Joe Dialyzer

Very Interesting!

2011-03-10T04:46:00.002-05:00

Very Interesting!

Amazing!

2011-03-05T10:38:00.000-05:00

Amazing process

Message Profile Pic

2011-02-05T21:18:00.000-05:00

National Kidney Foundation: E-Kidney

2011-02-02T19:22:00.000-05:00

National Kidney Foundation: E-Kidney

SCM11 / NATIONAL KIDNEY FOUNDATION

2011-01-21T23:28:00.001-05:00

SCM11 / NATIONAL KIDNEY FOUNDATION

Paddling on Dialysis for Kidney Health: Jump in your boat, grab a paddle and ride the rive...

2011-01-16T12:25:00.000-05:00

Paddling on Dialysis for Kidney Health: Jump in your boat, grab a paddle and ride the rive...: "This summer I paddled 225 miles in ten days, did nocturnal home hemodialysis each night and raised $17,000 for kidney disease prevention.&nb..."

She Focuses on the Present and Remembers the Past

2011-01-12T21:07:00.001-05:00

She Focuses on the Present and Remembers the Past

NKF | 60th Anniversary

2011-01-11T22:29:00.002-05:00

NKF | 60th Anniversary

Kidney International - Peritoneal dialysis in Mexico

2010-12-20T16:33:00.001-05:00

Kidney International - Peritoneal dialysis in Mexico: "- Sent using Google Toolbar"

CKD 2 - Treatment Options: Dialysis

2010-10-06T20:36:00.001-04:00

A Great Options Presentation.

2010-10-06T20:13:00.002-04:00

Joe Dialyzer on PD

2010-09-19T22:47:00.002-04:00

P D an Awesme Option!!!

2010-09-18T22:04:00.000-04:00

Are the days of kidney dialysis numbered? | Health Tech - CNET News

2010-09-05T11:21:00.001-04:00

Are the days of kidney dialysis numbered? Health Tech - CNET News

Gambro

2010-08-31T19:45:00.001-04:00

Very recently I have made a change in my practice of Dialysis. The organization I am working with now uses predominately Gambro Dailysis equipment. I have in my history used the Gambro CVVH machine. I will now be using The Phoenix Machine by Gambro in my daily practice and I am excited as it seems to be an excellent machine!

Causes, Growing Organs for people who need them.

2010-08-25T08:15:00.002-04:00

Causes

NKF 60 YEARS!!!

2010-08-17T19:03:00.001-04:00

http://kidney.informz.net/z/cjUucD9taT04OTIxMTAmcD0xJnU9NzYxMDY4MjY0JmxpPTM2MTUzNDU/index.html

Transplants!!!

2010-08-08T12:13:00.000-04:00

Very Excited to report THREE Kidney Transplants in my system this past week! Two adults and one small child were the recipients. One of the adults received from a related donor and the others from the transplant list. The child was in need of a Kidney and a Liver and therefore received the liver transplant too! All these transplants done at Strong Memorial Hospital, University of Rochester, Rochester,NY. Transplant, an awesome option!

One soldier's death helps the lives of 74 - TwinCities.com

2010-07-24T18:49:00.000-04:00

One soldier's death helps the lives of 74 - TwinCities.com

How Saving Umbilical Cords Saves Lives

2010-07-24T18:32:00.000-04:00

How Saving Umbilical Cords Saves Lives

KDOQI Publishes US Commentary

2010-07-21T18:36:00.000-04:00

KDOQI Publishes US Commentary on KDIGO's Guideline for Kidney Transplant Recipients

July 2010

The KDOQI US Commentary on the 2009 KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients is now available on American Journal of Kidney Diseases' (AJKD) website. Click here to read the entire Commentary.

Dr Margaret Bia, MD of Yale University School of Medicine and the primary author of the KDOQI commentary, outlined the main messages:

1. In the US, decisions about immunosuoppressive medication such should always be done by or in concert with the transplant center.

2. KDIGO recommendations provide an excellent road map to guide clinicians in the complex care of the kidney transplant recipient but should not be used as the basis of policy because of the paucity of guidelines that are based on a strong level of evidence.

3. The Guideline stresses the need for continued monitoring of recipient's kidney function and drug levels, with frequent use of kidney biopsy to determine causes of graft dysfunction even after the early post-transplant period.

4. Control of risk factors to prevent cardiovascular disease, opportunistic infection and skin cancer, as outlined in the Guideline has now become a major part of good post transplant care.

"KDOQI collected a work group of US transplant nephrologists and surgeons to develop the commentary, which supports many of KDIGO's international recommendations while focusing on implementation and application of guidelines to local practice in the United States. The commentary also serves as an important guide for all clinicians who care for kidney transplant recipients," said Dr Jeffrey Berns of the University of Pennsylvania School of Medicine, Vice Chair of KDOQI Guidelines and Commentaries.

All KDOQI commentaries are published in AJKD and available online at www.ajkd.org and www.kdoqi.org.

Profile Pic

2010-07-18T11:47:00.002-04:00

I have had for some time now this combination Pic/awareness banner for my profile Pic on facebook. I just wanted to throw this post up on my blog as an encouragement to others to use this and other awareness symbols in their social networking. I know that many are already doing this and that is fantastic! I just wanted to use this Blog vehicle to promote some more promotion! Below this text I will place the Donate Life banner I use so feel free to copy and paste it into where ever. In a future post I can provide some instruction on how to combine a pic of your choice with a banner, logo or symbol. Remember use of certain Logos can be an issue.

Transplants!!!

2010-06-30T19:19:00.000-04:00

In my Dialysis unit we have had three Patients that have received Kidney transplants in the last 3 months and one that is pending for July! OMG it is the Ultimate option!!! Please Donate Life if you Can!!!!

NKF - Great Story!

2010-06-08T22:59:00.000-04:00

A Kidney Transplant Turns the Doctors into Patients

Dr. Andrew Levey, a leading nephrologist at Tufts University in Boston, has thoroughly described for hundreds of patients what to expect following a kidney transplant operation. These days, however, Levey speaks with a different authority–the expertise of one who’s walked in their shoes himself.
Last December, the editor of NKF’s American Journal of Kidney Diseases and leader of the Foundation’s workgroup that created the groundbreaking definition and staging system for chronic kidney disease, became a kidney donor himself. Levey donated a kidney as part of a three-pair “kidney swap” so that his wife, oncologist Dr. Roberta Falke, could receive a kidney.
Levey and Falke, who met as medical residents, knew that ultimately they would face the challenge of kidney failure. Like her father and two of her siblings, Falke suffers from a familial disorder, polycystic kidney disease, and she expected that her own kidneys probably wouldn’t continue functioning past middle age. Falke took meticulous care of her health, regularly visiting the doctor and getting immediate treatment for acute illnesses and infections. Knowing she was doing all she could, she focused on her roles as mother to her son, Isaac, and physician to the cancer patients who relied on her. She was able to banish thoughts of her disease until she developed symptoms related to enlarging kidney and liver cysts, and advanced kidney disease, over the past three years. Although she had to reduce her work hours, she continued to practice until the week before her transplant.
For Levey, though, too much knowledge wasn’t necessarily a good thing. As a kidney specialist, he was all too familiar with every possible complication that could occur. He found it hard to relax, even before Falke showed any symptoms, because he knew what lay ahead. As a husband, he felt duty-bound to help his wife, but he also felt powerless to help restore her health by giving her a kidney, because of incompatible blood type. What he learned throughout this process, though, was that there was a path he hadn’t counted on that could provide hope and ultimately, a solution.
Up until a year or two ago, Levey hadn’t entertained the thought of participating in a paired exchange program, where kidney recipients essentially swap kidneys from willing donors. While medically eligible to donate, each donor has an incompatible blood type or positive cross match test with his or her intended recipient. By agreeing to give kidneys to unknown but compatible recipients, the donors can enable a chain of transplants when previously no transplant would have been possible.
The couple wasn’t sure that paired donor exchange could be a practical reality, so they set about trying to find a donor from among family and friends. But as time wore on, everyone they had considered as a potential donor was eliminated for one reason or another. At the same time, paired donor exchange was becoming more common, and it soon became apparent that this might be the best way for Falke to receive the gift of life.
On December 15, 2009, Levey went under a knife, expertly wielded by his trusted colleagues in his own workplace, Tufts Medical Center. He donated his kidney to Peter Scheibe. Scheibe’s wife Susan donated her kidney to Hai Nguyen, and Nguyen’s wife Vy Yeng donated her kidney to Falke. Lying in the hospital bed, Levey was struck by how different it is to be the doctor who strides into the room to check in and walks right out the door, versus the patient who is laid up in bed.
“Since donating my kidney, I can tell people exactly what to expect every day post-transplant. I always tended to be close to my patients, but now our connection is so much more direct. They feel like I’m one of them. I have done something that they hope their family members will do or already have done, and they know how important it is to them. They really feel in a way like I’m part of their families,” says Levey.
“I have clinic once a week and now when I see patients, we spend the first half of the appointment talking about Roberta and me. Eventually, I have to ask, ‘are we going to discuss your case?’ Usually, they tell me, with a wave of the hand, that we’ll get to that the next visit. They’re far more interested in how the doctor who became a patient is doing.”
Falke too has been moved by the experience. “My cancer patients are so sick themselves, yet they are all concerned about me. They want to take care of me now and to know that I’m going to be okay. I’ve truly been touched by their outpouring of support.”
Falke says that doctors who experience serious illness get a taste of what patients go through. She feels it’s helpful to know where patients are coming from in terms of the fear, vulnerability and actual physical pain. “For now,” Falke smiles, “I’ve had more than my share of experience, but I still maintain that it’s good for doctors to be on the other side every once in awhile.”
Both Falke and Levey say the donation has brought them closer together and given them hope for their own future. They’ve always been involved with the National Kidney Foundation, but now they’re thinking about participating in more of the patient programs, such as the Kidney Walk and possibly even competing in NKF’s Olympic-style U.S. Transplant Games down the road.

Dizzying Symptoms

2010-06-07T22:02:00.000-04:00

Many Dialysis Patients are on Hydralazine.

Dizzying Symptoms

By LISA SANDERS, M.D.

Published: May 31, 2010

“I feel a swimming in my head,” mumbled the voice on the phone. Dr. Stephanie Pouch, a resident in her second year of training, wasn’t sure what to make of this elderly gentleman’s strange complaint. Was he feeling dizzy? He wasn’t sure; all he could say was that his head was “swimming” and that he almost passed out. Uncertain of the cause or even the nature of the complaint, Pouch sent the man to the emergency room. She was on call that day at the University of Chicago Medical Center. She would figure it out when he got there.
Once Pouch found the 68-year-old man in the busy emergency department, a quick glance at his chart explained his vague complaint: his blood pressure was so low it could barely be measured. Whenever he tried to stand, his blood pressure dropped even further, and his head began to swim. A look at the patient himself explained the dangerously low blood pressure: he was severely dehydrated. His eyes were dull and apathetic; his dark skin hung off the bones of his face as if it were a size too large. Beneath a graying, well-trimmed mustache, his lips were dry and cracked, and he passed an equally dry tongue across them frequently.
He was started on intravenous fluids. That would certainly help. But what happened to bring him to this state? The patient was a man of few words. But slowly, with the help of the patient’s wife, Pouch was able to put together his story. For the past several months the patient was plagued by severe diarrhea. He was in the bathroom 5 to 10 times a day. And the pattern repeated itself at night. He couldn’t remember the last time he had an uninterrupted night’s sleep. He had no pain, no fever or chills, just these endless trips to the bathroom.
As the patient spoke, Pouch’s eyes were drawn to his hands. They were covered by strange stripes of dark, thick, rough skin that started at the knuckles and extended all the way down the fingers. She gently turned one of the patient’s hands to look at the palm and found more of the same. He had the rash a long time, he told her, for weeks, maybe months. Pouch found the same rash on his back, chest and feet.
The rash was like nothing Pouch had seen before. Still, it was the diarrhea — not the rash — that brought the patient to the hospital. She forced herself to focus on the problem: what could be causing this persistent and profuse diarrhea? Pouch paged through the patient’s thick chart. He had a lot of medical problems: diabetes, atherosclerotic disease (also known as hardening of the arteries) and, usually, high blood pressure. This combination of diseases could cause diarrhea by limiting the amount of blood that reaches the intestines and starving the tissue. There were many other possible causes of severe diarrhea: infection was one; cancer another. Certain tumors can cause diarrhea by producing too much digestive hormone.
Pouch sent off samples of the patient’s stool to look for evidence of infection and blood for overproduction of hormones. The patient also needed an ultrasound of the blood vessels that feed the gut to see if blood flow was compromised.
The next morning on rounds, Pouch presented the patient to the attending physician, Dr. Vineet Arora. The more experienced Arora was worried about the patient’s prolific diarrhea, but she was also struck by the unusual rash. Could they be part of the same disease process? Patients like this man are the most difficult to assess, Arora later told me, because they have many medical problems, and it’s difficult to distinguish the foreground (the disease) from the background (the complicated and sometimes abnormal base-line state that now represents the patient’s normal condition).
There were some important diseases to consider that could cause diarrhea and a rash. Celiac disease — a sensitivity to a component of wheat known as gluten — can cause both. And the rash in celiac disease, unlike most rashes, can spread to the palms of the hands and soles of the feet. Zinc deficiency could cause both. So could a number of B vitamin deficiencies. Pouch quickly ordered a series of blood tests for these deficiencies.
Over the next several days, the patient improved significantly. His diarrhea slowed, his blood pressure rose and he could sit and stand without the dizziness that took him to the hospital. Meanwhile, test results dribbled in but provided no real answers. The ultrasound confirmed the hardening of the arteries but showed adequate blood flow to his intestines. There was no evidence of infection. He didn’t have celiac disease. It wasn’t zinc deficiency. After nearly a week, the patient was better and was sent home, though the team still didn’t know what made him sick.
A couple of days later, Arora and her team got their answer — or at least part of it. The blood tests they ordered revealed that the patient had a severe deficiency of vitamin B6. Initially, Arora was flummoxed. Vitamin B6 deficiency is rare in this country, and while it can cause pain in the hands and feet, it causes neither a rash nor diarrhea. Finally, she hit pay dirt: deficiencies of this essential nutrient caused the patient to develop a condition known as pellagra. First described by 18th-century European physicians, the name pellagra comes from an Italian description of its most common symptoms: the “rough skin” that Arora and Pouch were first struck by when examining this patient.
For centuries, the disease was thought to be caused by an infection, but we now know that pellagra comes from a deficiency of niacin. If an individual is not ingesting niacin, the body can create it, but it needs vitamin B6 to do so. In medical school we are taught that pellagra is characterized by the four Ds: diarrhea, dermatitis (rash), dementia and death. This patient had two of the four.
If this vitamin B6 deficiency explained the rash and diarrhea, what explained the vitamin B6 deficiency? Again, Arora wasn’t sure. Further reading led to the answer. The patient was taking hydralazine, a blood-pressure medication that had the side effect of eliminating vitamin B6 from the body. Hydralazine was an old blood-pressure medication that slipped from use as newer, easier-to-take medications were developed. But a few years ago a study suggested that hydralazine might be particularly useful in African-Americans. This new information brought the old medication to the current generation of doctors — and African-American patients like this one. That hydralazine can also cause a vitamin deficiency was common knowledge in this medication’s first life but seems to have been forgotten in its reprise.
Now the story was beginning to make sense: the hydralazine caused the vitamin-B6 deficiency, which, in turn, led to the niacin deficiency and pellagra. The patient’s diarrhea caused the low blood pressure. While he was in the hospital, the doctors were not giving him hydralazine because his blood pressure was low. Without the hydralazine the patient was able to absorb vitamin B6 and make niacin. By the time he was discharged, the diarrhea had improved strikingly. Arora contacted Dr. Kevin Thomas, the patient’s primary-care physician, who immediately started him on vitamin B6 supplements. The diarrhea resolved completely within a week; the remarkable rash disappeared over the next two weeks.
Arora and Pouch presented this case to other doctors and found that few of them were aware of this side effect of hydralazine. “Why don’t we know this anymore?” Arora asked me, amazed. “If this medicine is going to be used again, then doctors definitely need to know about this problem.”

