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Baseline Kidney Function as Predictor of Mortality and Kidney Disease Progression in HIV
Death Within 90 Days: Comparison of Mortality Rate Between Hemodialysis and Peritoneal Dialysis
Off-Pump versus On-Pump CABG Outcomes Stratified by Pre-Operative Renal Function
Comparative Safety and Efficiency of Five Percutaneous Kidney Biopsy Approaches of Native Kidneys
Higher mortality among remote compared to rural or urban dwelling hemodialysis patients in the US
Clinical significance of hyperkalaemia-associated repolarization abnormalities in ESRD
Cause Analysis of Absence of Functional AV Access in a Prevalent Hemodialysis Patients Cohort

Dietary Intake in Hemodialysis Patients Does Not Reflect a Heart Healthy Diet.

Khoueiry G, Waked A, Goldman M, El-Charabaty E, Dunne E, Smith M, Kleiner M, Lafferty J, Kalantar-Zadeh K, El-Sayegh S.

J Ren Nutr. 2010 Dec 23.

Division of Cardiology, Staten Island University Hospital, Staten Island, New York.

Abstract

OBJECTIVE: Cardiovascular disease is highly prevalent and has a major effect on morbidity and mortality in patients undergoing maintenance hemodialysis (MHD). Dietary factors that may contribute to cardiovascular disease have not been well studied in this population. We hypothesize that dietary intake in this population does not meet the guidelines for cardiovascular risk reduction.

DESIGN: A cross-sectional study was completed using the validated "Block Dialysis 1 Food Frequency Questionnaire" to assess dietary intake of MHD patients.

SETTING AND PATIENTS: A total of 70 patients undergoing MHD at our outpatient dialysis center completed the questionnaire under the supervision of a trained dietitian. The population consisted of 38 men and 32 women.

MAIN OUTCOME MEASURE: Dietary intake was the main outcome measure, with a focus on calories, soluble fiber, saturated fatty acid (SFA), unsaturated fatty acid intake (UFA), and protein.

RESULTS: The mean fiber intake was 10.77 (±5.87) g/day, and only 2 of 71 (2.9%) were in compliance with the recommended daily intake of >25 g/day. As percentage of total calories, of the 70 patients, 5 (7.1%) had a fat intake of <30%, 22 (31.4%) had SFA intake of <10%, 64 (91.4%) had a UFA of ≤30%, 22 (31.4%) had a protein-based diet of ≥15%, and 66 (94.3%) had a carbohydrate diet of <60%.

CONCLUSIONS: Most patients did not meet the dietary guidelines for reducing the risk of cardiovascular disease. Substituting UFA or soluble fiber for SFA improves low density Lipoprotein (LDL) cholesterol levels without negative effects on other lipid parameters.

Author Interview: Dr. George Khoueiry, MD SIUH Dietary Intake in Hemodialysis Patients Does Not Reflect a Heart Healthy Diet

More on Diet in Chronic Kidney Disease and Hemodialysis

 

 
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Estimated Glomerular Filtration Rate and Prognosis in Heart Failure
Reduction in Bloodstream Infections in Outpatient Hemodialysis Centers Participating in CDC Collaborative
Risk Factors for Dialysis Withdrawal
One-Year Assessment of Quality Indicators in Acute Dialysis Program Operated by a Large Dialysis Provider
Characteristics of patients most likely to have a missed Dialysis session
More Frequent HB measurements & ESA titrations not Associated with Inreased Time in Target HB range

Study Shows Daily Home Hemodialysis Patients More Likely to Receive Kidney Transplant
Difference in KidneyTransplant Incidence with Daily Home Hemodialysis vs. Thrice-Weekly Dialysis

Characterizing Missed Dialysis Sessions in the ESRD Patient population
Hemoglobin Recovery following Hospitalization in ESRD patients
Association of Serum Sodium Levels with Mortality in Non-Dialysis Dependent Chronic Kidney Disease 
Talking Control Support in Hemodialysis Results in Higher Patient Satisfaction Survey Response
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Crit-Line Monitor Use in Incident Hemodialysis Patients Improves Dry Weight and Adequacy,
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Home Dialysis Summit Recommends Policy Changes to Increase Home Dialysis Usage

WASHINGTON, April 25, 2012 /PRNewswire -- On the heels of the first National Summit on Home Dialysis Policy, Summit organizers released a report reflecting the views of the delegates -- leaders in the kidney disease patient, clinician, facility and industry communities -- on federal policy steps to improve utilization of home dialysis for patients who can benefit from this often advantageous form of treatment. Many of the organizers also announced they have formed a new alliance, called the Alliance for Home Dialysis, to advance the recommendations identified at the Summit.

The Summit's "Report of the Delegates" highlights key findings from a March 29th meeting in Washington, DC where experts probed why, despite widely accepted and well-documented benefits of home dialysis -- improved outcomes, enhanced patient satisfaction, improved quality of life, and lower costs-- fewer than ten percent of the more than 390,000 current U.S. dialysis patients receive treatment at home. Current rates of home dialysis utilization reflect a steep decline from the 1970s, when almost 40% of U.S. dialysis patients were treated in-home.

Specifically, delegates found that policymakers should work with stakeholders in the dialysis community to confront three areas:

Accessibility: Patients and clinicians face array of hurdles in education, training, and infrastructure that hinder equalized access to home dialysis.

