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Public Reporting of Patient Survival (Mortality) Data on the Dialysis Facility Compare Web Site. Dialysis and Transplantation. 36(9):486, 491-499. September 2007.

This article reports on a study that the authors conducted on Medicare’s Dialysis Facility Compare (DFC) website, which publicly reports patient survival statistics––mortality data. The authors conducted a qualitative study to evaluate how well patients and family members understand the patient survival data as it is currently explained and presented on the DFC website. The study investigated the users’ view of the value of the website. The researchers tested potential improvements to the website that used alternative language and display formats. The results showed that, overall, participants responded positively to the patient survival data, leading the authors to conclude that publicly reporting this type of information has value to patients and their families. The authors found that participants could easily identify facilities with better performance from the website as it is currently set up, but they had difficulty understanding the statistical differences between patient survival ratings. The authors’ discussion focuses on the goals of publicly reporting mortality data, including the ultimate goal of improving quality of care for patients. 3 tables. 14 references.

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Renal Resource and Buyers Guide 2007. Nephrology News & Issues. 21(2): 14-64. 2007.

This special issue of Nephrology News & Issues offers the annual renal resources and buyers’ guide, a comprehensive directory of products and services available for the renal care community. The guide is separated into two sections: a products–and-services section, arranged alphabetically by category, with company contact information provided; and the company director, an alphabetical listing of the companies included. The products-and-services section categories include blood analysis devices, blood lines, blood pressure monitors, business support services, CAPD equipment, catheters, CCPD equipment, chairs, clothing, concentrate, dialysis machines, dialyzers, diet and nutrition, disinfectants, dry mouth products, equipment maintenance and repair, facility planning, fistula needles, hemodialysis supplies, hemofiltration supplies, heparin, home hemodialysis, immunosuppressives, implantable infusion devices, insulin, medical waste disposal, monitoring devices, needlestick protection, patient education, office supplies, peritoneal dialysis, pharmaceuticals, plasmapheresis, rehabilitation and exercise, reprocessing, scales, shunts, software, training, sterilants, syringes, ultrasound, vascular access, and water testing and treatment. The guide includes a list of nephrology conferences for 2007, a handy list of websites for renal associations, and an information page on how to use the journal’s website, www.nephronline.com.

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Self-Care Agency in Dialyzed Patients. Dialysis and Transplantation. 36 (2): 57-70. February 2007.

Advances in hemodialysis technologies and developments in peritoneal dialysis permit patients the benefits of receiving treatment in their own homes. This article reports on a study undertaken to evaluate the factors affecting patients undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) as a self-care situation. The cross-sectional study was based in the Turkish city of Edirne and included 77 patients on maintenance HD and 15 patients on maintenance CAPD. The study used the Kearney and Fleischer scale, which has a maximum score—indicating the highest degree of self care—of 140. The results of this study showed a mean score of 113 (range 48-137) and no significant differences were found between the HD and CAPD groups. Variables such as gender, health perception, no complications during dialysis therapy, and maintaining a suitable diet were significantly related to self-care. Male patients had a higher overall self-care mean score than women. The authors conclude by recommending compliance programs to help patients and families cope with dialysis-related problems and support for patients who are handling their own dialysis. 3 tables. 42 references.

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Self-Care Improves Outcomes and Outlook. In Control. 4(3): S2. September 2007.

This brief newsletter article describes how the use of in-center self-care, a method of dialysis delivery in which the dialysis patient shares responsibility with the clinic staff for running their dialysis treatments, can improve patient outcomes and outlook. The article reports on patients of Dr. Edward Jones, medical director of the Mt. Airy Self-Care Dialysis Facility in Philadelphia. Dr. Jones reports on his comparisons of 50 self-care patients and those who are dialyzed in a traditional, staff-assisted facility. The article reports on the benefits of in-center self-care, which include less morbidity and mortality, more patient empowerment, and benefits for the dialysis clinic as well as the patients. The article briefly describes the training process that is available to patients who choose in-center self-care and reports on the strategies that have resulted in the most success, including keeping self-care patients and traditional-care patients in different units.

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Should the Medicare ESRD Program Fund Daily and Nocturnal Hemodialysis?. Nephrology News & Issues. 21(12): 48-57. November 2007.

This article addresses the issue of Medicare end-stage renal disease (ESRD) funding for short daily hemodialysis (sDHD) and nightly nocturnal hemodialysis (NNHD) at home. The author reports on a recent paper that concludes that funding for conventional hemodialysis (HD) should be maintained and that the newer methods of sDHD and NNHD should not be covered under Medicare until they undergo rigorous testing through the use of a randomized control trial (RCT). The author comments on the paradox of requiring RCT testing of these newer modalities, when conventional HD has not been vetted in this manner. Indeed, the use of an RCT itself may be unethical and impossible when the treatments under study are widely disparate lifestyle-impacting modalities. The author reviews some of the positive health outcomes and cost-efficiencies of sDHD and NHHD, concluding that available data is adequate to develop funding models for these treatments. 24 references.