Lisa Sanders is the author of “Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis.”
If you have a solved case to share with Dr. Sanders, you can e-mail her at lisa.sandersmd@gmail.com. She is unable to respond to all e-mail messages.

By LISA SANDERS, M.D.

Published: May 31, 2010

Renal Caregivers - KDOQI EDUCATION (Survey)

2010-05-30T12:56:00.000-04:00

KDOQI EDUCATION

PUTTING GUIDELINES INTO PRACTICE

Participate in our survey

Dear Friend,
The National Kidney Foundation's (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI™) is recognized throughout the world for providing evidence-based clinical practice guidelines and transforming the care of patients with kidney disease.
KDOQI expanded its scope of work in 2009. In addition to guideline development and commentaries, KDOQI also supports targeted research, advocates public policy positions consistent with KDOQI guideline recommendations and develops implementation and education tools for KDOQI guidelines.
In order to help better define future roles for KDOQI education, we would like to hear from you about our programs and how we can improve our resources. Please take a moment to complete our survey. Click here.
Your thoughts will be a great asset to NKF and KDOQI.
Warm Regards,

Michael Choi, MD
Vice Chair of KDOQI Education

Michael Rocco, MD
KDOQI Chair

WWW.KDOQI.ORG

Moment of Truth

2010-05-23T17:46:00.000-04:00

I am a Nurse working full time in a Home Peritoneal Dialysis program. A large part of of my job is training new patients to do their treatments at home. Also in our system it is often necessary to train a spouse or assistant caregiver to aid the patient or sometimes completely control the treatment process.

There are many aspects to delivering and maintaining continued safe practices inside the realm of Peritoneal Dialysis but I believe the most important thing overall is the actual connection and disconnection of the patient catheter to the Peritoneal Dialysis system. This is what I refer to as "the moment of truth" and I actually use this phrase when training patients.

Infection (Peritonitis) is the number one problem that a Peritoneal Dialysis(PD) patient may encounter while on this modality of treatment. If a patient does develop Peritonitis they may be able to remain on PD with the aid of Antibiotic treatment, they may have to come off of PD temporarily to heal and rest their system or they may not be able to do PD at all again.

There are several ways that the PD patient may contract peritonitis but a very common reason is a touch contamination during connections and disconnections to the system. The patient connection is accomplished in a matter of seconds but must be continually meticulously executed using sterile technique in an attempt to continue on this modality of dialysis.
The mechanics of the connections are quite simple and very user friendly. There are differing brand names of PD equipment but the patient to system connection is very similar across the board. At the moment of truth the patient or caregiver has to remove a sterile cap from the end of their patient line and remove a sterile cap from the PD system line and make a safe quick connection. Once this union is made the circut is closed off to the outside world and the exchange of PD fluid can now occur in a sterile fashion. At the end of the PD fluid exchange the same careful technique is used to disconnect from the PD fluid line and a new sterile cap is placed onto the patient line. These patient to PD system connections are basically the same whether using a manual or automated PD system.

That's all for now on this topic. In one of my future posts I will discuss preparing for the "moment of truth". So to all you PD patients and PD trainers never fall short of that meticulous PD mindset.

Healthcare Reform and Dialysis

2010-05-16T21:05:00.000-04:00

Keith Chartier
05/05/2010

HEALTHCARE is a thorny issue, and platoons of pundits have happily weighed in on the left and the right to rile up their bases over the past year. However, on March 23, President Obama signed into law the biggest expansion of federal healthcare guarantees in more than four decades. That doesn’t mean the healthcare debate is over, but the reality is that the U.S. health system must work to adapt to the new rules. And just how will health reform affect the renal community?
“The bigger issue for all of dialysis is what’s going to happen with the bundle and how is it going to be implemented,” said Robert Sepucha, senior vice president, government affairs, Fresenius Medicare Care. The bundled payment system was mandated by 2008’s Medicare Improvements for Patients and Providers Act, which will arguably affect dialysis care more than the bill Obama signed into law. “I’m not sure there is anything unique to dialysis or renal care that is going to be impacted by virtue of healthcare reform, save for one exception,” Sepucha said. “But there’s nothing I think people should be overly concerned about.”
The one exception for dialysis in the reform bill is a provision that the General Accounting Office (GAO) must do a study on the impact of the inclusion of oral drugs in the dialysis bundle. The deadline for the report is a year from passage, or March 23, 2011. “That’s a good thing, so we can figure out whether or not these things are being adequately priced and if there are any safety concerns,” Sepucha said.

Accountable Care Organizations

One area of opportunity for the renal community in healthcare reform is accountable care organizations. Right now, Medicare reimburses hospitals through Part A and dialysis through Part B. However, quality advancements in dialysis can lower Part A costs, yet Part B does not share in the savings.
“Currently, CKD (chronic kidney disease) is fragmented and not coordinated between PCPs (primary care physicians) and all specialists. Implementing CKD care, disease management, HIT (health information technology), etc. will improve the coordination of quality care,” said Edward R. Jones, MD, president of the Renal Physician Association. “Use of guidelines, setting quality outcomes and instituting P4P (pay-for-performance) models will enhance CKD care. In addition, improved quality of care has demonstrated decreased costs but predominately from Part A services.”
ACOs have been officially endorsed by the healthcare reform bill, and the Department of Health and Human Services has been authorized to start reimbursing provider and doctor groups who band together for large cadres of patients. If they are able to improve outcomes and lower costs then those ACOs can potentially share in the savings. “Gainsharing within the ACO will allow sharing of cost savings provided by good quality care,” Jones said. “In addition, ACOs jointly formed by nephrologists, PCPs and other entities will allow for redistribution of cost savings to those providing the improved care.”
However, the ACO structures have not been defined, but an example would be dialysis organizations partnering with nephrologists, PCPs and others within kidney care delivery to accept the risks and share in the benefits of the ACO, said Jones. “It would require breaking down on the Part A and B barrier.”
In addition to structure, the way ACOs are compensated is still up in the air, but the Medicare Payment Advisory Commission’s June 2009 healthcare reform report to Congress could provide some insight. “In our model, the ACO would consist of primary care physicians, specialists, and at least one hospital,” MedPAC wrote in the report. “The defining characteristic of ACOs is that a set of physicians and hospitals accepts joint responsibility for the quality of care received by the ACO’s panel of patients.”
In the MedPAC version of ACOs, which would have at least 5,000 patients to distinguish actual improvement from random variation, providers would still be paid standard fee-for-service Medicare payment rates (such as the dialysis bundle). However, bonuses would be paid if ACOs met certain spending and quality targets.
Just how these bonuses are figured out will be up for much debate. In the report, MedPAC acknowledged that geographic consideration needs to be taken into account as some parts of the country use more services that other parts. “The financial incentives would need to be based on changes in spending rather than levels of spending,” MedPAC wrote in the report.
“The dialysis community got together to make sure that Congress specifically included dialysis providers and groups as eligible under ACOs,” Sepucha said. “It’s contemplated that we could be part of this overall solution.”
Medicare chief medical officer Barry Straube, MD, outlined some areas of interest for ACOs at the Renal Physicians Association’s annual meeting in March. They include physician offices, dialysis clinics and home training programs, fistula maintenance programs, transplant programs, CKD prevention and management programs and end-of-life and palliative care programs.
“I think dialysis and renal care are uniquely positioned because of the close relationship we have with CMS,” Sepucha said. “The bundle is a great example. The bundle is the tip of the spear in terms of how CMS and the federal government are going to reimburse providers going forward. People have figured out the fee-for-service doesn’t work in every context and may be sort of a bad way of reimbursing providers,” he added. “That’s what the bundle is, and people realize with global payments you need some sort of shared savings program. That’s what an ACO is. We feel like we’re moving to where people want to end up.”

Reform Basics for Patients

Although the new healthcare law has little to say specifically about kidney care, its other provisions will have a broader affect on patients and those providing care. Some of the benefits under the new health law take effect in 2010, and many others will be phased in over the next few years in order to allow the healthcare system to adapt to the changes.
Starting in 2010, private insurers cannot drop people from their plans if they get sick. In addition, young adults can remain as a dependent on their parents’ private insurance coverage until they reach 26 years old. Another major change is that health insurers can no longer impose lifetime limits on benefits meaning patients’ benefits can no longer run out because of a long or expensive illness. According to the National Kidney Foundation’s Web site, “this could ensure continued access to care and to all treatment options for individuals who have been on dialysis for several years and received two or more kidney transplants.”
Under the new law in 2010, children 18 years old and younger can no longer be denied private insurance coverage if they have a preexisting condition. However, adults will have to wait until 2014 until insurers can’t deny them for preexisting conditions. In the meantime, a temporary “high-risk” pool will be established to provide coverage.
Also in 2014, all U.S. citizens will be required to obtain health insurance coverage or pay a minor tax penalty. “This is to ensure that everyone is in the insurance pool so no one can get a ‘free ride’ by not having affordable coverage and then going to the emergency room for care,” according to a news release from the American Medical Association.
With the greater access to health insurance, one affect of healthcare reform is kidney disease patients receiving preventive care before going on dialysis. “Anyone who understands the renal business knows about the huge transition costs when someone crashes into dialysis,” Sepucha said. “If we can facilitate an orderly transition, we’re able to, not just reduce costs, but dramatically improve health outcomes and reduce mortality and reduce hospitalizations.”
Supermarket-like state-based health insurance exchanges will start in 2014. In these, people who don’t have access to employer-based insurance can shop and compare the benefits and costs of private insurance plans. Insurance companies will be required to provide a minimum benefit package, as well as additional coverage options beyond a basic plan. Those who can’t afford the full cost of coverage can access federal subsidies in 2014 through tax credits or vouchers. Medicaid coverage will also be expanded in 2014 to cover those who have incomes at or below 133 percent of the federal poverty level.
“From a dialysis perspective, people need to be concerned that large insurance groups aren’t able to dump chronic patients into healthcare exchanges,” Sepucha said. “If suddenly these exchanges are covering chronic patients and they’re woefully underfunded, then the system is destined for failure.”
There are also a number of changes for patients enrolled in Medicare and Medicaid. Starting 2011, beneficiaries will no long pay any cost sharing for a number of preventive services. In addition, the new law will start closing the Medicare Part D “donut hole,” which requires patients to pay for their drugs when the costs fall between $2,700 and $6,150. In 2010, Medicare patients will receive a $250 rebate, and during the next 10 years the co-insurance rate will be narrowed in phases until the hole is closed in 2020.

Reform Basics for Practices

Primary care physicians whose Medicare charges for office, nursing facility and home visits comprise at least 60 percent of their total Medicare charges will be eligible for a 10 percent bonus payment between 2011 and 2016. Also, the new law re-establishes the geographic payment adjustment, also known as the GPCI. In 2010 and 2011, Medicare will reduce the GPCI adjustment for physician practice expenses in rural and low-cost areas.
In addition, Medicare quality reporting incentive payments have been extended. Payments of 1 percent in 2011 and 0.5 percent between 2012 and 2014 will continue for voluntary participation in Medicare’s Physician Quality Reporting Initiative (PQRI).
Practices or businesses with more than 50 employees will be required to offer health insurance in 2014. However, according to the AMA, the vast majority of physician practices have less than 50 employees and will be exempt from this provision.
“People are worried that more coverage is going to change the dynamics of healthcare. That doesn’t play as much into the ESRD population because there is already universal coverage, but in CKD, it changes,” Sepucha said. “It’s one thing to be covered, and another to actually sit down and speak with your doctor. It can only help patients in the sense that if they’re covered they’re more likely to get treatment. That means a primary care doc might refer a patient to a nephrologist that much sooner, and they can get the care sooner.” RBT

Our friend Jim Sloand to the Ways and Means Commitee.

