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Your search term(s) "Dialysis" returned 150 results.

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Management of Dialysis Patients with Celiac Disease. Practical Gastroenterology. 31(6): 70-72, 77-80, 82. July 2007.

This article considers the management of dialysis patients who also have celiac disease, a condition of gluten intolerance. The author notes that these two diseases are not often reported in the same patient, but celiac disease is sometimes listed as one of the associated diseases of IgA nephropathy. There are no written guidelines for managing these combined diseases, because of the rarity of their co-occurrence, or perhaps because they are underdiagnosed. Celiac disease is characterized by inflammation of the small intestine and malabsorption after the ingestion of gluten; thus, celiac disease is managed by life-long avoidance of gluten in the diet. Kidney disease is manifested by fluid and electrolyte imbalance, which also involves life-long dietary restrictions. This article reviews the renal dietary guidelines and provides suggestions on how to combine those guidelines with the required changes to manage celiac disease. Specific topics include malnutrition, potassium, fluid and sodium, renal bone osteodystrophy, phosphorus, common medications of dialysis patients, and socioeconomic considerations. One table provides a renal and gluten-free diet in a chart format. 4 tables. 9 references.

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MATCH-D: A Roadmap to Home Dialysis Therapy. Nephrology News & Issues. 21(11): 41, 43-44. October 2007.

This article reviews the benefits of home dialysis therapy and encourages health care providers to tell patients about options beyond standard, in-center hemodialysis that may allow them more normal lifestyles. The author discusses the lack of guidelines for identifying patients who might be candidates for peritoneal dialysis (PD) or home hemodialysis (HD) and describes the development of the Method to Assess Treatment Choices for Home Dialysis (MATCH-D). The MATCH-D is a home dialysis appropriateness assessment tool that is best used as the basis of a discussion among the patient, family, and care team as they move to choose a treatment that best suits the patient’s lifestyle and capabilities. Topics include patient characteristics, the benefits of home dialysis, strategies to assess and eliminate barriers to home HD or PD, and patient and partner training needs. The author concludes that offering the lifestyle benefits of home treatment to more patients will not only help patients and their families but will also reduce the staffing burden on dialysis facilities, increase facility revenues if patients maintain jobs with employer group health plans, and alleviate some of the financial burden on Medicare and Social Security disability programs. 17 references.

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Medicare Coverage of Kidney Dialysis And Kidney Transplant Services. Revised ed. Baltimore, MD: Centers for Medicare and Medicaid Services. 2007. 55 p.

This booklet helps people with end-stage renal disease (ESRD) or permanent kidney failure understand Medicare coverage for kidney dialysis and kidney transplant services. The booklet describes how to get Medicare coverage, how Medicare helps pay for kidney dialysis and kidney transplants, and where to get more information and help. Specific topics include a description of dialysis, how to find a dialysis facility, home dialysis treatment options, dialysis adequacy, patient education, dialysis and travel, transportation to dialysis facilities, where to get a kidney transplant, donor’s services, how Medicare pays for blood, how to have blood replaced, appeals and grievances, and other kinds of health insurance. The booklet provides information about combined kidney and pancreas transplants. The booklet includes contact information for special kidney organizations, ESRD Networks, State Health Insurance Assistance Programs (SHIP), and other Medicare booklets that are available. The booklet is illustrated with black-and-white photographs and concludes with a glossary of terms and a subject index. The booklet is also available in Spanish. 10 figures. 5 tables.

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Multidimensional Characteristics of Symptoms Reported by Patients on Hemodialysis. Nephrology Nursing Journal. 34(1): 29-37. January-February, 2007.

This continuing education article describes the multidimensional characteristics of symptoms reported by patients who are on hemodialysis. The author explored the intensity, frequency and duration, distress, and concurrence of symptoms in this patient population. The author created a multidimensional profile for each of the symptoms, which demonstrated that those rated as the most severe were not necessarily the most frequently occurring, longest lasting, or most distressing to patients. Symptoms also tended to occur in groups. Patients reported individual symptoms as increasingly troublesome and their quality of life progressively lower as they experienced more of the symptoms in a grouping. The author concludes that health care providers need to view patients’ symptom experiences more broadly. Symptom assessment should include the full complement of symptoms patients experience and should move beyond the current practice of using the assessment of severity alone to include all symptom dimensions. A posttest with which readers can qualify for continuing education credits is appended to the article. 5 tables. 29 references.

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New CPM Report Shows Slight Improvements in Hemoglobin Levels. Nephrology News & Issues. 21(11): 50-52, 54. October 2007.

This article reviews the 2006 Clinical Performance Measures (CPM) report, an annual data survey of hemodialysis (HD) and peritoneal dialysis (PD) patients. The author focuses on HD adequacy, vascular access, and anemia management CPMs, presenting data primarily from in-center HD settings. In the area of dialysis adequacy, the report showed that 82 percent of patients had monthly adequacy measurements performed; 76 percent of patients had their dialysis delivery calculated using either UKM or the Daugirdas II formula; and 94 percent of patients on dialysis for 6 months or more and dialyzing three times a week had a mean delivered adequacy dose of spKt/V greater than 1.2, calculated using the Daugirdas II formula. Data for vascular access showed that 54 percent of new patients were dialyzed using an arteriovenous (AV) fistula; 44 percent of prevalent patients were dialyzed using an AV fistula; and 21 percent of prevalent patients were dialyzed with a chronic catheter continuously for 90 days or longer. In the area of anemia management, 35 percent of targeted patients prescribed epoetin had a mean hemoglobin of 11 to 12 grams per deciliter (g/dL); and 81 percent of patients who met the inclusion criteria were prescribed intravenous iron in at least 1 month during the study period. A table summarizes data on the end-stage renal disease (ESRD) CPM trends from 1998 through 2005. Readers are referred to www.cms.hhs.gov/CPMProject for the complete 2006 end stage renal disease (ESRD) clinical performance measures annual report and reliability report. 3 figures. 1 table.

