0.054) wereallocated to either standard IPD with theacetate dialysate then in use, or to dialysiswith the same solution with 50 ml 7.5%NaHCO3 added per litre. Arterial pH wasestimated every two hours till it rose above7.384, when the addition of NaHCO3 was discontinued. Only 40% of the controlsattained normal pH in 12 hours, whereas allthe NaHCO3 group did, in an average of6.26 hours. Clinical improvement was rapid,and there were no adverse effects. Patientsretained an average of 43 mEq of Na during
the addition of NaHCO3. Units with artifi-cial kidneys could use HD for severely aci-dotic patients, but units lacking HD havefound this a useful addition to their arma-mentarium.
We have also been able to economise ondialysate in HD by using a slower f low. Arate of 350 ml per hour has been adequate inthe short term, and yielded a saving of 12%in the cost of each dialysis. We economise inCVVHD by using high f lux polysulfonedialysers instead of CVVH cartridges, whichcost four times as much. We established thata dialysate f low rate of one litre per hourcoupled with an ultraf iltration rate of onelitre per hour cost 26% less than a f low of one litre with ultraf iltration of 300 ml per hour, and 23% less than a f low of twolitres per hour with ultrafiltration of 500 mlper hour, to achieve equal clearances of ureaand creatinine.
Patients and their families spend morethan they can afford in an effort to save life.Every little we can save for them is valuable.
1. MANI MK, RAIBAGI MH, DIN-GANKAR AD: The economics of peri-toneal dialysis. A cost eff iciency study.Nephron 17: 130 - 134, 1976.
2. SRIKANTHAN R, PRABHAKARANJ, RAMKUMAR TS, SHIVANANDNAYAK K, SUBBA RAO B, RAMA-LINGAM KS, MANI MK: Cost effec-tiveness of a low dialysate f low rate inhemodialysis: a short term comparativestudy. Dialysis and Transplantation 19:125-126, 1990.
3. WIG N, MAHAJAN SK: Comparison ofsodium nitroprusside added peritonealdialysis and haemodialysis. Ind J Nephrol6: 81 - 85, 1996.
Dialysis for ARF in Developing Countries: Theory and Practice
continued from page 1
Paul Chrisp, PhD, MRPharmS
Editor-in-chief, Core Evidence
Improving outcomes of patients with
chronic renal failure is a primary aim of the
RRI and the readers of this newsletter.
Information on key clinical and economic
outcomes is critical, and healthcare providers
place increasing reliance on evidence-based
measures to evaluate new and existing inter-
ventions, and to help prioritize resources. A
problem exists however, as the evidence is
often scattered and not available in a form
that is useful.
A new peer-reviewed journal, Core
Evidence, was launched in July 2005 to
address this need. The aim of the journal is
to apply the principles of evidence-based
medicine to review the potential place of
drugs in therapy by focusing on clinically
relevant outcomes, particularly those that
matter to patients. The journal is published
by Core Medical Publishing Ltd, a new
independent publishing company with offices
in New York and Manchester, UK.
The evidence on new drugs from clinical
development and practice is systematically
evaluated in Core Evidence on the basis of
its relevance, validity, and credibility. Expert
opinion obtained during peer review adds
clinical context to each article. Published
four times a year, each issue of the journal
contains up to seven reviews, covering drugs
from phase I clinical trials through post-
launch. Drugs are selected on the basis of
their potential impact on patient outcomes,
disease management, and healthcare priori-
ties, and regularly reviewed throughout their
development.
These selection criteria mean that Core
Evidence covers a range of drugs and ther-
apy areas of relevance to nephrologists. In
the first issue of the journal, the evidence on
the use of sevelamer (Renagel®) as a phos-
phate binder is reviewed. As perhaps would
be expected, the review found clear evi-
dence for sevelamer's effectiveness as a phos-
phate binder. But it also supported the view
that sevelamer reduced vascular calcification
compared with calcium salts, with evidence
of reduced risk of cardiovascular morbidity
and mortality. There is also some evidence
that this reduction somewhat offsets the
higher cost of sevelamer compared with cal-
cium salts, although this needs to be con-
firmed by more direct evidence.
Readers of Dialysis Times may also be
interested to know that the novel antihyper-
tensive aliskiren is also reviewed in issue 1 of
Core Evidence. The drug, which is the first
renin inhibitor, is currently in phase III as
monotherapy and phase II as combination
therapy in patients with mild-to-moderate
hypertension, and in patients with diabetic
nephropathy. The emerging evidence indi-
cates equivalent eff icacy to angiotensin
receptor blockers.