2010-05-13T19:12:00.002-04:00

Testimony By James Sloand, M.D., Statement

Statement of James Sloand, M.D., Medical Affairs U.S., Baxter Healthcare

My name is James Sloand, M.D. and I direct medical affairs for renal services at Baxter Healthcare for the U.S. I have also been a practicing physician for over 30 years. Baxter’s renal business has long served the needs of people with end stage renal disease (ESRD). ESRD is the most serious form of kidney disease and occurs when the kidneys lose approximately 85-90 percent of their natural function. Kidney disease is life threatening and requires treatment in order to remove toxins from the bloodstream. In 1956, the company introduced the first commercially available and disposable dialyzer to act as an artificial kidney in hemodialysis. Nearly 20 years later, Baxter pioneered peritoneal dialysis a primarily home-based treatment for ESRD patients that is used all over the world.
The development of kidney dialysis therapy and the many improvements made to it over the past several decades have vastly improved survival for patients with end-stage renal disease. Improvements in the care of patients with kidney disease, for example, have meant that more individuals are undergoing dialysis therapy for longer periods.[1] As such, total costs will continue to rise as the prevalence of patients on dialysis increases, (estimated to increase by 62% by 2020.[2] )
Finding a way to delay entry into dialysis and to lower the costs of caring by preventing hospitalizations for people with chronic kidney disease (CKD) is critical to reducing health care spending. Patients can play an important role preventing deterioration in health once they have been diagnosed with a chronic condition. Building in patient self-management and empowerment through provider reimbursement policies may be key to reducing costs.[3]
A patient with end stage renal disease has two different options for renal replacement therapy (dialysis) if a pre-emptive renal transplant is not available: treatment at home with either peritoneal or home hemodialysis or by in-facility hemodialysis. Home peritoneal dialysis is underutilized in the U.S. compared with (for example) Canada (7.6% in U.S. versus 37% in Canada in 2005). A recent study of nephrologists indicated that if maximizing survival, wellness and quality of life were the most important factors in deciding mode for dialysis, 33% should be on PD.[4] The underutilization of PD in the U.S. may thus have a negative impact on quality of life for patients that might otherwise use this modality and the data show that this deficiency increases costs to the Medicare program:

MedPAC said in a recent report "Home dialysis offers several advantages related to quality of life and satisfaction to those patients who are able to dialyze at home.”[5]

The Centers for Medicare and Medicaid Services states that, "If 5 percent additional patients were to opt for home peritoneal dialysis, which provides added health and quality of life benefits….the potential savings for these 5 percent additional patients could be as much as $295 million." (Page 20471 Final Regulation on the Medicare Conditions of Coverage for End-stage Renal Disease Patients). [Note: these savings are through reduced hospitalizations and improved outcomes and over 10 years would result in at least $3 billion in savings.]

A lack of education about different modalities has been one of the significant reasons for underutilization in the U.S. In fact, only 25% of patients on hemodialysis ever remember receiving information about peritoneal dialysis as an option.[6] The provision of information to patients is also associated with greater willingness to adhere to therapies[7] and may include delayed progression to ESRD.[8]
In 2008, the Congress added an education benefit to the Medicare program to educate patients in the final stages of kidney diseases to delay the onset of dialysis and to increase the information on dialysis options for care. The benefit allows up to six educational sessions for Stage 4 kidney disease patients including instruction on the management of co-morbidities, with the goal of delaying the need for dialysis. The educational sessions are also required to include a discussion of the treatment options available to patients. The Centers for Medicare and Medicaid Services (CMS) now has responsibility for implementing this important benefit. It is my hope that they recognize the need for a collaborative model between the physician and his staff where both contribute to the process to ensure that the therapy is as the law requires: individualized and aiding the patient in managing complications and co-morbidities of kidney failure.
I recommend that Congress further improve the management of kidney disease within the Medicare program by recognizing the direct link with the initial coverage under the Medicaid program for the low-income. However, almost one-third of all new starts in dialysis begin in Medicaid and then transition after three months to Medicare. Data show that Medicaid patients are less likely to have access to nephrologists and to critical information on diet.[9] Increasing information to empower patients on how to manage their co-morbidities and significant metabolic issues-- prior to kidney failure-- is both equitable (increasing patient satisfaction) and, by reducing avoidable hospitalizations during the months immediately preceding and following the initiation of dialysis, it reduces costs for Medicaid program.
Therefore Congress should specify that Stage 4 CKD patients should be part of targeted Medicaid case management services.[10] In this instance, the case manager (a nurse or social worker) could ensure through community outreach that Medicaid eligibles with Stage 4 CKD have access to information on kidney disease, to kidney care providers, and they evaluate whether patients are receiving the appropriate information. Further, similar to the recently enacted Medicare physician and practitioner model for renal education, the case manager would refer the Medicaid eligible to a physician for training on managing their co-morbidities, diet and metabolic issues, as well as the modalities of care and preparing for the appropriate access for dialysis. It could also be a required case management activity for Medicaid managed care plans, through a case manager and through separate payments to physicians.
In addition, prevention should be a cornerstone of all aspects of the health care system rather than an afterthought. This shift requires a fundamental change in the way providers are reimbursed in the system to reward those that are increasing the value of the health care services and reducing preventable admissions. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requirement on pay for performance was an important step, as discussed further in my testimony as follows on vaccines for patients with end-stage kidney disease. Dialysis patients have long been recognized as a vulnerable and an underserved population that would benefit from immunizations. Since 1995, hospitalization rates for dialysis patients for infection have risen 19 percent overall, and 28% for African Americans. The rates of death due to infection are also highest among African Americans. Studies show that vaccination will result in reduced risk of hospitalization and death from infections. As a result, the CDC has recommended that all dialysis patients and staff be immunized to improve anti-microbial resistance.
Patients with ESRD are under immunized (60% in 2002 and no significant improvement in the reported data since then [11]), with an even lower rate for the dual eligible population. A CMS objective is to increase the annual ESRD patient influenza vaccination rate to 90% by 2010. Vaccines are cost effective overall for the population over 65, reducing costs by $117 per person.[12] Specifically, vaccinations reduce the risk of any hospitalization for hemodialysis patients by 7% (see chart below.)

*Influenza vaccine delivery and effectiveness[13]*
Hospitalization	Reduction in Risk
-Any cause -Influenza -Bacteremia -Respiratory infection	-7%
	-16%
	-24%
	-12%

Mr. Chairman, I request that your Committee urge CMS to include a measure concerning the percentage of vaccines, which is a national Quality Forum, for use in the pay for performance system that is required under the new dialysis payment system, effective January 2011. The statute provides for flexibility in the measures to be used for dialysis pay for performance, but does not specifically require vaccination for influenza as a measure. Given that spending on hospital services for patients undergoing dialysis was $7.05 billion a year in 2006, the estimated savings for an increase up to the CMS influenza vaccine target would be $150 million a year, or roughly $800 million over 5 years. This could be a key part of aligning incentives for excellence of care for providers in the Medicare program and also for reducing disparities for vulnerable kidney patients.
Thank you for this opportunity to submit testimony for the record on health care reform and reforming the delivery system.

[1] “Technological Change and the Growth of the Health Care System”, Congressional Budget Office, January 2008.
[2] Gilbertson and Collins, USRDS (the NIH US Renal Data System).
[3] “The Healthcare Delivery System: A Blueprint for Reform, from Chapter 5, Second Generation Consumerism: Increasing Consumer Activation to Improve Health Outcomes and Lower Costs for Patients with Chronic Disease by Judith Hibbard, and Katherine Hayes, J.D., Center for American Progress
[4] Mendelssohn et al, 2001
[5] MedPAC
[6] Golper, 2001
[7] Swatz, Robinson, Davy and Poltoski, 1999
[8] Golper, 2001
[9] Solid, Collins, USRDS, Minneapolis, Medical Research Foundation, 2007
[10] Case management is not the direct provision of medical and related services, but rather is assistance to help beneficiaries receive care by identifying needed services, finding providers, and monitoring and evaluating the services delivered.1 Targeted case management (TCM) refers to case management that is restricted to specific beneficiary groups. Targeted beneficiary groups can be defined by disease or medical
condition, or by geographic regions, such as a county or a city within a state. Targeted populations, for example, may include individuals with chronic physical or mental illness, developmental disabilities, or other groups identified by a state and approved by the Centers for Medicare and Medicaid (CMS). TCM and case management are optional services that states may elect to cover, but which must be approved by CMS through state plan amendment (SPAs). CRS Report to Congress: Medicaid Targeted Case Management Benefits, March 27, 2008
[11] One large chain recently reported an 85% vaccination rate.
[12] The Efficacy and Cost Effectiveness of Vaccination against Influenza among Elderly Persons Living in the Community, Nichol et al, NEJM September 1994).
[13] Odds ratios for the impact of vaccinations on mortality and morbidity in hemodialysis patients during the period 1998-1999 from “Influenza vaccine delivery and effectiveness in end stage renal disease”, Gilbertson et al, Kidney International, 2003

25 Facts About Organ Donation and Transplantation. NKF.

2010-05-12T19:46:00.000-04:00

The success rates of transplant surgery have improved remarkably, but growing shortages exist in the supply of organs and tissues available for transplantation. Many Americans who need transplants cannot get them because of these shortages. The result: some of these people die while waiting for that "Gift of Life."
Each year, the National Kidney Foundation develops special public education programs aimed at increasing public awareness of the need for organ and tissue donation. Learning more about organ and tissue donation will help every American to make an informed decision about this important issue. Here are some facts everyone should know:

104,748 U.S. patients are currently waiting for an organ transplant; more than 4,000 new patients are added to the waiting list each month.
Every day, 18 people die while waiting for a transplant of a vital organ, such as a heart, liver, kidney, pancreas, lung or bone marrow.
Because of the lack of available donors in this country, 4,573 kidney patients, 1,506 liver patients, 371 heart patients and 234 lung patients died in 2008 while waiting for life-saving organ transplants.
Nearly 10 percent of the patients currently waiting for heart transplants are young people under 18 years of age.
Acceptable organ donors can range in age from newborn to 65 years or more. People who are 65 years of age or older may be acceptable donors, particularly of corneas, skin, bone and for total body donation.
An estimated 12,000 people who die each year meet the criteria for organ donation, but less than half of that number become actual organ donors.
Donor organs are matched to waiting recipients by a national computer registry, called the National Organ Procurement and Transplantation Network (OPTN). This computer registry is operated by an organization known as the United Network for Organ Sharing (UNOS), which is located in Richmond, Virginia.
Currently there are 58 organ procurement organizations (OPOs) across the country, which provide organ procurement services to 250 transplant centers.
All hospitals are required by law to have a "Required Referral" system in place. Under this system, the hospital must notify the local Organ Procurement Organization (OPO) of all patient deaths. If the OPO determines that organ and/or tissue donation is appropriate in a particular case, they will have a representative contact the deceased patient’s family to offer them the option of donating their loved one’s organs and tissues.
By signing a Uniform Donor Card, an individual indicates his or her wish to be a donor. However, at the time of death, the person's next-of-kin will still be asked to sign a consent form for donation. It is important for people who wish to be organ and tissue donors to tell their family about this decision so that their wishes will be honored at the time of death.
All costs related to the donation of organs and tissues are paid for by the donor program. A family who receives a bill by mistake should contact the hospital or procurement agency immediately.
Tissue donation can enhance the lives of more than 50 people. Donated heart valves, bone, skin, corneas and connective tissues can be used in vital medical procedures such as heart valve replacements, limb reconstruction following tumor surgery, hip and knee joint reconstruction and in correcting curvature of the spine.
In 2008, a total of 14,208 organ donors were recovered in the U.S. Of these, 7,990 were cadaveric donors, which represented a decrease over the total of 8,019 in 2006. Living donors decreased from 6,732 in 2006 to 6,218 in 2008.
Donor organs and tissues are removed surgically, and the donor’s body is closed, as in any surgery. There are no outward signs of organ donation and open casket funerals are still possible.
Acceptable organ donors are those who are "brain dead" (whose brain function has ceased permanently) but whose heart and lungs continue to function with the use of ventilators. Brain dead is a legal definition of death.
Organ transplant recipients are selected on the basis of medical urgency, as well as compatibility of body size and blood chemistries, and not race, sex or creed.
Advances in surgical technique and organ preservation and the development of more effective drugs to prevent rejection have improved the success rates of all types of organ and tissue transplants.
About 94.4 percent of the kidneys transplanted from cadavers (persons who died recently) are still functioning well at one year after surgery.
The results are even better for kidneys transplanted from living donors. One year after surgery, 97.96 percent of these kidneys were still functioning well.
Following are one-year patient and organ graft survival rates:

Organ		Patient Survival Rate		Graft Survival Rate
Kidney (cadaveric) Kidney (live donor) Liver		94.4% 97.9% 90.1%		89.0% 95.1% 82.0%

Following is a comparison of the numbers of organ transplants done in 2008 and the numbers of individuals who are on the national waiting list as of November 2009.

Organ		Number of Transplants in 2008		Number of Patients on Waiting List* (of November 2009)
Kidney Kidney/Pancreas Pancreas Liver Heart Heart/lung Lung Intestine Total:		16,520 837 436 6,319 2,163 27 1,478 185 27,965		82,364 2,220 1,488 15,915 2,884 83 1,863 229 107,046

Of the 13,156 single kidney transplants performed in 2008, 5,968 were from living donors and the rest were from cadaveric donors. In addition, 837 kidneys were transplanted in combination with pancreas transplants.
Over 2,500 bone marrow transplants were performed in the U.S. in 2004. Marrow is collected from a pelvic bone using a special needle while the volunteer donor is under anesthesia. The majority of bone marrow transplants are done for leukemia.
In the United States fewer than 2.5% of patients with end-stage kidney disease undergo transplantation as their first treatment or therapy. The National Kidney Foundation is dedicated to educating kidney patients about the benefits of pre-emptive transplantation - when a person is able to go straight to transplant without dialysis they usually have good health outcomes.
2008 was the first time in 20 years that there was a decline in the number of deceased donors used for transplants. Living donors in 2008 were at their lowest numbers since 2001.
Virtually all religious denominations approve of organ and tissue donation as representing the highest humanitarian ideals and the ultimate charitable act.

Spouses of Dialysis Patients Have Reduced Kidney Function

2010-05-06T21:11:00.001-04:00

Spouses of Dialysis Patients Have Reduced Kidney Function

Married couples share a bed, a life, children, but chronic illness? A new study, reported in the May issue of American Journal of Kidney Diseases, suggests that a shared home environment and health habits can contribute to the development of chronic kidney disease (CKD) in the spouses of dialysis patients.

“We were surprised to find that the risk of developing chronic kidney disease for spouses of hemodialysis patients is just about as high as it is for blood relatives of these patients,” said study author Dr. Hung-Chun Chen of the Division of Nephrology at Kaohsiung Medical University Hospital in Taiwan.