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Open Operative Management of Dialysis-Dependent Ischemic Nephropathy. Dialysis and Transplantation. 36(4): 192-204. April 2007.

This article reports the results of a retrospective review that examined the use of open operative management of dialysis-dependent ischemic nephropathy among adults with hypertension. The study included 820 patients who underwent open operative repair of 1,220 kidneys between February 1987 and July 2005. A subgroup consisting of 45 hypertensive patients (19 women, 26 men; mean age 68 years) considered permanently dialysis-dependent prior to renal artery (RA) repair forms the basis of this report. RA repairs to 73 kidneys included RA bypass (44 repairs: 22 saphenous vein repairs and 22 prosthetic grafts), RA endarterectomy (25 repairs; 13 transrenal and 12 transaortic), and RA reimplantation (four repairs). Thirty-five patients had bilateral procedure, including four procedures to solitary kidneys. Of 28 RA occlusions, 25 were repaired. Three nephrectomies were performed for unreconstructable RA to a nonfunctioning kidney. After RA repair, two patients (4.4 percent) died within 30 days of operation or in-hospital. Twenty-nine of the 43 (67 percent) surgical survivors stopped being dialysis dependent. Four patients initially removed from dialysis progressed to eventual dialysis-dependence on follow-up. The authors conclude that open operative management of dialysis-dependent ischemic nephropathy can remove selected patients from dialysis. Patients who showed beneficial renal function response were those who experienced a rapid decline in preoperative renal function. 4 figures. 3 tables. 24 references.

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Peritonitis Caused by Neisseria Sicca in a Child on Chronic Peritoneal Dialysis. Dialysis and Transplantation. 36(8): 457, 463. August 2007.

This article reports a case of peritonitis caused by Neisseria sicca in a child on chronic peritoneal dialysis (PD). Peritonitis is an serious complication of PD and has an incidence of about one episode per year in children on PD. The case report is a 6-year-old African American boy, diagnosed in utero with hydronephrosis, who received a Tenckhoff catheter for chronic outpatient PD at home just after his 6th birthday. Two months after beginning PD, the boy was admitted to the hospital for Pseudomonas aeruginosa urinary tract infection (UTI); 2 weeks later, after a mishap, the catheter connector was replaced in the outpatient nephrology clinic under sterile conditions. One week after this episode, the boy was admitted to the hospital with a diagnosis of peritonitis. On the third day, the boy’s cultures showed N. sicca, which is sensitive to penicillin. Although the patient recovered uneventfully, an elective kidney transplant from a living related donor had to be postponed several months because of this infection. The authors discuss this case and conclude by reiterating the importance of physicians to continually reinforce the understanding of parents and patients of the vital necessity of proper PD catheter care and must stress extremely close supervision of a child on chronic PD. 9 references.

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Planning for Changing Dialysis Needs. InControl. 4(4): P1, P4. December 2007.

This newsletter article helps patients understand the steps that might need to be taken for a patient who changes from one type of kidney replacement therapy to a different type; for example, a patient may change from peritoneal dialysis to in-center hemodialysis, or to one of various home hemodialysis options, or vice-versa. The author stresses that the patient’s first choice does not have to be permanent. Most people who have kidney failure for a long time will end up using more than one type of treatment. Readers are encouraged to make healthy choices in the months or years before they have to start dialysis, including learning about the different options for dialysis before it becomes necessary. Topics include the role of preemptive transplant, the importance of patient preferences, and the use of peritoneal dialysis as a good first dialysis option. Readers are referred to a website for information about all five home dialysis treatments (www.homedialysis.org/learn/types/). The article concludes with a five-item quiz for readers to check their understanding of the material covered in the article.

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Precis: Background on the US ESRD Program. American Journal of Kidney Diseases. 49(1): s17-s32. January 2007.

This Precis chapter is from a special supplemental issue of the American Journal of Kidney Diseases that presents excerpts from the 18th annual report from the U.S. Renal Data System on the end-stage renal disease (ESRD) program in the United States; data through 2004 is included. This Annual Data Report (ADR) also presents information on patients with chronic kidney disease (CKD) and assesses care of at-risk populations and international comparisons of ESRD. In this Precis, the authors provide an overview of the ESRD program itself, beginning with statistics on patient counts and rates, modalities, and costs. This chapter also covers modality use over time and across the country; the transplant waiting list; indicators of quality of care, such as vascular access use, dialysis adequacy, anemia treatment, diabetes preventive care, and prescription drug therapy; and trends in hospitalization and mortality rates. A final section examines expenditures related to ESRD, as well as expenditures for patients in the Medicare and employer group health plan (EGHP) populations who have chronic kidney disease. 38 figures. 2 tables.

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Protein: An Important Part of Your Dialysis Diet. In Control. 4 (1): P1, P4. March 2007.

This patient education newsletter article focuses on the importance of protein in the diet of patients who are on dialysis. Dialysis patients need more protein than the average healthy adult because they lose protein during dialysis and because kidney disease alters the body’s ability to use and process amino acids, the building blocks for muscles and healthy cells, organs, and bones. The article briefly reviews the types of protein found in common foods, concerns about foods that also have potassium or phosphorus, the use of serum albumin testing to measure blood levels of protein, the symptoms of low serum albumin levels, and how appropriate levels of dialysis can improve the patient’s appetite. Readers are encouraged to visit a website for more information on this topic––www.kidneyschool.org. The article is published in large print and concludes with a brief true/false quiz on protein and dialysis; the answers are elsewhere in the newsletter issue.

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