Further information about Core Evidence
can be found on the Core Medical
Publishing website (http://www.coremed-
icalpublishing.com), or by contacting the
Editors at editor@coreevidence.com, or
914-220-8351.
New Evidence-Based Medicine Journal
RRI Newsletter 10/21/05 2:16 PM Page 2
DIALYSIS TIMES Page 3
DIALYSIS TIMESpublished by
Renal Research Institute, LLC207 East 94th Street, Suite 303
New York, NY 10128Telephone 212-360-4900 • Fax 646-672-4174
E D I T O R I A L C O M M I T T E ENathan Levin, MD
J. Michael Lazarus, MDPeter Kotanko, MD
Mary Carter, MBA, MPHTom Graham
Danielle Callegari
The statements and opinions contained in the articles published in DialysisTimes are based upon the views of the author and do not necessarily ref lectthe opinions of the Renal Research Institute or any affiliated company oracademic institution. Renal Research Institute does not warrant, eitherexpressly or by implication, the factual accuracy of the articles herein, nordoes it warrant any views or opinions offered by the author of such articles.If you have any questions regarding information in this article, please con-tact the author directly. Any views, comments, or responses to this articleare welcome at dialysistimes@rriny.com.
To search past issues online, register to receive future issues, or submit articles or letters for publication, visit
www.renalresearch.com or e-mail dialysistimes@rriny.com.
New York - The care of kidney trans-
plant recipients will be the focus of a global
“Controversies Conference” organized
by “Kidney Disease: Improving Global
Outcomes” (KDIGO), a global organization
managed by the National Kidney
Foundation (NKF). The Conference will be
held February 2 - 4 in Lisbon, Portugal. Its
goal is to improve the outcomes of kidney
transplants worldwide. The Conference will
make general recommendations and define
key questions that require a rigorous scien-
tific process by which KDIGO will develop
evidence-based clinical practice guidelines
on the subject.
The Conference and KDIGO are man-
aged by the NKF, headquartered in New
York City. KDIGO is a three year old
organization created to launch a global effort
to improve outcomes through guidelines and
their implementation.
“Thousands of kidney transplantations
are performed each year, but their outcomes
and the shortage of organs remain a major
problem,” said Fred L. Brown, NKF
Chairman. “We urgently need to help recip-
ients live long and healthy lives with their
transplanted kidneys. We can improve
outcomes and reduce the need for second
transplants through development and imple-
mentation of guidelines on better care.”
“The NKF Board of Directors felt so
strongly about this vital issue that they are
donating the money themselves to make the
development of the guidelines possible,”
Brown added. “We are also fortunate to
have support from Wyeth Pharmaceuticals,
Amgen, the Dole Food Company,
Transwestern Commercial Services and the
Robert and Jane Cizik Foundation so that a
complete program of a Controversies
Conference, Guideline Development and
implementation programs can be organized.”
The Conference and subsequent guide-
line will focus on improving the clinical
management of transplant recipients. This
includes post-transplant complications such
as malignancy, diabetes, anemia, bone disease
and cardiovascular risks. These complications
threaten the recipient's life, the survival of
the graft, and increase the cost of care.
KDIGO's guideline process is modeled on
NKF's successful series of guidelines on
chronic kidney disease and its treatment
known as KDOQI or Kidney Disease
Outcomes Quality Initiative.
Co-chair of KDIGO, Dr. Garabed
Eknoyan of Houston, Texas said, “We can
do much better in caring for our trans-
planted patients. This Conference will bring
together nearly 100 experts from around the
world to deliberate and determine what we
know, what we can do with what we know
and what we still need to discover.”
Dr. Norbert Lamiere, KDIGO Co-chair,
announced that the Conference Co-chairs
will be Dr. Francis Delmonico of Harvard
Medical School and Dr. Martin Zeier of the
University of Heidelberg. The Conference
Steering Committee met recently in Boston
to plan the organization and content of the
Conference.
Guideline Development
Following the Conference, KDIGO will
begin an 18 month process to empower an
independent work group and three method-
ology centers from different parts of the
world to examine the evidence and create
practice guidelines recommending ways to
improve outcomes. Such recommendations
will focus on what practicing kidney doc-
tors, primary care doctors and patients
themselves can do to prevent the loss of an
organ or threats to the life of a recipient.