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Supplement Program Improves Serum Albumin. In Control. 4 (1): S2. March 2007.

This brief patient education newsletter article focuses on the use of a nutritional supplement to improve serum albumin levels in patients who are on dialysis. The author reports on a program in which the National Kidney Foundation of South Carolina began providing free nutritional supplements to needy dialysis patients several years ago. A 3-month supply of nutritional supplements––either two cans of liquid supplement or six scoops of powdered protein per day––was delivered directly to the clinic of each patient who qualified for the supplement program (n = 130). Average patient age was 62.3 years––99 patients were on hemodialysis, 31 on peritoneal dialysis. Patients were enrolled because of low albumin levels (n = 116), in appropriate weight loss (n = 43), or both (n = 29). Data collected after 3 months of supplement use showed a statistically significant increase in serum albumin levels, a finding that was particularly strong in patients with original albumin levels less than 3.0 milligrams per deciliter. 1 figure. 1 reference.

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Surviving Change: Can the ESRD Provisions in the SCHIP Create A Level Playing Field? Nephrology News & Issues. 21(10): 52-54, 56. September 2007.

This article reviews the key provisions that are incorporated into the Children’s Health and Medicare Protection Act of 2007, including the creation of an end-stage renal disease (ESRD) bundled payment system, elimination of the hospital differential for treatment payments, creation of quality outcome incentive payments and performance standards, and extension of the Medicare Secondary Payer (MSP) provision. The proposed bill includes two provisions from the Kidney Care Quality and Education Act: establishing a demonstration project on education for chronic kidney disease (CKD) patients and requiring technical certification. However, the bill fails to include an inflationary update. The author encourages readers, regardless of which dialysis provider they work for, to work for the passage of this legislation. The author stresses that any rearrangement of payments called for by legislation should be budget neutral so as not to take any dollars from the ESRD program as a whole.

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Treatment Modalities. American Journal of Kidney Diseases. 49(1): s99-s110. January 2007.

The two major therapies for end-stage renal disease (ESRD) are dialysis and transplantation. This chapter on ESRD treatment modalities 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 ESRD program in the United States; data through 2004 is included. The 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. This chapter provides data on modalities and the types of patients using each kind of therapy. Tables present data on incident and prevalent counts and rates, while graphs show patient distribution by insurance coverage, and maps illustrate regional variations in rates over time. The chapter also includes updated data on the probability of death or a change in modality during the first 5 years of therapy, as well as information on patient distribution by provider. 16 figures. 6 tables.

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Underutilizing PD: Looking for Answers. What is Needed to Make Peritoneal Dialysis a Success?. Nephrology News & Issues. 21(8): 29-31. July 2007.

This article reviews some of the reasons why peritoneal dialysis (PD), particularly continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD), are underutilized. These factors include lack of professional training, which tends to focus on hemodialysis; a lack of support for PD as a viable choice from national organizations, board examiners, and fellowship reviewers; a lack of support for chronic kidney disease (CKD) patient education; financial disincentives from a physician perspective; a slow regulatory process for new technology; physician bias and problems with the outcomes of the therapy; and the impact of home hemodialysis. The author reminds readers that the benefits of PD over in-center hemodialysis therapy include greater freedom, better patient control over treatment times, a more liberal diet, and use of an implantable catheter to avoid needlesticks. One sidebar describes a chosen Internet resource for the home dialysis patient, Nocturnal Dialysis (www.nocturnaldialysis.org), an Australian-based web site that promotes awareness of the benefits of nocturnal home hemodialysis. 3 figures.

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US Renal Data System: Excerpts from the USRDS 2006 Annual Data Report. Special Issue. American Journal of Kidney Diseases. 49(1 Suppl 1): 1-296. January 2007.

This special supplemental issue of the American Journal of Kidney Diseases presents excerpts from the 18th annual report from the U.S. Renal Data System (USRDS) 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. Sections include: an overview, the healthy people 2010 goals, CKD, the incidence and prevalence of ERD, patient characteristics, treatment modalities, clinical indicators and preventive health, morbidity and mortality, transplantation, pediatric ESRD, cardiovascular special studies, ESRD providers, the costs of CKD and ESRD, and international comparisons. Most of the information is presented in tabular and graph format. Detailed appendices cover the chapter topics as well as data sources, data management and preparation, ESRD networks, database definitions, vascular access, census populations, statistical methods, USRDS services, data requests, a glossary of terms, forms, and a subject index.

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