To see how environmental factors might contribute to the development of CKD, researchers examined prevalence of chronic kidney disease in 95 spouses and 196 first- and second-degree relatives of 178 hemodialysis patients, who had been undergoing dialysis for between three months and 21 years.

The prevalence of CKD was found to be significantly higher in spouses and relatives of hemodialysis patients, than in a matched control group who were not related or married to patients. Both types of relatives were found to have a noticeably lower estimated glomerular filtration rate (eGFR), a measure of kidney function, and a high rate of albuminuria, or protein in the urine, an early sign of kidney disease.

The spouses had higher rates of habitual smoking, use of herbal medicines and analgesics and high blood pressure than their control group. Additionally, diabetes, which can be caused by obesity and poor health habits, was found to be a significant risk factor for CKD in spouses of dialysis patients.

“In light of these findings, it is critically important that spouses of dialysis patients receive careful screening for chronic kidney disease, in addition to first degree relatives,” said Dr. Kerry Willis, Senior Vice President for Scientific Activities, National Kidney Foundation. “Education about the role of environmental factors and health habits in increasing the risk of developing CKD is essential, as well.”

The National Kidney Foundation offers free screenings to those at risk of chronic kidney disease—anyone with high blood pressure, diabetes or a family history of chronic kidney disease, through its Kidney Early Evaluation Program.

Shad Ireland Ever Inspiring

2010-05-06T06:40:00.001-04:00

I have seen this presentation before and wanted to share it as this man is so motivating!

Nocturnal programs continue to grow!

2010-05-06T06:16:00.001-04:00

Nighttime dialysis launched in Tennessee
FMCNA successfully launched a nighttime dialysis program at the facility in Smyrna, Tenn. The service allows patients to receive treatments in the clinic for eight hours at night while sleeping or resting, three times a week. Laura Beach, RN, in photo, heads the Nocturnal program.

Michael Peoples used to receive life-sustaining dialysis treatments for four hours, three days a week.

Fresenius Medical Care North America, operator of the nation’s leading network of dialysis facilities, has launched a night-time dialysis program at Fresenius Medical Care Smyrna, according to a press release. The service allows patients to receive treatments in the clinic for eight hours at night while sleeping or resting, three times a week.

Dialysis is a process that cleans waste products from the blood, removes extra fluids, and controls the body’s chemistry when a person’s kidneys fail. Patients typically require treatment on an ongoing basis unless they receive a kidney transplant.
In addition to having their days free for other activities, patients often report having more energy and better dialysis results.

“Since I began dialyzing at night, I feel better and have more energy during the day,” said Peoples. “I love nighttime dialysis because when I wake up in the morning it doesn’t feel like I have had a dialysis treatment, I’m full of energy. The treatment is also spaced over a longer period of time, so it's easier on me physically.”

Clinical Manager Shannon McCurry said nocturnal dialysis can improve a patient’s overall quality of life.

“During the day, they may be able to work, spend more time with their families or enjoy their favorite hobbies,” she said.

For Peoples, that means being able to focus more on producing his own music.

'JumpStart' uses retired Rochester officer's story to highlight kidney disease

2010-04-30T06:38:00.005-04:00

(CARLOS ORTIZ staff photographer)

Jon Hand • Staff writer • April 29, 2010 JHAND@DemocratandChronicle.com

The current story line of the comic strip JumpStart has been pulled from the real-life health problems of retired Rochester police Officer Greg Raggi, a dialysis patient who has been in line for a life-saving kidney transplant for 3 ½ years.
Artist Robb Armstrong's strip, which is printed daily in the Democrat and Chronicle, features the lives of a fictional police officer, Joe, and his wife, Marcy, a nurse.
Since April 12, the strip has focused on Joe's "cop lifestyle" of eating fast fatty foods, working long hours and dealing with high stress. In the past few days, Joe and Marcy have discussed how that lifestyle can lead to diabetes and renal failure. In a subplot of the comic, Joe's partner, Crunchy, has left the fictional world of JumpStart to give his brother, Stanley (also a police officer), a kidney because Stanley has diabetes.
Armstrong said he developed the story line after a phone call from Mike Mazzeo, a friend and longtime partner of Raggi's in the narcotics unit of the Rochester Police Department.
Mazzeo, who is also the president of the Locust Club, the city police officer's union, first met Armstrong last year during a dust-up over a strip by Armstrong depicting a police shooting. The strip ran about the same time two city officers were shot and some in the community criticized Armstrong and the newspaper for being insensitive.
Mazzeo disagreed and publicly came to Armstrong's defense.
A bond was formed and the next time Mazzeo talked to Armstrong, he was asking him to help his friend, Raggi, and bring awareness to a problem many officers are concerned about.
"It's something that has affected many of us," said Mazzeo, who spent many hours taking his own father to dialysis treatments.
At least one other retired Rochester officer, Stan Prewasnick, is on dialysis and a third, Lt. Lou Genovese, died this past year after spending a year on dialysis, Mazzeo said.
Armstrong said he loved the idea right away.
"I have people walking up to me all the time saying, 'This is so funny, you have to write about it in JumpStart,'" Armstrong said from his home in Pasadena, Calif. "Mike came up to me and told me about something that wasn't funny but was so important. I said: 'Wow, this isn't just good for JumpStart, this is perfect.'"
Dr. Carlos Marroquin, a transplant surgeon from Strong Memorial Hospital, said no studies have been done to calculate whether police officers have a higher incidence of renal failure compared to other professions. But it's clear, Marroquin said, poor diet and stress can be a harmful combination.
"Clearly it is an issue, given the lifestyle, the stress, the dietary habits of a police officer," said Marroquin, who, at Mazzeo's invitation, spoke to union members in March to discuss kidney health and the safety of becoming "live donors." Donna Dixon, education director for the local chapter of the National Kidney Foundation, also spoke to the officers.
For his part, Raggi acknowledges that many of his old habits as an officer likely "caught up with him."
"I'm sure, eating the way I did, sleeping the way I did, middle shifts, night shifts, waking up early for court, it all took a toll on me," he said. "I'm not complaining. I loved it. But I wish I'd known better."
He retired in 1993 after 20 years in the department, and was diagnosed with Type 2 diabetes in 1995. The symptoms became more prevalent following a heart attack in 2004 and he went on the donor list in 2006.
He began peritoneal dialysis about 18 months ago, which requires Raggi to attach a tube leading from a suitcase-sized machine to a permanent tube in his abdomen each night for about nine hours while he sleeps. The process takes the place of the natural function of Raggi's kidneys, to filter toxins from his blood.
"I feel OK. I have good days and bad days; my doctor tells me to hang in there," said Raggi.
Doctors told him to expect it to take four to five years to find a donor kidney from the date he was placed on the list.
That surgery would change his life, he said. He's been looking forward to one thing, in particular.
"We never travel anymore because of the dialysis," he said. "I'd like to take a trip with my wife."
JHAND@DemocratandChronicle.com

Nasal mupirocin prevents Staphylococcus aureus

2010-04-25T20:17:00.001-04:00

If you are a Peritoneal Dialysis patient or a PD Nurse you may want to mention this study in your clinic and ask for the opinion of the professionals in the office.
J Am Soc Nephrol. 1996 Nov;7(11):2403-8.

Nasal mupirocin prevents Staphylococcus aureus exit-site infection during peritoneal dialysis. Mupirocin Study Group.

[No authors listed]

Abstract

A total of 1144 patients receiving continuous ambulatory peritoneal dialysis in nine European centers was screened for nasal carriage of Staphylococcus aureus. Two hundred sixty-seven subjects were defined as carriers of S. aureus by having had at least two positive swab results from samples taken on separate occasions, and were randomly allocated to treatment or control groups. Members of each group used a nasal ointment twice daily for 5 consecutive days every 4 wk. The treatment group used calcium mupirocin 2% (Bactroban nasal; SmithKline Beecham, Welwyn Garden City, United Kingdom) and the control group used placebo ointment. Patients were followed-up for a maximum period of 18 months. There were 134 individuals in the mupirocin group, and 133 individuals acted as control subjects. There were no differences in demographic data, cause of renal failure, type of catheter, system used, or method of exit-site care between the groups. Similarly, there were no differences in patient outcome or incidence of adverse events between both groups. Nasal carriage fell to 10% in those subjects who received active treatment and 48% in those who used the placebo ointment. There were 55 exit-site infections in 1236 patient-months in the control group and 33 in 1390 patient-months in the treatment group (not significant). S. aureus caused 14 episodes of exit-site infection in the mupirocin group and 44 in the control group (P = 0.006, mixed effects Poisson regression model). There were no differences in the rate of tunnel infection or peritonitis. There was no evidence of a progressive increase in resistance to mupirocin with time. Regular use of nasal mupirocin in continuous ambulatory peritoneal dialysis patients who are nasal carriers of S. aureus significantly reduces the rate of exit-site infections that occurs because of this organism.

PMID: 8959632 [PubMed - indexed for MEDLINE]

See Social Networking can be Very Good!

2010-04-22T19:04:00.000-04:00

Conn. mayor donates kidney to Facebook friend

By STEPHANIE REITZ, Associated Press Writer Stephanie Reitz, Associated Press Writer – Wed Apr 21, 7:32 pm ET

HARTFORD, Conn. – Politicians long ago discovered the uses of Facebook. East Haven Mayor April Capone Almon found something else there: a constituent who needed her kidney.CaponeAlmon, 35, had more than 1,600 "friends" on Facebook last year when shesaw one of them, Carlos Sanchez, post a status update saying hisfriends and relatives had all been tested and couldn't donate a kidney.She knew him casually through activities and friends in the New Haven suburb of East Haven, but they weren't so close that she had heard he was ill.Sanchez, a 44-year-old father whose kidneys were failing because of diabetes,sent out the request on Facebook only hesitantly and on his doctor'ssuggestion. He worried people might pity him — and certainly hadn'tpinned his hopes on finding a donor that way.He didn't have long to wait. Capone Almon was the first person to respond."Isent him a private message and just said, 'Hey, I'll try. I'll gettested,'" Capone Almon said Wednesday. "I really felt from the verybeginning that I was going to be a match and a donor. I don't know why,but I just knew it."Sanchez had no such certainty."Ithought she was joking. The mayor of East Haven would offer me herkidney?" said Sanchez, an office administrator. "She responded back andsaid, 'I am serious, I am willing to get tested.'"Iwasn't putting too much faith in it," he said. "I didn't want to get myhopes high. But at a point she made me feel so comfortable that Istarted feeling maybe this was meant to be."CaponeAlmon, a Democrat, was running for second term as mayor at the time butkept the details of her medical plans a secret. She won the election asthey awaited word on when she could donate the kidney, saying they grewas close as family during the lull."I know he voted for me, too," she joked.Theoperation was set only after Capone Almon passed a battery of tests andwas given a long explanation of the process, which involved three smallincisions near her ribcage and a scar similar to that of a cesarean section."Whatthe doctors said to me is, 'Your recipient is already sick and we'renot going to make you sick to make him somewhat better,'" she said."They do not compromise the donor's health in any way, shape or form."Their tenuous connection was cemented into a lasting bond April 8, when doctors at Yale-New Haven Hospital removed Capone Almon's left kidney and transplanted it into Sanchez.Theywere released from the hospital in less than a week and are expected tomake full recoveries. His insurance paid for both their surgeries, andthe mayor is back on the job in this middle-class city of about 30,000.CaponeAlmon said that she fields questions almost daily from people askingwhether she's worried her one remaining kidney might someday fail, butthat she's confident enough in modern medicine and her own health —especially after the numerous tests — that she barely gives it athought."I don't want people to see this assomething larger than life," she said. "There's nothing special aboutme. Anybody can try to do this, and if it's meant to be, you'll be amatch and a donor and you can really help someone."Michael Lawlor, an East Haven attorneyand longtime friend of Capone Almon's, said she kept the details of herplans private for a long time, even as he and others quizzed her toensure she recognized the serious nature of the donation."I remember saying, 'Wow, that's really something. I wonder ifshe's really thought through the fact that it might actually be amatch,'" said Lawlor, the area's state representative to the GeneralAssembly."Almost everybody says the same thing: I don't know if I woulddo that if it wasn't a relative ... but she said, 'No problem,'" hesaid. "When she found out she was a match, she was genuinely happy andtruly excited to do it."

Transplant!!!!!

2010-04-22T18:36:00.004-04:00

Many of you may remember Keith Barr from our 2010 Geneseo Kidney Walk - his outgoing personality and creative advertising caught all of our attentions!!

We are very excited to announce that Mr. Barr received notice last Wednesday that a kidney was available to him - and he received his transplant on Thursday. I spoke with Keith today and he said he is feeling great! We want to send a congratulations to him and his family - we are all so excited for you and wish you the best!

Keith promised to attend the Geneseo Kidney Walk next year with a sign that says "Received My Kidney 1 year ago!"

We are all very excited to see Keith and the rest of our great kidney walkers next year!

Thanks,
http://organdonor.gov/

Michelle Castrogiovanni

Division Special Events Manager

National Kidney Foundation

Serving Upstate New York

NKF Healthy Tips!!! Toss the Salt!

2010-04-18T21:56:00.000-04:00

TOSS THE SALT!
——————————————
LIVE LONGER.
New research shows dramatic
health benefits from reducing salt
intake by just 1/2 teaspoon per
day, resulting in a longer and
healthier life!
What is 1/2 teaspoon of salt?
1150mg of salt or 460mg of sodium
Helpful Hints to being Salt Smart:
♦ Toss your salt shakers!
♦ Cook with herbs and spices
instead of salt
♦ When eating out, ask for foods
without salt
♦ Cook and eat fresh foods
♦ Avoid processed foods
BE SALT SMART
AND
SODIUM SENSIBLE!

If PD fails: Think about home HD

2010-04-16T07:08:00.000-04:00

If PD fails: Think about home HD

Print this article

Some people happily do peritoneal dialysis (PD) for 10, or 15, or even 20, years. But many who choose PD stop after just 2–3 years.¹ The peritoneum may fail, or they may have "buyer's remorse" if PD doesn't fit their lives the way they hoped it would.

If this happens to you and you don't have a kidney transplant donor lined up, you'll need to switch to a form of hemodialysis (HD). Why not home HD?