Outcomes can be improved through better
management of cardiovascular risk, other
complications and the relationship between
kidney disease and the suppression of a
patient's immune system.
A previous KDIGO Controversies
Conference established the principal that
transplant recipients whose kidney function
is compromised still have chronic kidney dis-
ease and must be treated aggressively.
“KDIGO would like to acknowledge
and express appreciation to the
Transplantation Society and the Global
Alliance for Transplantation for their partici-
pation and input in this collaborative effort
toward our shared objective of improving
outcomes for kidney transplant recipients
throughout the world,” said John Davis,
CEO of the National Kidney Foundation.
KDIGO is a Belgian not-for-profit
foundation with a 40 member international
Board of Directors and managed by NKF. Its
mission is to improve outcomes for kidney
patients worldwide through coordination,
development and implementation of practice
guidelines.
Global Transplant Conference to Lay Groundwork for New Clinical Practice Guideline
RRI Newsletter 10/21/05 2:16 PM Page 3
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DIALYSIS TIMESPage 6
By Jennifer Cheng MS, RDThe holiday season with its culinary
temptations can challenge even the mostcompliant dialysis patients. During the fes-tivities, indulging in food and drinks inexcess can be difficult to avoid. In this time,many will gain a few “holiday pounds” andlose their resolve to stay on their diets.Unfortunately, this deviation can have harm-ful effects on our dialysis patients.
Our patients might enjoy a few mealseither eating out in restaurants or gatheringwith family and friends in their homes. Inboth situations, patients will definitely comeacross tempting holiday treats. These holidayfoods are often rich sources of phosphorus,potassium, and sodium. As our patientsattend parties and join family gatherings,they may also need to closely monitor theirf luid intake and, for diabetics, consumptionof concentrated sweets. The following aresome tips on how to stay in control of thesechallenges.
Phosphorus: Eggnog, macaroni &cheese, ice cream and chocolate are justsome of the high phosphorus foods foundaround the holidays. Patients need to bereminded that they must take their phos-phate binders with EVERY meal and snack.Dosage of these binders should also bereviewed; patients should learn to adjust thenumber of binders they take with the size ofthe meal they consume or with the presenceof high phosphorus foods.
Ideally the patients would adjust thenumber of phosphate binders to the phos-phorus content of each meal (e.g 1 binderper each 100 mg of phosphorus). An innova-tive education program has recently beendeveloped in Germany which allows toteach patients to accurately estimate the mealphosphorus content by eye. According tothis new concept the meal phosphorus con-tent is estimated by phosphate units, not bemilligrams, and phosphate binders are dosedin relation to the total number of phosphateunits contained in a meal (e.g. 1 binder perphosphate unit). First practical experienceswith the phosphate education program(PEP®) indicate high physician, dieticianand patient satisfaction and a high compli-ance rate. (for more information: m-k-kuhlmann@web.de)
Often when patients eat out, they tendto neglect to take their phosphate binders.
Eating out is a great way to enjoy differentcuisines, but noncompliance with theirbinders when eating out should not becomea habit. Advise patients to put their bindersin small pill boxes and set them out on thetable before they begin their meal so thatthey will be reminded to take their binders.
Potassium: Allowing patients to have asmall serving of their favorite high potassiumfood will let them satisfy their craving andhelp them feel less deprived during the holi-day season. Some popular high potassiumfoods are sweet potato, brussel sprouts,beans, squash and spinach. Of course, renalpatients should also continue to avoid toma-toes, potatoes, bananas and oranges.
In the case of potatoes and sweet pota-toes, patients can “dialyze” or leach outsome of the potassium out of these vegeta-bles by these 4 steps:1. Peel, cut and soak vegetable overnight in
a large bowl.2. Next day, throw away the water.3. Cook vegetable in fresh water. 4. Incorporate into recipe as desired.
It is important to remember that leach-ing does not reduce phosphorus content andwill not remove all of the potassium; there-fore, portion control is still important to pre-vent hyperkalemia.
Sodium: Sodium content of foods can behighly variable depending on the amount ofsalt added during cooking, but some foodsare salty even before cooking. For example,these foods include canned foods, processedmeats/fishes, and frozen foods. When eatingout, patients should also be cautious ofsauces and dips as these foods often haveadditional salt added to them during thecooking process. “Dining Out for theDialysis Patients” (below) further explainsthe pitfalls in food choices of each cuisine.
