Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
How do you approach COVID-19 vaccination in those who underwent kidney transplantation for native kidney glomerular disease?
The approach to all kidney transplant recipients regardless of the cause of end-stage kidney disease remains the same following the guidelines for immunocompromised patients. The benefits of vaccination and protection against COVID-related hospitalization and death outweigh vaccine-related incidents...
Do you routinely advise patients waiting for a kidney transplant to seek referrals at multiple institutions to decrease waiting time?
If your center is in a region (e.g., California and New York) with long wait time of up to 8-10 years, we routinely advise patients to seek referral at multiple centers with a shorter wait time out of the region if the patient does not have any potential donors.
For which patients do you prioritize ambulatory blood pressure monitoring over self-measured blood pressure?
Self-measured blood pressure can be useful for anyone who has been diagnosed with hypertension or is found to have office blood pressures (BPs) above normal (120/80 mm Hg).1 Correctly measured home BPs inform my decision on when to start antihypertensive medications or when to adjust antihypertensiv...
What is your approach to thiazide diuretic use in those with uncontrolled hypertension and advanced chronic kidney disease?
The Chlorthalidone for Hypertension in Advanced Chronic Kidney Disease (CLICK) trial provides an answer to this question. Chlorthalidone is still effective at lowering BP when eGFR is 15-30 mL/min/1.73m^2. Personally, I find it helpful to continue chlorthalidone in advanced CKD to help with kaliures...
How do you estimate daily dietary sodium intake in your patients with hypertension?
The best and simplest method is to check 24-hour urine for sodium excretion. In the steady state, the 24-hour urine sodium will closely approximate the daily intake of sodium.
What degree of hyperkalemia do you tolerate for those with proteinuric chronic kidney disease and persistently elevated serum potassium levels?
The K comes back 6.3 and you send them to the ER, and repeat K is 5.7, no EKG changes. That dance gets tiresome. How often do you think the opposite would occur? (K is 5.7 and you repeat it and it is 6.1?) K varies day to day and lab measurement to lab measurement.I am extreme, I do not expect other...
Do you advise patients to limit physical exertion including lifting heavy objects following a kidney biopsy?
I don’t think there is data on this, who would do a trial, but for an uncomplicated biopsy I tell them to take it easy for 3 days, usually over the weekend, a reason I like to do them on a Friday. No sports no working out no heavy lifting. I also tell them not to just lay around because if they are ...
How frequently do you obtain 24 hour urine stone risk profiles in your patients with kidney stone disease who pass less than one stone per year?
When I do 24h urine collections in patients, I repeat the collection in order to see if the goal of therapy was achieved. Whether that was fluids, dietary changes, or medications, I usually want to see if we were successful. After that, I'm less interested in repeating the study especially if the st...
In which patients do you obtain genetic testing for further evaluation of kidney stone disease?
First stone as a pre-adolescent, stone complicated by kidney failure, history of growth retardation, family history of stones or nephrocalcinosis or unexplained kidney failure, hearing impairment, ocular crystals High stone burden on imaging or nephrocalcinosis Concomitant low molecular weight prot...
How do you advise your kidney stone patients about optimal daily fluid intake?
Measuring urine is better than counting liters of intake and shoot for 2-3 liters/day. If they aren’t getting up most nights to urinate they probably aren’t drinking enough water. When they get tired of drinking and urinating I tell them to remember the pain associated with their stone.