Quality of life on PD vs. HD

When making a switch from PD to HD, it makes sense to think about how your quality of life will be affected.
Standard in-center HD three times a week for 3–4 hours can be a "default" treatment. People may end up with it and not even know that there are other options.² But PD is always done as a conscious choice. A study of why people choose PD in the first place found these reasons:³

Flexible schedule
Convenience of being home
Option of nighttime treatments

Statements from people who do PD bear out these key points:

"[In-center] hemodialysis wore me out, to where I couldn't do much other than go to treatments and sleep. Then I found PD, which no one had ever talked with me about before—and after a little research, I made the switch. It was the BEST choice I ever made. I now use a cycler at night, and work during the day."

"I had a terrible time on [in-center] hemo. I was scared at first because I wasn't sure if I could be in charge of my own care. But the difference is night and day for me. I have taken charge, and not only do I feel better physically but emotionally and spiritually too."

"Personally, I prefer PD to even the thought of HD. PD does not interfere with my lifestyle as much as HD would. I am very busy and tell people that I do not have time to sit on a machine for 4–5 hours 3 days a week. I do PD at night on a cycler and am dry during the day so can forget about dialysis during the day. I am able to continue all my activities and work. If I were on [in-center] HD I would have to quit work and would be unable to be as active as I am."

One study looked at quality of life in 60 people on PD and 60 on HD.⁴ It found that those on PD had a much better quality of life in the areas of:

Stress
Sleep
Social function
Major depression

And, on a scale of 1-10 (with 10 being high), people on PD rated their overall satisfaction at 8.02. Those on standard in-center HD rated theirs at 7.25—significantly lower.⁵ Why choose a treatment with which people are less satisfied?

Survival on PD vs. in-center HD

A new study matched 6,337 pairs of people who started PD or standard in-center HD in 2003. It found much better survival on PD than on HD.⁶ This was even more true for those under age 65, those who did not have heart disease, and those who did not have diabetes.
While those on PD don't seem to fare any worse after switching to in-center HD,⁷ why not aim for better?

Types of home HD

Medicare rules as of 2008 require people with kidney failure to be told about all of their treatment options—and where to get them.⁸ But we suspect that this is not yet happening everywhere. If PD is no longer working for you, and you need to make a switch, knowing your home options can help you choose a treatment that will fit your life:

small home hemo machine

Conventional home HD (CHD) – This treatment is done 3x/week. A huge plus of PD is getting treatment all or nearly all the time, so you don't have "ups and downs." CHD 3x/week will give you ups and downs. Just 3 treatments also means more fluid and diet limits and meds to take. And, just 3 treatments raises your risk of sudden cardiac death on the day after the 2-day no-treatment weekend by 50%.⁹ You can schedule treatments when you want, though, and be at home.
Short daily home HD (SDHD) – A small machine (about the size of a microwave â€“ see below) is used to do 2–3 hour treatments 5–6 days a week. You won't have ups and downs,^10,11 can have a more normal diet and fluids, and won't need as many blood pressure pills¹² or binders. While it can take as long as 6.67 hours to feel well again after standard HD, those on SDHD felt well in 30 minutes or less.¹³ Studies find that survival on SDHD is much better than standard HD or PD—in fact, it's about the same as deceased donor transplant!^14,15
Nocturnal home HD (NHHD) – HD treatments are done for 6–8 hours at night while you sleep, 3–6 times/week. Slow, gentle treatments are easy on the heart—and clean the blood so well that no special diet or fluid limits may be needed,^16,17 and blood pressure pills can be stopped.¹⁸ People feel well about 10 minutes after NHHD treatments.¹³

Most who do PD use a cycler at night. NHHD is the closest to this, in terms of lifestyle. People who switched from PD to NHHD had higher levels of protein in their blood, higher hemoglobin levels (with less EPO). They had lower levels of phosphorus—even though they didn't need binders.¹⁹ NHHD was not any more of a burden than PD. Finally, like SDHD, studies have found that survival on NHHD is about the same as deceased donor transplant.^21,22

Barriers to home HD

Dialysis needles. The most obvious barrier in switching from PD to home HD are the dialysis needles. Some programs permit home HD using a catheter. HD catheters at home are safer than in-center.²³ Learning how to put in your own needles if you have a fistula or graft puts control in YOUR hands and removes a lot of the pain and fear. You can read about how to do this in our articles:

If you are going to have to have needles anyway for HD, you might as well get the benefits of longer and/or more frequent home treatment!
Needing a partner. Many programs require a partner for home HD. If you don't have one, look for programs that do not require this. Or, see if you can do in-center nocturnal treatments (3x/week) in your town. This gives you most of the pluses of home treatment with no need for a partner.

Finding a home HD program. Not knowing where to find home HD can also stop you. Look at the "Find a Clinic Near You" database on Home Dialysis Central to search by type of treatment and zip code.

Both PD and home HD have been growing. We have kept track of the numbers of home programs since we started Home Dialysis Central in 2004, and this is what we've seen:

Treatment	'04	'09	% Growth
CAPD	1460	2143	46.7
CCPD	1428	2126	48.9
3x week HHD	294	765	160.2
Daily HHD	37	537	1351.3
Nocturnal HHD	73	274	275.3

There are about 5,000 U.S. dialysis clinics. In 2004, about 30% had some type of PD. Today, about 45% do. Growth has been much higher in home HD, but only about 15% of clinics offer some type of home HD.

Conclusion

You may or may not want to switch from PD to some form of HD. But if you need to for some reason, it's good to know that there are home HD treatment options that can help you keep the freedom, flexibility, and control of PD.

References

Jaar BG, Plantinga LC, Crews DC, Fink NE, Hebah N, Coresh J, Kliger AS, Powe NR. Timing, causes, predictors, and prognosis of switching from peritoneal dialysis to hemodialysis: a prospective study. BMC Nephrol. 2009 Feb 6;10:3.
USRDS 1997 Annual Data Report, USRDS Dialysis Morbidity and Mortality (Wave 2), 53.
Wuerth DB, Finkelstein SH, Schwetz O, Carey H, Kliger AS, Finkelstein FO. Patients' descriptions of specific factors leading to modality selection of chronic peritoneal dialysis or hemodialysis. Perit Dial Int. 2002 Mar-Apr;22(2):184-90.
Noshad H, Sadreddini S, Nezami N, Salekzamani Y, Ardalan MR. Comparison of outcome and quality of life: haemodialysis versus peritoneal dialysis patients. Singapore Med J. 2009 Feb;50(2):185-92.
Juergensen E, Wuerth D, Finkelstein SH, Juergensen PH, Bekui A, Finkelstein FO. Hemodialysis and peritoneal dialysis: patients' assessments of their satisfaction with therapy and the impact of the therapy on their lives. Clin J Am Soc Nephrol. 2006 Nov;1(6):1191-6.
Weinhandl ED, Foley RN, Gilbertson DT, Arneson TJ, Snyder JJ, Collins AJ. Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients. J Am Soc Nephrol. 2010 Mar;21(3):499-506. Epub 2010 Feb 4.
Van Biesen W, Dequidt C, Vijt D, Vanholder R, Lamiere N. Analysis of the reasons for transfers between hemodialysis and peritoneal dialysis and their effect on survivals. Adv Perit Dial. 1998;14:90-4.
Medicare and Medicaid Programs; Conditions for Coverage for End-Stage Renal Disease Facilities; Final Rule, from CMS. Accessed 3/2010.
Bleyer AJ, Russell GB, Satko SG. Sudden and cardiac death rates in hemodialysis patients. Kidney Int. 1999 Apr;55(4):1553-9.
Okada K, Abe M, Hagi C, Maruyama N, Ito K, Higuchi T, Matsumoto K, Takahashi S. Prolonged protective effect of short daily hemodialsyis against dialysis-induced hypotension. Kidney Blood Press Res. 2005;28(2):68-76.
Goldfarb-Rumyantzev AS, Leypoldt JK, Nelson N, Kutner NG, Cheung AK. Crossover study of short daily haemodialysis. Nephrol Dial Transplant. 2006 Jan;21(1):166-75.
Fagugli RM, Reboldi G, Quintaliani G, Pasini P, Ciao G, Cicconi B, Pasticci F, Kaufman JM, Buoncristiani U. Short daily hemodialysis: blood pressure control and left ventricular mass reduction in hypertensive hemodialysis patients. Am J Kidney Dis. 2001 Aug;38(2):371-6.
Heidenheim AP, Leitch R, Kortas C, Lindsay RM. Patient monitoring in the London Daily/Nocturnal Hemodialysis Study. Am J Kidney Dis. 2003 Jul;42(1 suppl):61-5.
Blagg CR, Kjellstrand CM, Ting GO, Young BA. Comparison of survival between short-daily hemodialysis and conventional hemodialysis using the standardized mortality ratio. Hemodial Int. 2006 Oct;10(4):371-4.
Kjellstrand CM, Buoncristiani U, Ting G, Traeger J, Piccoli GB, Sibai-Galland R, Young BA, Blagg CR. Short daily haemodialysis: survival in 415 patients treated for 1006 patient-years. Nephrol Dial Transplant. 2008 Oct;23(10):3283-9.
Geary DF, Piva E, Tyrrell J, Gajaria MJ, Piccone G, Keating LE, Harvey EA. Home nocturnal hemodialysis in children. J Pediatr. 2005 Sep;147(3):383-7.
Warady BA, Fischbach M, Geary D, Goldstein SL. Frequent hemodialysis in children. Adv Chronic Kidney Dis. 2007 Jul;14(3):297-303.
Nesrallah G, Suri R, Moist L, Kortas C, Lindsay RM. Volume control and blood pressure management in patients undergoing quotidian hemodialysis. Am J Kidney Dis. 2003 Jul;42(1 Suppl):13-7.
Wong JH, Pierratos A, Oreopoulos DG, Mohammad R, Benjamin-Wong F, Chan CT. The use of nocturnal home hemodialysis as salvage therapy for patients experiencing peritoneal dialysis failure. Perit Dial Int. 2007 Nov-Dec;27(6):669-74.
Fong E, Bargman JM, Chan CT. Cross-sectional comparison of quality of life and illness intrusiveness in patients who are treated with nocturnal home hemodialysis versus peritoneal dialysis. Clin J Am Soc Nephrol. 2007 Nov;2(6):1995-200.
Pauly RP, Gill JS, Rose CL, Asad RA, Chery A, Pierratos A, Chan CT. Survival among nocturnal home haemodialysis patients compared to kidney transplant recipients. Nephrol Dial Transplant. 2009 Sep;24(9):2915-9.
Johansen KL, Zhang R, Huang Y, Chen SC, Blagg CR, Goldfarb-Rumyantzev AS, Hoy CD, Lockridge RS Jr, Miller BW, Eggers PW, Kutner NG. Survival and hospitalization among patients using nocturnal and short daily compared to conventional hemodialysis: a USRDS study. Kidney Int. 2009 Nov;76(9):984-90.
Perl J, Lok CE, Chan CT. Central venous catheter outcomes in nocturnal hemodialysis. Kidney Int. 2006 Oct;70(7):1348-54.
Dialysis Needle Fear: Easing the Sting, Home Dialysis Central. Accessed 3/2010.
Dialysis Needles, Self-Cannulation, and the Buttonhole Technique, Home Dialysis Central. Accessed 3/2010.
Copland M, Murphy-Burke D, Levin A, Singh RS, Taylor P, Er L. Implementing a home haemodialysis programme without adversely affecting a peritoneal dialysis programme. Nephrol Dial Transplant. 2009 Aug;24(8):2546-50.

Innovative HeRO® Device

2010-04-14T07:03:00.001-04:00

Innovative HeRO® Device Improves

Outcomes, Quality of Life for Kidney Disease Patients
1,000 patients nationwide have now received the device
from Minnesota-based Hemosphere, Inc.
February 24, 2010 – Eden Prairie, Minn. – One thousand end stage renal disease patients have now benefited from a novel device that provides vital access to their blood for filtering and replacement kidney function and reduces the risk of potentially fatal bacteremia infection.
The HeRO® Vascular Access Device, produced by Hemosphere, Inc., in Eden Prairie, Minn., provides access for hemodialysis similar to a conventional graft. The device is surgically implanted completely under the skin and its innovative design bypasses central venous damage caused by catheters. More than 1,000 patients in over 220 hospitals across the United States have received the device since its commercialization in May 2008.
“Reaching this significant medical milestone demonstrates increasing physician acceptance of the HeRO Vascular Access Device and its positive contribution toward improved quality of life for kidney disease patients,” said Doris Engibous, President and CEO of Hemosphere, Inc. “The strong clinical results, and the subsequent increasing adoption of the device, reinforce that HeRO can provide improved vascular access performance and reduce healthcare costs compared to catheters.”
Before the introduction of HeRO, hemodialysis patients received a tunneled dialysis catheter when the damage to their central venous systems prevented them from supporting a fistula or graft. Catheters have a number of disadvantages, including high rates of life-threatening infection, inadequate dialysis compared to fistulas and grafts, and are widely known to cause damage to the central veins over time.
HeRO has the potential to establish a new standard of vascular access care to reduce long-term catheter use. The device provides a new option that improves a patient’s quality of life by increasing the effectiveness of hemodialysis treatment and reducing a patient’s risk of developing an often-fatal systemic infection.
“The HeRO device allows for better and more efficient dialysis, so many of my patients who have been implanted with HeRO say they feel better and have more energy,” said Dr. Brad Grimsley, vascular access surgeon at Texas Vascular Associates in Dallas, who performed the 1,000th implant. “Because HeRO is implanted under the skin, it has a significantly lower risk of potentially life-threatening infections than a catheter and allows my patients to enjoy daily activities, like showering or swimming, without worrying about exposing their access to germs and bacteria.”
How HeRO Works
The HeRO Vascular Access Device is made up of two pieces that are surgically implanted under the skin. During surgery, a reinforced tube (called the outflow component) is inserted directly into a large vein in the neck. X-ray is used to direct the tube past any blockages that have caused trouble for other access sites. A regular dialysis graft is sewn to an artery, just like a conventional graft. The graft is then joined to the outflow component with a special proprietary connector. Once the system is in place, blood will flow from the artery through the graft and
Internal Use Only: 15-0002, Press Release 1,000th Implant
outflow component into the heart. Unlike a catheter, there is continuous blood flow even when a patient is not receiving dialysis treatment.
“Our customers, including our earliest supporters in the clinical trial, as well as the dialysis care centers and our most recent certified surgical implanters, are the key to our success. Without their belief and support, HeRO would not be the solution for access challenged patients,” said Engibous. “We are committed to collaborating with clinicians and other members of the dialysis care continuum to improve clinical outcomes for patients for years to come.”
About Hemosphere, Inc. Hemosphere, Inc., is leading innovation and collaboration in the global development and commercialization of technologies that revolutionize care and restore quality of life for end-stage renal disease patients with compromised vasculature.
For more information on Hemosphere, Inc and the HeRO® Vascular Access Device, visit the company’s Web site at www.heroaccess.com.