Fluids: If a patient chooses to have alco-hol, advise them to avoid high potassiumcocktails such as Bloody Marys, Screwdrivers,and Pina Coladas. Eggnog and hot chocolateare high in phosphorus. Remind yourpatients that these beverages should becounted as part of their daily f luidallowance.
Concentrated Sweets: These foodsinclude cake, ice cream, cookies, and pie.Our patients may want to indulge and treatthemselves to various desserts that are notregularly included in their diet. The effect of
this is more important for those with dia-betes. These patients should be encouragedto monitor their blood sugar daily and tolimit their portion sizes of concentratedsweets.
During this time, our patients need extraencouragement and advice with adhering totheir renal diet. With a little planning ahead,our patients can learn to choose appropriatefoods from a restaurant menu and modifytheir traditional holiday recipes into “RenalFriendly” foods that everyone can enjoy!
Dining Out for the Dialysis Patient
Restaurants foods are often higher insodium than those prepared at home.Remind your patients to control theirsodium and f luid intake for the rest of theday as they may have increased thirst after arestaurant meal.
The trick with eating out at restaurants isto watch the portion sizes. Eating a largeamount of low phosphorus or low potassiumfoods can result in a high phosphorus and/orpotassium load in the body. To manage this,tell your patients to ask for a take-out boxand transfer half of their meal into the boxand save it for another day.
Italian Food: Ask for “sauce on the side.”Most Italian dishes either contain tomato-based red sauces (which are high in potas-sium) or cream-based white sauces (whichare high in phosphorus). A good choicewould be pesto or garlic and oil sauces.Pizzas are high in sodium, potassium andphosphorus from the tomato sauce andcheese.
Asian Food: Avoid dishes that are sautéedwith soy, hoisin, and sweet and sour sauces.These sauces tend to be high in sodium andmonosodium glutamate (MSG). Betterchoices would be stir-fry vegetables withfresh garlic, steamed fish (without the soysauce), and grilled fish or chicken.
Mexican Food: Mexican food contains alot of beans, tomatoes, and cheese that arehigh in potassium, phosphorus and sodium.Avocados are also high in potassium. A goodchoice would be meat tacos with plain rice.
Jennifer Cheng MS, RD is a Renal Dietitianat Upper Manhattan Dialysis Center. She has aMasters degree in Nutrition Education fromColumbia University. Ms. Cheng contributes tothe monthly “UMDC HealthLink” newsletterwith renal diet advice for UMDC patients.
Renal-Friendly Holiday Eating
RRI Newsletter 10/21/05 2:16 PM Page 6
DIALYSIS TIMES Page 7
CKD On Capitol Hill
By Mohammed AliToday about 20 million Americans - 1 in 9 US
adults - have CKD and millions more are at risk.
Groups which are at increased risk for kidney disease
include African Americans, Hispanics, Pacif ic
Islanders, Native Americans and seniors.1
Since 1991, costs for the Medicare and ESRD
programs have grown 110 and 196 percent. The
ESRD program now accounts for 6.7 percent of the
Medicare budget, up 41 percent over the last 11
years. In 2002, ESRD spending reached $16.2 billion
for Medicare paid claims, $3.6 billion for Medicare
patient obligations, $0.83 billion for Medicare HMO
costs, and $4.7 billion for non-Medicare costs;
Compared to the Medicare program, and even after
taking deductibles and co-pays into account,
employer group health plans pay close to a $50,000
premium for treating younger ESRD patients.2
While the cost of dialysis treatment and its med-
ications is high, its benefits are only increased with
treatment increasing the three times a week threshold,
frequent HD makes a formidable case for frequent
therapies. Data showed that regimens associated with
the best biochemical profiles; volume, hypertension
control, and nutritional status do not provide the evi-
dence for superior survival when compared to long
nocturnal thrice-weekly or every-other-day conven-
tional HD. This correlation between frequency and
clinical outcomes may seem very clear, but may not
be directly linear. Perhaps the greatest benefits are
gained from the simple avoidance of 48 hr without
dialysis. By avoiding this gap, the benefits of dialysis
may be increased to better patient life.3
Currently Renal Research Institute, LLC based
in New York and two other organizations are recipi-
ents of cooperative agreement grants from the
National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK) to conduct clinical trials
on daily or more frequent hemodialysis. The benefit
of more frequent treatments is something that cannot
be denied, to prove these benefits will prove to be
invaluable. The NIDDK is interested in understand-
ing the potential medical benefits of more frequent
dialysis for patients with end stage kidney disease.
