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Speedy-Snail

A Rational Approach To Dialysis Time And Frequency

This blog post was made by Dr. John Agar, Home Dialysis Central

Speedy-Snail

Good dialysis depends on the combination of both:

  1. Optimal frequency: to permit small and large solute removal.
  2. Optimal time: to allow slow, perfusion-friendly rate of volume removal.

The current Kt/Vurea formula has unfortunately encouraged clinicians to increase one of the two numerator variables (K) in an effort to reduce the other (t). This has resulted in the human body being treated like a multiplication table, where increasing one variable and reducing the other yields an unaltered result. Both 2 x 4 and 4 x 2 = 8.

Short Hours, Low Frequency Dialysis

This is the current majority reference point for most dialysis patients, and is how current “conventional” dialysis can best be described. Even conventional dialysis—as the term is loosely used in the dialysis literature—is not a single entity:

  • In the US, it is commonly 3.0 – 3.5 hours, 3 times a week.
  • In Japan and ANZ, it is more commonly 4.5 – 5.0 hours, 3 times a week.

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Heart

Humanizing Dialysis: Trying To Make Something Good Out Of A Really Bad Diagnosis

This blog post was made by Gale Schulke, RN, CDN, Home Dialysis Central

Heart

As a nurse for home dialysis programs, I find that we are in a perfect position to humanize dialysis. Being a training nurse is more than just administering dialysis. We need to learn as much as we can about our patient clients. When they ask to do dialysis in the home, they are asking to be empowered. They are asking us to teach them as much as we can so they can take care of themselves. They ask us for independence and to be a CARE PARTNER with them on this journey. So what does that mean, exactly?

The first thing that comes to mind is education. Since our clients are not “cookie cutter” people, each training session must be tailored to the individual. Adult learning varies from person to person. Some people learn best by getting their hands on whatever they are learning. Some want to be talked to, some need to read. Some need to take notes. Some use a combination of things. It is important that the nurse be aware of how their patient clients learn; if you don’t do that first, you are wasting valuable time. Most patients know how they learn best. Ask them:

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Home-Therapy-jobs

How To Help People With Kidney Disease Keep Their Jobs

This blog post was made by Dori Schatell, MS, Executive Director, Medical Education Institute

Home-Therapy-jobs

For 16 years, with Amgen support, the non-profit Medical Education Institute (MEI) which created Home Dialysis Central, ran the Life Options Rehabilitation Program to help people with kidney disease live long and live well. A key aspect of that program—but never the only focus—was helping people to maintain employment, because work can boost self-esteem, offer social contacts, and provide an income and perhaps benefits, and all of these help mitigate the emotional and financial and even physical impact of a chronic illness.

Recently, it has been suggested that the degree to which dialysis clinics help their clients keep their jobs should be a metric used to judge the quality of the care they deliver. You would think that with a 16-year track record of advocating for employment (along with encouragement, education, exercise, and evaluation, the original “5 E’s” of renal rehabilitation) MEI would strongly support this notion. But, we don’t support it unconditionally. Because, by the time people reach end-stage and start on dialysis, it is far too late to start worrying about their jobs. That concern needs to happenupstream during CKD and then continue into ESRD.

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Victim-or-consumer

Unwitting Victims Or Informed Medical Consumers? How Are Dialysis Patients Viewed By Their Nurses And Staff?

This blog post was made by David Rosenbloom, Home Dialysis Central

Victim-or-consumer

On May 31, 2016 Nephrology News & Issues, a highly respected trade publication that reports on developments in nephrology and dialysis treatment, carried an interview with Francyne N. Rosenstock, Vice President of Business Development and Marketing for Renal Reserve entitled Reducing Dialysis Nurse Burnout. 1 Renal Reserve is a medical staffing agency specializing in supplying dialysis centers with long-term (13-week) traveling nurses and permanent RNs, licensed practical/vocational nurses, patient care technicians, registered dietitians, and social workers. They understand and deal with the causes of staff turnover at U.S. dialysis centers.

When asked if burnout is more common among dialysis nurses, compared to other specialties, Ms. Rosenstock said, “This is not a simple yes or no answer. I think nursing, in general, has a higher burnout rate than other disciplines in health care because nurses are on the front lines of patient care. They have a connection to their patients, especially patients who they are involved with over a long period of time. Outcomes, good or bad, affect them.”

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Scales

Choosing Between Home HD And Home PD: When, And Why

This blog post was made by Dr. John Agar, Home Dialysis Central

Scales

From time to time, I have noticed some questioning and uncertainty arising at the Home Dialysis Central Facebook site regarding the difference between, relative place of, and effective efficiency of the two main dialysis therapies: peritoneal dialysis (PD) and haemodialysis (HD) – especially as theses factors apply in the home. Many who respond clearly do understand this, but some still seem a little hazy. I thought it might be useful to pick through some of the myths and legends about both, and put them in context.

Firstly, one of the two therapies is exclusively a home therapy (PD), while HD, though in my view best performed at home, is most commonly still offered as a facility-based treatment. I do not intend to pick over the bones of the “at home” versus “at facility” argument here—that has been the subject of several previous blogs and is a theme that runs strongly though most of the views expressed at this site. Rather, I seek to concentrate on some of the practical differences between the two options.

Firstly, there is the efficiency of dialysis. PD uses a natural, inbuilt body “membrane”—the peritoneum—a layer of mesothelial cells a single cell width thick, that line the internal cavity in which lie our internal abdominal organs. I ask my patients if they have ever opened the belly of a fish, or animal…most will certainly have at the least slit open a fish…and have seen the silver shiny membrane that lines the belly cavity inside. This same peritoneal membrane also extends to cover all of the internal abdominal organs. Underlying this membrane is a myriad of small, blood-carrying capillaries (microscopic blood vessels) that carry the blood and the wastes, impurities, and extra water it contains, and that would normally be removed by healthy kidneys, up close to the under-surface of this thin shiny membrane. We are built no differently to a fish, or any other animal. Opened up, the inner lining of a human belly shines and glistens too.

The principle of PD is to instil a specially formulated fluid into the belly cavity so that it can interact with and remove water and solutes from the blood in these peritoneal capillaries, with the peritoneal membrane acting as a separating, but permeable “divider” between blood and the dialysis fluid…just like the artificial membrane of a haemodialyser does.

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claims

Is Medicare Advantage A Plus For People On Dialysis?

This blog post was made by Beth Witten, MSW, ACSW, LSCSW, Home Dialysis Central

claims

When Medicare HMO plans came into being in the 1970s, members of the renal community were concerned that insurance companies operating them might put other interests ahead of the needs of the members they were established to serve. Nothing changed when these plans were renamed Medicare + Choice in 1997 and Medicare Advantage (MA) in 2003.1

Are MA plans workable today for those on dialysis? Here are some questions to consider:

  • How are MA plans paid? Medicare pays more to insurance companies that administer MA plans than what it costs traditional Medicare to treat people. This creates a burden to taxpayers—with no improvement in care quality.2
  • Does the MA plan follow CMS rules described in the Medicare Managed Care Manual?3
  • With an average of three or more chronic health conditions, people with CKD need access to specialists. Do MA plan primary physicians offer timely referral to nephrologists and other specialists for people with CKD?

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