Great Re-Blog, Post By Bill Peckham-DSEN.

2010-04-12T06:43:00.002-04:00

The Good Dialysis Index

By Bill Peckham
Dr. Agar has posted his Good Dialysis Index, which he presented during the morning session of Comprehensive Course in Hemodialysis on the Saturday of the Annual Dialysis Conference weekend last month in Seattle.
Answering yes to one of the 20 questions earns you a point; anything above 16 indicates Good Dialysis. This simplicity is a design feature. The idea is to create something usable, that matches clinical experience.
The Good Dialysis Index is a survey across four categories of questions: Patient Directed; Process Directed; Laboratory Directed; Chart Directed. Agar acknowledges that any snap shot of dialysis quality will give an incomplete picture, but over time a good GDI score will mean more than a good Kt/V.

Patient Champion Series: I wanted to share some of these awesome human stories that FMC has shared with me.

2010-04-11T21:46:00.003-04:00

Marian Carr

Age 41 • Kansas City, Mo. • Featured on March 24, 2010
Helping Other Patients With Ambitious Work Ethic
Marian Carr, a 41-year-old dialysis patient, was diagnosed with end stage renal disease (ESRD) in July 2002. She went on dialysis and shortly after regained her kidney function for nearly five years. Marian then returned back to dialysis in 2007, had an unsuccessful kidney transplant in 2009, and now receives in-center hemodialysis at Fresenius Medical Care Kansas City Dialysis. The cause of her kidney failure is unknown, although her father had kidney trouble too.
Despite her struggles with ESRD, Marian has persevered and continues to set and accomplish ambitious goals. She firmly believes that people should live the life they want to have, and not let health restrictions or setbacks get in the way.
Among many academic accomplishments, Marian completed her doctorate in psychology and obtained an International Counseling Certification from the Viktor Frankl Institute of Logotherapy – all while managing her dialysis schedule. As part of her doctoral thesis, she developed a counseling model for dialysis patients. Marian is currently active in two nonprofit organizations, as president of the local Minority Donor Awareness Group, and board chair of the Renaissance Education Group in Durham, N.C., which provides education programs for disadvantaged high school students.
To accommodate Marian’s rigorous schedule and numerous travels for work and vacation, she utilizes the Fresenius Medical Care Patient Travel Service. She has traveled all across the U.S., including trips to Dallas, New Orleans, Boston, Florida, Indiana, Michigan, California and North Carolina.
When she's not working, Marian enjoys reading and spending lots of time with her family. She is the eldest of four children and has two nieces and two nephews. This year, Marian and her friend have started a small business to provide counseling and training services for adults, and they plan on expanding it.

Patient Champion Series: I wanted to share some of these awesome human stories that FMC has shared with me.

2010-04-09T07:04:00.003-04:00

Tanysha Pitts

Age 33 • Tampa, Fla. • Featured on March 23, 2010
Nighttime Dialysis Allows Patient to Dream Big

Tanysha Pitts, a 33-year-old Tampa, Fla., resident, is living her dream, and likes to spread the word that anything is possible on dialysis. Tanysha, who has had kidney failure for almost 20 years as a result of a case of prolonged strep throat, is an in-center nighttime dialysis patient at Fresenius Medical Care Tampa North. Her unique treatment schedule (dialyzing overnight), which she began in 2008, has enabled her to pursue her education as a full-time medical student at Sanford Brown Institute.
Tanysha's dedication to her studies as medical assistant and to her dialysis treatment inspires patients and staff alike at her facility. Her passion for the medical field and her goal to one day work with people with chronic illnesses stems from her personal experience with kidney disease. Tanysha says she sees many young people starting dialysis who feel their lives have changed forever, but she is there to tell them a different story. Tanysha talks to her fellow patients about their dialysis treatment options and encourages them to try the nighttime program, sharing her success on the treatment plan and how they can fulfill their own dreams.
Tanysha will graduate from Sanford Brown Institute with her medical assistant certification in late March 2010, and plans on pursuing another degree in nursing or social work. In addition to school, Tanysha enjoys cooking, spending time with her friends, volunteering at various organizations and attending church services.

NKF Healthy Tips!!!

2010-04-07T20:51:00.002-04:00

Four Ways to Eat Healthier if You Have Kidney Disease

The nation’s sports fans are focused on the Final Four in April, but for those with chronic kidney disease, National Food Month is an opportunity to learn about the first four dietary nutrients to monitor with these tips from the National Kidney Foundation.

1. Protein

Getting the right amount of protein is important to your overall health and how well you feel. Your body needs the right amount of protein to:

Build muscles
Repair tissue
Fight infections

Your doctor may recommend that you follow a diet that has controlled amounts of protein. This may help decrease the amount of wastes in your blood and may help your kidneys to work longer.
Protein comes from two sources. You will need to get some protein each day from both of these sources:

Animal sources: eggs, fish, chicken, red meats, milk products and cheese
Plant sources: vegetables and grains

2. Sodium

Kidney disease, high blood pressure and sodium are often related. Therefore, you may need to limit the amount of sodium in your diet. One tactic to accomplish this is to learn how to read food labels so you can make lower sodium choices when you shop for foods. Sodium is a mineral found naturally in foods. It is found in large amounts in table salt and in foods that have added table salt such as:

Seasonings like soy sauce, teriyaki sauce and garlic or onion salt
Canned foods and some frozen foods
Processed meats like ham, bacon, sausage and cold cuts
Salted snack foods like chips and crackers
Most restaurant and take-out foods
Canned or dehydrated soups (like packaged noodle soup)

3. Potassium

Potassium is an important mineral in the blood that helps your muscles and heart work properly. Too much or too little potassium in the blood can be dangerous. One of the kidney’s jobs is to regulate the amount of potassium in your body and eliminate excess in the urine. When your kidneys begin to lower in function you may need to assist them by monitoring potassium in your diet. Foods that contain higher amounts of potassium are fruits and vegetables.

4. Phosphorous

Your kidneys also have the job of removing excess phosphorus from your blood. A high blood phosphorus level may cause your skin to itch and your bones to lose calcium which increases the risk for breaks. If you have CKD stage 3-5, eating fewer foods that are high in phosphorus, is very important and will help lower the amount of phosphorus in your blood.
Phosphorus is found in large amounts in the following:

Dairy products such as milk, cheese, pudding, yogurt and ice cream
Dried beans and peas such as kidney beans, split peas and lentils
Nuts and peanut butter
Beverages such as hot chocolate, beer and dark cola drinks

National Kidney Foundation!

2010-04-07T20:26:00.001-04:00

Double Donation: Husband and Wife Each Give Gift of Life

When Marcus and Monica Gilbert decided to purchase a Charley’s Grilled Subs franchise in a food court at a Utah mall, the idea of saving two lives was not in their business plan. Yet, that is exactly what resulted. Together, this couple, married seven years, has shared many successes --owning a thriving business, raising four healthy children and, within a 16-month span, giving the gift of life through kidney donation to two individuals.
Like many married couples, Marcus and Monica balance their days between running after their four children -- Jessica, Taylor, Christian and Emma –and managing a business. Unlike many married couples, they found the time and opportunity to each donate a kidney.
It all began when Marcus hired 17-year old Juan Delgado to work at one of his Charley’s Grilled Subs franchises. Marcus was determined to help Juan and his family, knowing that he had a difficult schedule to work around while undergoing thrice-weekly dialysis treatment. He even arranged a few fundraisers at Charley’s to defray Juan’s rising medical costs. But Marcus was still not satisfied with his results and decided to take his efforts one step further and get tested to become his employee’s kidney donor. After hearing that he was a perfect match, Marcus and Juan underwent successful kidney transplant surgery in September 2008.
“I felt I was in a good spot to donate and that I couldn’t pass up on the opportunity of giving someone so young his life back,” said Marcus.
After watching her husband donate his kidney without a hitch, Monica decided she too wanted to be a living donor. So she underwent tests with the goal of donating her kidney to anyone in need.
A few weeks later, Monica was notified that she was a match for a 44-year old named Pepe Sione Lee, a husband and father from Salt Lake City. Pepe’s kidneys had failed due to diabetes and he had been receiving dialysis treatment for 18 months. On February 11, 2010, Monica successfully donated a kidney.
In recognition of Monica’s gift, Pepe and his wife are planning a luau party this summer—just around the time when Juan plans to graduate from high school. Like both their kidney recipients, Marcus and Monica have returned to their daily routines with plenty of energy, which they will use to continue to chase their children around the house.

Patient Champion Series: I wanted to share some of these awesome human stories that FMC has shared with me.

2010-04-06T22:24:00.001-04:00

Anthony Lee

Age 43 • Saginaw, Mich. • Featured on March 19, 2010
The More You Do, The Better You Feel
Anthony Lee is a 43-year-old dialysis patient from Saginaw, Mich., who loves spending quality time with his family and staying active. Lee was first diagnosed with diabetes, with the end result being the failure of his kidneys. He received a kidney transplant that lasted until three years ago, and he has been on dialysis ever since.
Anthony is a busy father with two teenage daughters, and he recently decided to transition from in-center hemodialysis to home hemodialysis with Fresenius Medical Care Saginaw Riverside. He will soon start dialyzing at home and is looking forward to the flexibility and independence that home treatment will give him.
Anthony likes relaxing at home and going to church to be around positive people. He also loves being active with his daughters and enjoys playing basketball. He’s a believer in the saying, “the more you do, the better you feel,” and encourages other patients to become more active and live life to the fullest. He wants to help his fellow patients understand how CKD affects their body, and the importance of following their treatment program.

Our friend Jim Sloand to the Ways and Means Commitee.

2010-04-06T06:14:00.003-04:00

Testimony By James Sloand, M.D., Statement

Statement of James Sloand, M.D., Medical Affairs U.S., Baxter Healthcare

MedPAC said in a recent report "Home dialysis offers several advantages related to quality of life and satisfaction to those patients who are able to dialyze at home.”[5]

*Influenza vaccine delivery and effectiveness[13]*
Hospitalization	Reduction in Risk
-Any cause -Influenza -Bacteremia -Respiratory infection	-7%
	-16%
	-24%
	-12%

New Study Suggests Peritoneal Dialysis May Offer Significant Savings to Medicare

2010-04-04T06:49:00.000-04:00

New Study Suggests Peritoneal Dialysis May Offer Significant Savings to Medicare

May 13, 2009

by Astrid Fiano, DOTmed News Writer

The Clinical Therapeutics Journal is publishing a new paper, "The Financial Implications for Medicare of Greater Peritoneal Dialysis Use" by Nancy Neil, PhD, Steve Guest, MD, and several associates. The paper details the use of in-home versus in-center dialysis, including the patterns of dialysis utilization and the results of a budget-impact analysis that indicate if the peritoneal dialysis (PD) share of total dialysis were to increase to 15%, Medicare could yield over one billion dollars in savings over five years.

Dr. Steve Guest, Medical Affairs, Baxter Healthcare, Renal Division, McGaw Park, IL, spoke to DOTmed about the issues and findings in the paper. Dr. Guest first explained that providing care to patients with end stage renal disease (ESRD) is very costly due to the therapy itself but also for the care required to manage the oftentimes concurrent advanced co-morbidities. The overall impact to Medicare is significant as the ESRD Medicare patients represent less than 1% of Medicare enrollees but consume approximately 7% of Medicare resources as measured by payments for medical care billed to Medicare in a given calendar year.

"However, in reality," Dr. Guest said, "the differences in Medicare expenditures between peritoneal dialysis and in-center hemodialysis are very complex with resources being applied to a variety of cost centers."

For example, Dr. Guest described peritoneal dialysis as being most dependent upon disposable resources such as the dialysis solutions and supplies, used to perform the therapy at home. By comparison, in-center hemodialysis is most dependent upon fixed resources, in which investments have been made in bricks and mortar facilities, water treatment capabilities, hemodialysis machines and in-center staffing requirements. "The cost of an unused investment is high and so as not to waste those investments, they must be used to repay the capital outlay." The article is an analysis of these more comprehensive fixed resources used for in-center hemodialysis that include:

-- the facilities in which the hemodialysis is performed;
--the capital investment in the machines themselves;
--the supporting equipment necessary to treat municipal water to become medical grade water and the equipment needed to prepare the dialysate from this treated water;
--ongoing maintenance of the facilities and machines;
-- health personnel, including nurses, technicians, medical assistants, receptionists, etc.

PD does not have the same requirements for a special facility as the home is the site of care. However, Dr. Guest points out that while there is less of a capital investment for peritoneal dialysis, there are significant costs for PD therapy nonetheless: "These costs impact the dialysis providers if they are supplying the patient's dialysis supplies for peritoneal dialysis. But other economies can be realized with home therapy, such as a ratio of 20 patients to 25 patients per nurse for peritoneal dialysis compared to four to six patients per staff member for in-center hemodialysis."

Dr. Guest further detailed the findings regarding the differences in spending. "The differences in spending for hospitalization, outpatient use of erythropoiesis stimulating agents, vitamin D injectables, iron and vascular access reveal that the medical care provided to patients receiving in-center hemodialysis is more costly than that provided to patients on the home-based peritoneal dialysis therapy". Additionally, transportation costs were analyzed as in-center therapy such as hemodialysis requires the typical patient to present to the center at least three times per week for their hemodialysis treatments while peritoneal dialysis, as a home-based therapy, generally requires a patient to visit their nurse and physician only once per month. "This alone represents at least a 12-fold higher monthly cost of transportation for many in-center hemodialysis patients."

