Through process redesign, more of our patients are known to us before commencement of dialysis, a greater proportion of which are provided with pre-dialysis education and permanent vascular access. Our results highlight that implementation remains the final and most difficult challenge of the guideline process.

Flecainide is a sodium channel blocker used mainly in the treatment of supraventricular arrhythmias. Central nervous system side effects such as dizziness, visual disturbances, headache and nausea are commonly associated with flecainide, but severe central nervous system toxicity is rare. We report the first case of flecainide toxicity in a patient with end-stage renal failure. Cessation of flecainide therapy resulted in a fall in serum flecainide levels, with associated resolution of adverse central nervous system effects. We also review the pharmacokinetics of flecainide in patients with chronic kidney disease.

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