Nephrology impact on quality and length of life, and so psychological support, health education and advanced care planning play key roles in nephrology. Chronic kidney disease is typically managed with treatment of causative conditions (such as diabetes), avoidance of substances toxic to the kidneys (nephrotoxins like radiologic contrast and non-steroidal anti-inflammatory drugs), antihypertensives, diet and weight modification and planning for end-stage kidney failure. Impaired kidney function has systemic effects on the body. An erythropoetin stimulating agent may be required to ensure adequate production of red blood cells, activated vitamin D supplements and phosphate binders may be required to counteract the effects
Four Organs work, each tone sounds almost in sequence. A continuous maraca beat serves as a rhythmic framework. Reich describes the piece as "the longest V–I cadence in the history of Western Music," the V and I chords being contained within the one chord. "You'll find the chord in Debussy and Thelonious Monk – the tonic on top and the dominant on the bottom." He has cited the music of Pérotin and other twelfth and thirteenth century composers as suggesting the technique of note augmentation used in "Four Organs". For performances of the piece, Reich recommended using electronic organs with as plain