"Medicare expenditure differences in favor of peritoneal dialysis compared to in-center hemodialysis are significant" and Dr. Guest states may have been attenuated due to the fact that, in the United States, it appears that peritoneal dialysis patients are generally healthier overall than patients receiving in-center hemodialysis.
In the paper, it is mentioned that factors influencing the lesser use of PD include physician bias and lack of patient awareness due to insufficient exposure to full dialysis options education. Dr. Guest spoke of addressing the factors. "In testimony we recently submitted to the record for the House Ways and Means Committee, we provided recommendations to strengthen the education received by patients living with kidney disease who are Medicaid eligible. Medicaid accounts for one third of the starts on end stage kidney disease. As peritoneal dialysis patients rate greater satisfaction with this therapy compared to in-center hemodialysis, we point out the benefit of both increasing patient satisfaction and reducing overall Medicare costs as the Medicaid eligibles transition onto Medicare after 90 days".

In House testimony by colleague James Sloand, M.D., Medical Affairs U.S., Baxter Healthcare Dr. Sloand referenced that the lack of education about different modalities has been one of the significant reasons for underutilization in the U.S and surveys have shown that only 25% of patients on hemodialysis recall receiving information about the more cost-effective and cost-efficient peritoneal dialysis option. Dr. Sloand also commented that dialysis patients are a vulnerable and an underserved population that would benefit from improved influenza and bacterial pneumonia immunizations and greater vaccination rates could result in reduced risk of hospitalization and death from infections, which could further reduce Medicare expenditures

Patient Champion Series: I wanted to share some of these awesome human stories that FMC has shared with me.

2010-04-03T14:10:00.002-04:00

Harvey Jones
Age 56 • Greensboro, N.C. • Featured on March 18, 2010

Dialysis Patient Uses Voice to Inspire Peers, Legislators

After years on the road as a singer with Al Green, Mary J. Blige, Hall & Oates, Michael McDonald and many others, Harvey Jones wasn’t about to let kidney failure stop his momentum. Rather, he embraced his diagnosis and puts all his extra energy into helping other chronic kidney disease patients.

Since beginning dialysis in June 2001, Harvey continues to sing all over the United States, as well as internationally. Over the past 19 years, he has been on in-center hemodialysis, peritoneal dialysis and received a transplant which his body rejected after 8 years. Harvey is currently on in-center hemodialysis, and is on the kidney transplant waiting list.

Being on the road, traveling from one music venue to another makes it hard for Harvey to sit still. He owns a publishing company, enjoys reading and is also a minister. In order to keep physically fit, he walks two to three miles a day.

One of Harvey's most rewarding activities is his participation in an end stage renal disease (ESRD) patient support group in Greensboro, N.C., called the Dialysis Action Committee (D.A.C.). The D.A.C. is a nonprofit which provides patient support through celebrations and picnics, kidney disease screenings with the local National Kidney Foundation chapter, and meetings with local legislators about laws that impact the ESRD community.

Harvey receives a tremendous amount of support from his family. He has been happily married for 38 years and is a father of three. He also loves his local dialysis care team and facility, and says, “I wouldn’t dialyze anywhere other than Fresenius Medical Care.”

Harvey’s goal is to assist others living with ESRD and help them embrace their diagnosis, and remain optimistic and happy. “Attitude and laughter are part of the medicine needed to help you live with kidney failure," he says.

AWARENESS!!! It's Organ donation Month!!!

2010-04-01T21:12:00.002-04:00

Great Basic Kidney Information from Second Opinion.

2010-04-01T06:23:00.003-04:00

More Nxstage Users!

2010-04-01T05:43:00.001-04:00

Another great example of the growing Home Hemodialysis population!

Licorice Chemical Question as related to Transplant!

2010-04-01T02:34:00.000-04:00

Licorice May Block Effectiveness Of Drug Widely Used By Transplant Patients

ScienceDaily (2009-03-31) -- Chemists in Taiwan are reporting that an ingredient in licorice -- widely used in various foods and herbal medicines -- appears to block the absorption of cyclosporine, a drug used by transplant patients to prevent organ rejection. This drug interaction could potentially result in illness and death among transplant patients and others taking cyclosporine and licorice together, they caution. ... > read full article

FMC- Patient Champion Series

2010-03-30T23:01:00.005-04:00

I wanted to share some of these awesome human stories that FMC has shared with me.

Marlene Meza, a 62 year-old dialysis patient in Miami, is not afraid anymore. When first diagnosed with end-stage kidney disease in June 2009, Marlene did not know what life had in store for her. What she did know was that she wanted to continue working, traveling and spending lots of time with her family. After going through Fresenius Medical Care’s educational Treatment Options Program (TOPs), Marlene realized there was a dialysis treatment that fit her future goals perfectly. Today, she receives peritoneal dialysis through the home treatment program at Fresenius Medical Care Homestead.
Marlene's nurse says she is a big help and enjoys talking to new dialysis patients about their treatments. She offers them hope and reassures them that there are different treatment options for kidney disease that allow for flexible and fulfilling lifestyles. With seven children, 19 grandchildren and five great-grandchildren, it is not hard to understand why Marlene would want exactly that.
Marlene believes that anything is possible with the help of family and doctors. For her, home dialysis has been the answer. She continues to work at Goodwill Industries, where she has been employed for 16 years. In May, Marlene is planning an extended trip home to Nicaragua. Until then, she is busy planning the next family dinner, where all 32 members of her family will get together to eat and enjoy each other’s company.

FMC - Liberty Cycler

2010-03-30T00:11:00.001-04:00

This is a nice new cycler. I train all my new Patients on this cycler with the exception of Pediatrics.

FMC- Patient Champion Series

2010-03-29T22:52:00.002-04:00

I wanted to share some of these awesome human stories that FMC has shared with me.

Ronnie Glasper, a 38-year-old dialysis patient from Monroe, La., believes taking a proactive role in your health care is one of the keys to a successful life on dialysis. Ronnie has been on dialysis for two years because of kidney failure related to juvenile diabetes. He receives hemodialysis treatments at the Fresenius Medical Care Northeast Louisiana dialysis facility.
Every three days, when Ronnie arrives at the facility, he visits with the other patients, asking how they are doing and sharing information he has learned regarding kidney disease. He believes that, ultimately, your health is your own responsibility. He encourages dialysis patients to take an active role in their health care by asking questions, learning how the machines work, and understanding all of their dialysis needs. Currently, he’s a Network Patient Representative and has been nominated to be a member the Fresenius Medical Care Patient Advisory Board.
Beyond his support of fellow dialysis patients, Ronnie is an inspiration to children and adults through his work at Big Brothers Big Sisters of Northeast Louisiana. As a case manager, he matches children with mentors, who provide them with guidance and support. He also volunteers as a mentor. For Ronnie, having an activity he enjoys outside of dialysis is extremely important, and he advises other patients to find that outlet. Ronnie loves to read and research his family’s genealogy. That hobby takes him frequently to his hometown of Clayton, La., with the help of the Fresenius Medical Care Patient Travel Service.
Ronnie is currently on the waiting list for a kidney and pancreas transplant. His ultimate goals are to educate young people and give back to the community. That includes raising awareness about kidney health among adolescents.

FMC- Patient Champion Series

2010-03-29T21:39:00.009-04:00

I wanted to share some of these awesome human stories that FMC has shared with me.

Mary Ann Milo is a 39-year-old dialysis patient who lives in Avondale, Ariz. Mary Ann was diagnosed with kidney disease at the age of two, and her kidneys lost all function by the time she was nine. At that point, she started her first round of peritoneal dialysis. Her first transplant, from her father, lasted 12 years but eventually failed. Then she returned to peritoneal dialysis. She was able to get a second transplant that lasted up until three years ago, and is now currently on in-center hemodialysis at Fresenius Medical Care Avondale.
Despite her ups and downs, Mary Ann’s mission in life is to bring happiness to those around her and help patients on dialysis. Mary Ann has taken great interest in educating other patients about dialysis, and she created a patient council that meets every month. She has also volunteered to be a patient representative at her clinic. Mary Ann is very dedicated to her treatment program, and has even learned to help set up her own dialysis treatment at the clinic.
Mary Ann is a fourth-grade teacher at Freedom Elementary School located in Buckeye, Ariz., where she has taught for nine years. Prior to teaching, she volunteered at the Geisinger Medical Center where she worked with pediatric dialysis patients. Mary Ann loves to hike, travel, and remain as active as possible. Mary Ann is planning a vacation to visit her sister in El Paso this year, and intends to study nursing with a focus in nephrology.
https://www.ultracare-dialysis.com/engine/renderpage.asp?pid=s1581

Kidney Walk to call attention to organ donors

2010-03-27T18:02:00.007-04:00

Caroline McKay wants people to know kidney donation changes lives, but it won’t impact the day-to-day life of a donor.
“Even three years later you can’t tell that I’m functioning with one kidney,” she says.
There is very thorough testing performed on potential donors and a healthy donor should experience a relatively quick recovery and continue regular activities with no side effects from the surgery.
“The only potential downfall for me would be the rare case that one of my family members would need a kidney, I wouldn’t have one to donate,” explains McKay.
McKay generously donated her kidney to a high-school classmate, Danny Bonner, whose sole kidney was failing.
At their 20-year reunion, his classmates held a silent auction to raise money for his medical costs, and awareness of his condition. Bonner had been on dialysis every other day for years, his health deteriorating.
All of his family members and his girlfriend were unable to donate due to age, health problems, or incompatibility. The two were not close in high school, but that did not matter to McKay. She just wanted to help.
She approached him after the silent auction at the reunion and told him her intentions. She knew at that point that she was the same blood type, but still needed to go through further physical tests.
“When people come forward to help you like that, it’s hard to describe the feeling,” said Bonner.
“When someone is willing to give up a part of their body to help you…it’s like a miracle.”
Following the surgery, McKay needed to avoid heavy lifting for a few months, a minor setback as a server at Applebee’s and a house-painter.
McKay is leading a team, “Givers of Hope,” in the upcoming kidney walk in Geneseo for the National Kidney Foundation. So far she has raised $1,000, 80 percent of her initial goal.
She is interested in becoming more active in raising awareness of kidney disease and organ donation. According to the National Kidney Foundation, one in nine people in the Livingston County area has chronic kidney disease and there are 400 people on the kidney transplant waiting list at Strong Memorial Hospital.
Proceeds from the kidney walk provide funding for free kidney check-ups, kidney health classes, Kidney Kinship patient support programs, professional medical programs, kidney transplant options, and local research grants. Take Care of Your Kidneys So They Can Take Care of You.

This is only the second year that a kidney walk is being held in Geneseo, to be held Friday, March 26 at SUNY Geneseo in the Wilson Ice Arena. Registration begins at 6 p.m. and the walk begins at 7 p.m.
The walk last year raised nearly $20,000 and with 21 teams already registered this year, the local NKF chapter hopes to raise $25,000, according to Special Events Manager Michelle Castrogiovanni.
For more information on how to participate or to donate, visit donate.kidney.org or call Michelle at 697-0874, ext. 30.

1 David J Undis March 11, 2010 at 1:55 pm: The generosity of live organ donors is wonderful. It's a shame we need so many live organ donors. Americans bury or cremate 20,000 transplantable organs every year. There is another good way to put a big dent in the organ shortage — if you don't agree to donate your organs when you die, then you go to the back of the waiting list if you ever need an organ to live. Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. About 50% of the organs transplanted in the United States go to people who haven't agreed to donate their own organs when they die. Anyone who wants to donate their organs to others who have agreed to donate theirs can join LifeSharers. LifeSharers is a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at http://www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition. LifeSharers has 13,000 members, including 755 members in New York. David J. Undis Executive Director LifeSharers http://www.lifesharers.org Report abusive comments
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The Bundle According to FMC

2010-03-26T00:41:00.012-04:00

Demystifying the bundle
It’s 2010 and the renal community is gearing up for one of the
biggest changes to occur in the dialysis industry in more than
25 years. On Jan. 1, 2011, Medicare’s current payment system
for outpatient End Stage Renal Disease (ESRD) dialysis
facilities gets replaced with a new prospective payment
system, more commonly known as “the bundle.” The bundle
will provide a fixed-rate payment to dialysis facilities for
virtually all ESRD-related healthcare expenses including
treatment, drugs and laboratory tests.
An underlying reason for the change to a bundled payment
system is to improve efficiencies in health care and increase
the quality of care provided to patients with ESRD. Today,
Medicare pays dialysis facilities a composite rate that is a
lump-sum payment. When the composite rate was first put into
place, it covered the majority of services and items needed to
treat Medicare patients with ESRD. Since then, more drugs, lab services and other items have
become available. These items are not covered in the composite rate and are billed separately to
the government. Separately billed items now represent a significant portion of government
spending on health care for ESRD patients on Medicare.
Although the final description of the new bundled payment system is not available until mid-
2010, the renal community has a sense of what will likely be included. In September, the Centers
for Medicare and Medicaid Services (CMS) issued a 500-page proposed rule outlining the new
bundled payment system and inviting public comment. In the proposed regulation, CMS
estimated that the payment for a “relatively healthy ESRD patient with no co-morbidities” will be
approximately $232 per dialysis treatment. CMS also estimated that payments could be
significantly lower or higher than this average based on a specific patient’s profile. Regardless of
the actual payment amount for an individual patient, under the proposed system, Medicare’s
fixed-rate payment to dialysis facilities will cover virtually all ESRD-related healthcare expenses
including treatment, drugs and laboratory tests. In other words, the composite rate and the
currently separately-billed items will be bundled together under one per treatment rate.
“The reality is there are pros and cons to the proposed bundled system,” said Rice Powell, Chief
Executive Officer of Fresenius Medical Care North America (FMCNA). “But overall, we believe
FMCNA is in a good position to be successful under a bundled payment. A number of
opportunities come from our vertical integration where we offer not only the entire product
spectrum in the dialysis sector but also high-quality treatment in dialysis clinics worldwide.”