These recent awards from the NIDDK, as part of the
National Institutes of Health (NIH) and U.S.
Department of Health & Human Services, will exam-
ine the feasibility of randomization of patients to a
more frequent than current dialysis schedule with the
eventual aim of constituting a trial with suff icient
power to study differences in patient outcomes. This
is a 4 year project which is currently underway and
shows promise of great results.4
Recently the issues of dialysis and its costs as well
as the necessity of quality dialysis care have been
brought to the government's attention coinciding
with the steady increase in the dialysis population
which is predicted to grow over the next few years.5
Two new bills have been introduced to Congress.
The first one entitled Kidney Patient More Frequent
Dialysis Quality Act of 2005 H.R. 3096, was submit-
ted to the House of Representatives. The bill is to
amend title XVIII of the Social Security Act to pro-
vide for payment under the Medicare Program for
more frequent hemodialysis treatments. The bill pro-
poses to cover the treatment cost of dialysis treatment
if it is given four to five times a week compared to
the conventional thrice weekly as it is currently
scheduled for most dialysis patients nationwide. If
approved the bill will be a help in bringing the ideal-
ization of more frequent hemodialysis with the elimi-
nation of a 48 hour gap in dialysis sessions to life; a
move which is hypothesized to better the quality of
life for a dialysis patient.6
The second bill is in the senate entitled Kidney
Care Quality Act of 2005, S.635. The bill is endorsed
by U.S. Senator Rick Santorum (R-PA), Chairman
of the Senate Republican Conference Senator Kent
Conrad (D-ND) and members of the Washington
Redskins professional football team. They have all
teamed up to raise awareness for the bill. The act
seeks to improve the quality of care for End Stage
Renal Disease (ESRD) patients as well as the financial
stability of Medicare's ESRD program.7
Currently, Medicare reimburses dialysis facilities
through a prospective payment system (PPS) known
as the “composite rate,” which pays these providers
each time they administer dialysis to a patient.
However, unlike every other Medicare PPS, the
composite rate has no automatic annual payment
update mechanism to keep dialysis reimbursement in
line with the rising costs of providing care. The lack
of a payment update mechanism for dialysis providers
poses unique issues in terms of patient access to this
vital healthcare service.
The bills have support from various organiza-
tions, including the National Kidney Foundation
(NKF). “The Kidney Care Quality Act would make
it possible for providers to continue to improve the
quality of care and the other provisions in the legisla-
tion will address the goals of the foundation to reach
out to patients in earlier stages to improve their out-
comes as well” said Dolph Chianchiano Vice
President for Health Policy at the NKF. When asked
to comment on the Frequent Hemodialysis act Mr.
Chianchiano stated “more frequent dialysis is appro-
priate for certain patients and this legislation will
make it more accessible to the care they need”.
Dialysis is a life saving treatment method and for
now the only ray of light for people who have kidney
failure, at least until someone donates a kidney.
1 National Kidney Foundation
2 United States Renal Data Services
3 Hemodial Int. 2005 Jul; 9(3):309-13. “Beyond thrice-
weekly hemodialysis” Diaz-Buxo JA.
4 Fresenius Medical Care AG
5 Blood Purification 2004;22:6-8 “The Drumbeat of
Renal Failure: Symbiosis of Prevention and Renal
Replacement Therapy” , John H. Dirks;
6 Local Government website;
http://thomas.loc.gov/cgi-bin/query/z?c109:H.R.3096:
7 Office of Senator Rick Santorum
Paul Zabetakis, M.D., Chief Executive Officer of
Fresenius Medical Care Extracorporeal Alliance will
assume the additional responsibility of President,
Renal Research Institute (RRI), responsible for
Administration and Operations of managing RRI
clinics.
Nathan Levin, M.D., will continue as Medical
and Research Director of RRI and Chief Scientific
Officer for Fresenius Medical Care. He will continue
to have responsibility for the ongoing research activi-
ties of RRI.
The role of Research Laboratory Director will be
held by Peter Kotanko, M.D., from Hospital
Barmherzige Bruder, Teaching Hospital Medical
University of Graz, Austria. Dr. Kotanko will con-
tinue to oversee and manage all research laboratory
studies and activities. RRI is recognized for its signif-
icant research contributions to the renal field.
Renal Research Institute Update
RRI Newsletter 10/21/05 2:16 PM Page 7
RRI Newsletter 10/21/05 2:16 PM Page 8
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