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Alan S. Kliger

It is now one year since Nephrologists Transforming Dialysis Safety (NTDS) began its work. The Centers for Disease Control and Prevention (CDC) awarded the American Society of Nephrology (ASN) 3 years of funding to sponsor NTDS, as part of its effort to improve infection-control practices in dialysis facilities across the United States.

The critical need to eliminate preventable infections in dialysis is shown in the dialysis databases. The PEER Report (2014) demonstrates only modest improvement in the rate of patient admission for infection between 2004 and 2014.

The USRDS 2016 Annual Data Report (vol 2, ESRD, Ch 5) shows hospitalization

Alan S Kliger MD

Approximately 10% of individuals with ESRD died in 2012 due to infections.1

Approximately 63,690 dialysis patients died from infectious complications in 2012. 1

While overall mortality rate and death from heart disease have improved in recent years, infection-related morbidity and mortality have not. Stopping these infections will require a transformation in the way we detect and manage infection.

Alan S. Kliger and Bonnie Freshly

Since its creation in 2016, Nephrologists Transforming Dialysis Safety (NTDS) has worked with the Centers for Disease Control and Prevention (CDC) in its mission to “enhance the quality of life for people with kidney failure by engaging nephrologists as team leaders in transformational change that continuously improves the safety of life-sustaining dialysis.” The first goal of NTDS was to target zero infections in dialysis patients. NTDS created a series of Targeting Zero infection-prevention webinars and online educational resources for the kidney community, which provide practical, evidence-based guidance for providers and can be accessed on demand at

Alan S. Kliger and Sarah Henrickson Parker

Each year in the United States, more than 8000 hemodialysis patients die after experiencing sepsis or other serious infectious complications. Of those patients, the highest percentage have infections related to a central venous catheter. Other vascular access sites can also become infected and cause sepsis.

Infections caused by multidrug-resistant organisms are far more common in the dialysis population than in the general population and have a high rate of mortality. Influenza is common and can be deadly in patients receiving dialysis. It has recently been estimated that more than 1000 dialysis patients in the United States die annually of influenza-like

Jeffrey Silberzweig, Alan S. Kliger, and Susan Stark

The COVID-19 pandemic has been devastating for kidney patients and challenging for nephrologists, nurses, and other caregivers. However, in the kidney community, it has led to collaborations that reduced the impact of COVID-19—collaborations that promise to serve kidney patients and professionals long into the future.

In March 2020, ASN formed the COVID-19 Response Team as a forum to gather accurate, unbiased information from reliable sources and to share it broadly with the kidney community, nationally, and regionally. The pandemic's ever-changing realities required continuous refinement, underscored the need to learn from one another's experience, and offered the opportunity to build on

Jeffrey Perl, Alan S. Kliger, Martin J. Schreiber, and the Home Dialysis Subcommittee of the ASN COVID-19 Response Team

The world is struggling with the new and uncertain realities of the COVID-19 pandemic, which has challenged all facets of the healthcare system in unprecedented ways. As the initial experience in the United States has taught us, none are more vulnerable to COVID-19–related morbidity and mortality than the ESRD population (1). These individuals carry a high burden of comorbidity, may be immunocompromised, have high rates of healthcare use, and often have a high prevalence of many of the symptoms that overlap with those of COVID-19. Moreover, the risk of viral transmission may be greatest for patients receiving in-center