The renal community had until mid-December to submit comments on the proposed rule to CMS
before the final rule is released sometime in mid-2010. To that end, the FMCNA Government
Affairs department collaborated with key representatives from Fresenius Medical Services (FMS)
and Renal Therapies Group (RTG) to gather feedback on the impact of the proposed bundle.
Together, they developed specific suggestions on how the new bundled payment system could
work more effectively for both patients and providers. FMCNA submitted these comments to
CMS prior to the deadline.
“With the bundle, we cannot focus on one FMCNA revenue stream without considering the
impact on the others,” said Powell. “We need to extend our thinking and collaboration beyond
functional and organizational boundaries. No matter what part of the business you’re in—
treatment, pharmaceuticals, laboratory services—we all share a common purpose as FMCNA
employees. It’s critical to operate in a manner that is in the best interest of the overall company
without focusing only on what works best for individual functional areas or business units.”
“The bundle’s impact will be industry-wide, and will not be limited to just FMCNA,” said Robert
Sepucha, Senior Vice President, Government Affairs. “Certainly, one of the biggest challenges
for everyone in the dialysis industry comes from the fact that the law requires the bundle to take 2
percent out of the Medicare payment system.” Based on projected 2010 Medicare payments, that
means the dialysis industry will need to find roughly $200 million in savings to remain
economically neutral under the new payment system. “Some of this can be achieved by
increasing operational efficiencies to a higher level,” said Sepucha.
In addition to improving efficiencies, quality is important, too. There is a quality requirement in
the bundle that becomes effective in 2012 that allows the government to withhold up to 2 percent
of Medicare payment for a facility’s failure to meet established quality measures for anemia
management and Urea Reduction Rate. For the first time, money will be taken away for not
meeting certain quality standards.
“The perception of how we as an organization bring value to the industry is probably going to
change with the implementation of the bundle,” said Powell. “Each of our functional
organizations and business units needs to keep an eye on the value we provide to our customers.
Our customers may have different needs in the changing environment. Deeply understanding
customer needs and ensuring all of our organizations are delivering superior value is critical.”
In addition, there are payment adjustments in the proposed bundled payment system including a
case/mix adjustment, facility adjustments and an adjustment for inflation. The case/mix
adjustment is a calculation that allows dialysis facilities to get additional compensation for
patients that require more resources. So if a patient has a high body mass, for example, the
adjusters help cover the costs. There are also facility adjustments that reflect the extent to which
costs incurred by low-volume facilities exceed the costs incurred by other facilities. Finally, the
bundle includes an adjustment to help offset inflation.

“The bundle gives us more flexibility in terms of how we run our business. This is an opportunity
to step back and take a closer look at how we can achieve efficiencies and seize new
opportunities while still maintaining our core commitment to quality. It’s a rare opportunity given
how quickly the industry and our business are moving forward,” said Sepucha.
Although the bundle is effective in 2011, providers can make a one-time election in 2010 to either
fully opt-in to the new bundled payment system, or to phase-in to the bundle over a period of four
years.
“We are in the midst of defining our bundle strategy based on the information in the proposed
bundled payment system as it stands today,” said Sepucha. “Once we have the final rule, we’ll
have a more concrete view on its impact and we will be able to finalize and execute our
implementation plans.”
This article is a reprint from the Winter 2009-2010 issue of the Messenger. The Messenger is published by
Fresenius Medical Care North America by Employee Communications for internal use only, and is not
intended for dissemination to the general public. The publication and all of its contents are the property of
Fresenius Medical Care North America. No part of this publication can be used without the consent of
Fresenius Medical Care North America.
© 2010 Fresenius Medical Care North America. All rights reserved.

What Health Care Reform Means for You Today

2010-03-23T23:08:00.001-04:00

What Health Care Reform Means for You Today:

*
No Denials for Pre-Existing Conditions Insurers may no longer exclude individuals under 19 years old with pre-existing medical conditions. The age limit increases over time. By 2014, people with pre-existing conditions could no longer be denied insurance.
*
More Young Adults Insured Parents will be allowed to keep their children on their health insurance plan until age 26.
*
Broader Coverage Within 90 days, people who have been locked out of the insurance market because of a pre-existing condition would be eligible for coverage.
*
Insurance Stability All insurance plans will be barred from imposing lifetime caps on coverage. Insurers can no longer cancel insurance retroactively except for outright fraud.
*
Prescription Drugs The 4 million Medicare beneficiaries with prescription drug bills so high they are not fully covered will get a $250 rebate this year. Next year, charges will be cut in half for seniors who fall into the Medicare coverage gap known as the doughnut hole.
*
Tax Credits for Small Businesses Small business owners will no longer be forced to choose between offering health care and hiring new employees. Tax credits of up to 35 percent of premiums will help them insure their employees.
*
Holding Down Premiums Insurers must report how much they spend on medical care versus administrative costs, a step that later will be followed by tighter government review of premium increases.
*
Health Centers Funding for community health centers will begin to go up this year. About 40 million patients, twice as many as today, will be treated in community health centers within five years.
*
Professional Training Investments in training more primary care doctors, nurses, nurse practitioners and physician assistants will begin later this year.
Let's push the 110th Congress to tackle the health care crisis.(Heath Policy and Politics): An article from: Nursing Economics

Patient sketches

2010-03-23T19:51:00.001-04:00

Delightful Sketches.

The Big Hole!!

2010-03-22T19:51:00.002-04:00

How would health care reform help The Dialysis Patient?

The Medicare Part D doughnut hole will begin to be eliminated now under the Senate-passed reconciliation bill, saving patients thousands of dollars. Their brand-name drugs will be discounted 50 percent in 2011, and that savings will increase to 75 percent by 2020. Generic drugs would be equally discounted (although in some Medicare plans, there is no copay for generics.) In addition, they will receive a $250 federal rebate if they pay any money into the doughnut hole this year.
Comment/Opinion---- Not enough soon enough! This leaves Money and control in the hands of the Pharms for another decade!!! Hopefully one thing that is speculated is that this Bill is a framework that can be tweeked and changed with great strides in the short days, months ahead, Hopefully not to take many years to transpire!

K E E P your EYES on your KIDNEY"S

2010-03-20T07:33:00.002-04:00

NKF-- KEEP screenings. What an awesome program!!!

Kidney Quiz!!!

2010-03-20T07:05:00.000-04:00

A verybasic NKF Kidney Quiz.
http://www.kidney.org/kidneyDisease/kidneyQuiz_v2.cfm

Phosphorus Challenge

2010-03-16T21:59:00.000-04:00

Cool DaVita Link!

Phosphorus ???

Another Options Link

2010-03-13T23:44:00.002-05:00

PD = Peritonitis Myth.

2010-03-10T22:11:00.007-05:00

Don't be swayed away from the kinder gentler treatment because of misinformation.

March 11th is World Kidney Day

2010-03-09T20:26:00.001-05:00

March 11th is World Kidney Day

Posted using ShareThis

National Kidney Foundation: Newsletters

2010-03-09T19:51:00.002-05:00

National Kidney Foundation: Newsletters

Help for Haiti

2010-02-28T09:55:00.002-05:00

This may not be Dialysis related but I needed to share this.

CKD Legislation

2010-02-27T19:41:00.000-05:00

Thank you to everyone who submitted letters to their state representatives regarding the proposed Chronic Kidney Disease (CKD) education legislation. Our voices were heard and we are excited to announce very positive results! The final bill, Kidney Disease Education (KDE), went into effect January 1, 2010, and includes much needed benefits for both patients with Stage 4 kidney disease and health care providers.

The legislation states that Medicare will cover up to six one-hour face-to-face pre-End Stage Kidney Disease (ESKD) education sessions concerning modality choices. This legislation is designed to ensure that patients will have the opportunity to actively participate in their choice of therapy. In particular, the sessions should be designed to provide comprehensive information regarding:

* The management of comorbidities, including delaying the need for dialysis
* Prevention of uremic complications
* Options for renal replacement therapy (including peritoneal dialysis, home hemodialysis, in-center hemodialysis, as well as vascular access options and transplantation)

The KDE bill also allows for health care providers to be reimbursed for providing CKD education to Stage 4 CKD patients. Health care providers will be reimbursed at a rate of approximately $108* per individual session (HCPCS code G0420). Group sessions (between 2-20 people) will be reimbursed at a rate of approximately $26* per person (HCPCS code G0421).

Together, we were able to ensure this landmark legislation became law and help over 900,000 people in the United States with Stage 4 kidney disease. Now, more than ever, patients will be empowered to select a therapy option that best meets their needs and lifestyle.

If you would like to learn more about the new Kidney Disease Education (KDE) bill and how Baxter can assist with your education program, please contact your local sales representative at 1-888-736-2543, option 4.

Transplant!!!!!

2010-02-22T22:13:00.002-05:00

Awesome!!! one of my Primary patients received a Kidney transplant on Sunday!!!! This was from the Kidney transplant list(non-living donor). So please people sign your license for donation cuz this is one of the best examples that life does go on if you will please help it!!!

Banbury Needs a Dialysis Unit!

2010-02-21T22:49:00.001-05:00

Great cause-group in facebook!

Organ Transplant Patients, Families and Friends

2010-02-21T22:41:00.002-05:00

Neat facebook group!

Davita (facebook)

2010-02-17T19:49:00.004-05:00

Some Info from Davita

New Modalities?

2010-02-13T17:49:00.002-05:00

Wow a wearable Kidney???

My Local NKF Stuff!!!

2010-02-04T20:02:00.002-05:00

Upcoming NKF for Me!!!

Your cause, Support Organ and Tissue Donation, has reached 7,500 members!!!

2009-11-16T20:41:00.004-05:00

Your cause, Support Organ and Tissue Donation, has reached 7,500 members! I got this notification in my facebook tonight and how very appropriate!

I had just left our PD(Peritoneal Dialysis) office and had to wait at a usually long traffic light. I looked over to my right and next to me at the light was a former primary HD patient of mine. Since I had seen this fellow I had heard that he had received a Kidney Transplant via the list. I hit my horn quick we rolled down windows and we had a short exchange. I said Congratulations on the transplant.
As a Dialysis Nurse it is such a thrill and so satisfying to have a connection with a patients that are transplant recipients. It is the ultimate Option and it is the way it should be for all ESRD Patients. In our PD office in the past 6 months there have been 5 Patients transplanted. Again it is so so Awesome!!!

PD Cycler Time Commitment

2009-11-09T18:20:00.005-05:00

I wanted to talk a bit today about an option inside of options. For ESRD patients there are four basic options: Transplant, PD(peritoneal dialysis),HD(hemodialysis) and to do nothing and go without treatment.
Some may notice that my order puts PD in front of HD and my reason for this is that PD would be my choice before HD and I would recommend PD before HD to anyone seeking my advice. This choice is based upon a lot of PD advantages but in short it is the kinder and gentler dialysis.
Once PD has been chosen there two options inside of PD. CAPD(continuous ambulatory peritoneal dialysis) these are manual bag exchanges usually done four times throughout the day.
The other is CCPD(continuous cycling peritoneal dialysis) these are automated exchanges while connected to a small machine overnight.
When I begin the CCPD training for patients there seems to be a common misconception as to time commitment needed to receive adequate CCPD. The patient mindset seems to be that whatever their normal sleep time is will be equal to their total CCPD treatment time. When doing CCPD it is very common that your total treatment time can be nine or more hours. This is because the nighttime cycler prescription is written for several cycles and each cycle has a drain/dwell/fill time and again this is necessary for the Patient to receive enough dialysis.
Once the Patient understands this requirement it is almost never enough to deter them from doing CCPD. I think that this PD shortcoming in information can be avoided in the future by including this cycler information in whatever options program your system may provide. Hopefully this post will help too!

Home Hemodialysis

2009-04-27T11:29:00.015-04:00

Hemodialysis treatments preformed at home is not a new concept at all, in fact I have known some patients that were doing hemodialysis(HD) at home as early as the late 1970's. The home HD option has become more widely used. I am very encouraged about this because it is a perfect transition mode of treatment for people on Peritoneal Dialysis(PD that for a number of reasons can no longer continue PD.

I am very excited of late as I have on good information from Doctors and staff that a home HD program will be starting in my area (Rochester NY) using the Next Stage equipment! Enabling the former PD patient to continue dialyzing at home is great because these folks have been running their own show, for the most part doing their dialysis treatments around their own schedule and not that of an outpatient hemodialysis center. With the next stage machine patients can travel just as easily as they could when on PD as this system does not need a special water treatment for dialysis. Another great benefit of home HD is that the patient can do more frequent shorter treatments at home instead of long treatments three days a week. These shorter more frequent treatments are a much better dialysis process for the body because there are less fluid management problems (osmosis) and better control over the removal of toxins (diffusion). Again not as good but similar to PD where in most cases you are dialyzing 24/7.

In most home HD programs you must have a partner that is trained and will be with you for all treatments. Some home programs offer the option of doing the treatments at night and they are monitored by health care staff remotely. As a Dialysis Nurse it is a great thing that the option of Home Hemodialysis is increasing in availablity.

The Peritoneal Dialysis Option

2009-04-19T07:40:00.019-04:00

When a person reaches the point where they have been categorized as ESRD(End Stage Renal Disease) and it has been determined that they must start Dialysis treatment to stay alive there are two treatment options. One is Hemodialysis(HD) usually where the Patient has a scheduled treatment time at an outpatient treatment center three times a week for most commonly 3 to 4 hours each treatment.

The other option is Peritoneal Dialysis(PD). In this treatment the blood stream is not accessed directly. A special tube(PD Catheter) is surgically placed in the Abdomen and via this tube Dialysate solutions are exchanged in and out of the Peritoneal Cavity. The Peritoneum is a membrane that encompasses our internal organs and this membrane is the natural filter that makes PD possible.

These treatments are done at home. The person does the treatment by themselves or with the assistance of a partner. Treatments can be preformed in two ways, Manual exchanges of Dialysis solution 4 to 5 times a day or automated with a PD Cycler mechanically doing the exchanges for you usually while you sleep.

With the Hemodialysis Option you have to comply to the outpatient treatment center schedule, there are more dietary restrictions and there can be more drastic physical reactions to the treatment such as extremes in blood pressures,nausea,electrolyte imbalances.
With Peritoneal Dialysis your treatment can be worked around your own schedule,you can travel more easily with PD. I think the single most important advantage to the PD option is that you are always being dialyzed like your kidneys it is a natural process occurring inside you.
One disadvantage is that in most cases patients are usually on PD for only a few to several years and then if not transplanted they have to move to Hemodialysis. This is usually because after some time the Peritoneum lessens in its ability to adequately preform the dialysis commonly because of infection(Peritonitis.

As a Nurse working in both PD & HD for 5 years, personally if I had to made the choice I would opt for the more natural treatment PD at first if I could. There are many more specifics to these options but I feel like I have covered the basics for now. Thanks, Joe Macomber RN