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Sensing Savvy

Deborah Brouwer-Maier RN, CNN

Deborah Brouwer-Maier is a nephrology nurse for more than 30 years. Her area of expertise is hemodialysis vascular access. She served on the KDOQI Vascular Access Work Groups in 1997, 2000 and 2006. She also served in various volunteer roles for the Fistula Frist Initiates since the formation of the initial Work Group. She is the support for the Hemodialysis Circle of Care Transonic products to support access creation, surveillance and preservation.

Recent Posts

Kidney Care News to Know

Posted by Deborah Brouwer-Maier RN, CNN on Oct 2, 2019

Large Dialysis Providers have Strong Growth in Home Dialysis

According to a survey from Nephrology News & Issues, the 10 largest dialysis providers had 35% of patients on home dialysis, that‘s 15 percentage points higher than survey results from 2018 and 2017. Among the providers, home hemodialysis grew from 5,783 patients in 2013 to 8,807 patients in 2019.

Source: Nephrology News & Issues

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Kidney Care News to Know: Fresenius Invests in BioIntelliSense

Posted by Deborah Brouwer-Maier RN, CNN on Aug 14, 2019

Trump Administration Announces Plan to Change Kidney Care in the U.S.

President Trump signed an executive order to launch Advancing American Kidney Health, which is designed to increase earlier intervention, incentivize dialysis providers to direct more patients to home hemodialysis and increase the number of kidneys available for transplant.

Specifically, the initiative aims to:

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Hemodynamic Monitoring: Updated Cardiac Function Parameters

Posted by Deborah Brouwer-Maier RN, CNN on Aug 12, 2019

Hemodialysis patients who do not feel well at the end of a session are subject to an unidentified decrease in Cardiac Index. End-stage renal disease (ESRD) patients are at increased risk of complications and death from cardiovascular disease (CVD). In fact, mortality rates from CVD are up to 30 times higher for ESRD patients than those in the general population.

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Kidney Care News: Outset Medical Appoints New Chief Financial Officer

Posted by Deborah Brouwer-Maier RN, CNN on Jul 31, 2019

Outset Medical Appoints New Chief Financial Officer

Rebecca Chambers is the company’s new CFO. Prior to joining Outset Medical, Chambers worked at Illumina Inc.

Source: Nephrology News & Issues

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Home Hemodialysis: A Brief History

Posted by Deborah Brouwer-Maier RN, CNN on Jul 10, 2019

In the early 1960s, the demand for dialysis outweighed its availability, which meant many patients with end-stage renal disease (ESRD) or chronic kidney disease were turned away from treatment.

After the 15-year-old daughter of a friend of Les Babb’s was denied dialysis treatment, Babb, a professor of nuclear engineering at the University of Washington and Belding Schriber set to work developing a small home dialysis system. A few months later in London, Stanley Shaldon began using a similar machine to treat dialysis patients at home.

Since there was no government funding to pay for treatment in the ’60s, home hemodialysis became an affordable treatment option for patients.

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Kidney Care News to Know: CPR Underused by Dialysis Clinics

Posted by Deborah Brouwer-Maier RN, CNN on Jun 24, 2019

California’s Legislation of Dialysis Profit Restriction Could Cause DaVita to Lose Up to $40 Million

DaVita has estimated it could lose up to $40 million in revenue if California’s restricting dialysis profits and use of third-party payers to cover Medicare premiums becomes law. The company spent $30 million in Q4 2018 in an effort to counter union policy efforts and spent $93 million on advocacy efforts last year.

Source: Nephrology News & Issues

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Debbie Brouwer-Maier Offers Her Perspective on Kidney Care Issues

Posted by Deborah Brouwer-Maier RN, CNN on Jun 7, 2019

As a nephrology professional who has devoted countless hours of volunteer time to support the body of work reflected in the 2006 National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines on vascular access, it is difficult to witness the “march of time” with regards to the arteriovenous fistula (AVF) as the best access for patients on dialysis.

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Topics: KDOQI

Process of Care, Part III: Hemodialysis Catheters

Posted by Deborah Brouwer-Maier RN, CNN on Jun 3, 2019

The same concerns over process of care related to the KDOQI VA proposed changes that reverse the momentum of the past guidelines and Fistula First (identifying early indications of assess dysfunction, staff assessment competency) also apply to hemodialysis catheters. The proposed guidelines suggest that hemodialysis catheters could be a viable long-term access choice. Similar to the limitations on assessment skills, many states restrict the accessing of a central venous catheter to a licensed nurse. Questions raised by the proposed guidelines include:

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Process of Care, Part II: The Impact of Proposed KDOQI Guidelines

Posted by Deborah Brouwer-Maier RN, CNN on May 29, 2019

Dialysis facilities typically open early in the morning Monday to Saturday. The first shift of patients must get their treatments initiated to prevent delays for the later patient shifts. Commonly, limited licensed nursing staff is on duty to perform any needed early morning assessments. The One Minute Check has now been shortened to 10 seconds in some facilities in order to save time. Once the needles are placed, it is not safe to perform the check or a higher-level expert examination. Typically, the nephrologist and advance practice team members see dialysis patients once they are on their way to treatment. They may be able to assess later shift patients before their needles are inserted. However, routine process of care makes it very difficult for nephrologists to fully assess the AVF or AVG with an expert-level physical exam detailed in the current draft of the KDOQI Guideline updates.

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Topics: KDOQI

Process of Care, Part I: Hemodialysis Vascular Access Process of Care Overview

Posted by Deborah Brouwer-Maier RN, CNN on May 27, 2019

A quick review of the process of care is critical to understand how the proposed KDOQI Vascular Access Guidelines will impact the dialysis facilities and thus the patients.

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Topics: KDOQI

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