Accountability: Utilization of home dialysis can be improved through measures within government programs that are designed to recognize and support excellence in the delivery of home dialysis services.

Aligning Incentives: Reimbursement policies, regulation of new technologies and other policy incentives can be realigned to better support federal policy goals of expanding access to home dialysis.

The Report includes 15 recommendations to serve these goals, including that federal policymakers should:

Maintain parity for home and in-center dialysis in Medicare reimbursement;

Support home dialysis mentoring programs, particularly those that use existing patients as mentors; and

Align federal and state regulatory requirements for home therapies, such as revising the Centers for Medicare and Medicaid Services Conditions for Coverage requirements, to reflect differences in home and in-center dialysis.

Summit supporters will begin work through the new Alliance to dialogue with federal policymakers and advance policy improvements in the three consensus areas that emerged at the Summit.

SOURCE National Summit on Home Dialysis Policy


 

 National  Kidney Foundation's Top 10 Things Every Dialysis Patient Should Know.

  1. You have treatment choices. Options exist for how, where and when you dialyze. Dialysis can be done in a hospital, in a dialysis unit that is not part of a hospital, or at home. You and your doctor will decide which place is best, based on your medical condition and your wishes. There are different types of dialysis - peritoneal and hemodialysis. Work with your health care team to determine a treatment plan that makes you feel comfortable. Recent studies show that the majority of patients beginning in-center hemodialysis (HD) know very little, if anything, about the option to dialyze at home. Once informed, 40% or more of patients are interested in this treatment option, and yet less than 10% actually begin home dialysis. If you're dissatisfied with the type of dialysis treatment that you're receiving, ask your healthcare team if another type of dialysis treatment would be better.
  2. You can compare in-center dialysis facilities online. Information on over 5,600 US-based dialysis centers is available online through the Medicare website. To help you make choices about your care, you can compare different facilities side-by-side and evaluate each facility based upon clinic characteristics and quality measures. You can search for dialysis facilities by name or geographic proximity. After completing an initial facility comparison to determine which facilities best meet your needs - such as the number of hemodialysis stations at a particular location and whether there are evening shifts available - visit the facilities that you're most interested in. Talk to the staff and other patients, as well as your doctor to ensure that this dialysis facility is a good fit for you.

  3. There are ways to prepare ahead for an emergency. Ask your dialysis facility about their emergency plan in case of a snow storm, fire, power outage or other natural disaster. As back up, make sure you have the names, locations and phone numbers of other dialysis units and hospitals in your area. Since regular community transportation services may not be working in an emergency, be prepared to make other arrangements for getting to dialysis. You may need to contact the police and Emergency Medical Services (EMS) for assistance. If you dialyze at home, make sure you have at least two weeks' worth of unexpired supplies on hand. If you have to miss a dialysis treatment, begin your emergency meal plan.

  4. There is an easy way to transfer patient records between clinics. There is an easy, secure way for your health care team to transfer your treatment records online. In 2009, the Centers for Medicare and Medicaid Services (CMS) created a centralized web-based data collection system called CROWNWeb to help reduce and eliminate patient treatment interruptions. This central system helps to streamline patient care regardless of the reason for changing dialysis centers. For example, if you've been admitted to the hospital, or if you needed to relocate during an emergency evacuation, your doctors and health care team can access up-to-date information about your dialysis so that you continue to receive appropriate care no matter where you are.

  5. You can travel while on dialysis. 
    Dialysis centers are located in every part of the United States and in many foreign countries. The treatment is standardized, but you need to plan ahead by making an appointment for dialysis at another center before you go. The staff at your center may help you make these appointments.

  6. You can be your own best advocate. Know what key questions to ask your doctor or other healthcare professionals. Take notes so that you can refer back to them later. Partner with your doctor and decide on a treatment plan together. Advocate for yourself and share how you're feeling.

  7. You have many rights. You as a patient have a great deal of control over your treatments. Patients have a bill of rights which includes receiving quality care, counseling about your medical information, and an expectation of privacy. 

    You also have responsibilities.
     Once you decide on a course of treatment, it's important to follow the recommendations of your health care team. If you decide to receive in-center dialysis, arrive at dialysis on time so that you can receive the full treatment without delays.


  8. You can receive insurance coverage. If you have end stage renal failure, you are likely eligible for Medicare insurance coverage. Speak with your health care team and social worker for help filling out insurance paperwork.

  9. You may need to follow a special diet. When your kidneys are not working properly, you may not be able to eat everything you like, and you may need to limit how much you drink. Your diet may vary according to the type of dialysis you receive. It is important to speak with a renal dietitian so that you are able to understand what you can and cannot eat based on your full health history.

  10. Dialysis patients can work. Many dialysis patients can go back to work or school after they have gotten used to dialysis. After establishing a dialysis routine, many patients have more energy and find that they are able to time to work around this new schedule. Some patients even find creative ways to work remotely from dialysis with the use of a laptop or cell phone, depending on their field of expertise.

More from National Kidney Foundation Press Releases

New Book to Help Educate Patients with Chronic Kidney Disease who may be facing Dialysis or Hemodialysis:

Help, I Need Dialysis!
How to have a good future with kidney disease


By Dori Schatell, MS and Dr. John Agar

An internationally known nephrologist and life-long kidney patient educator explain how dialysis works, each of the ways to do it, and how your treatment choice may affect your diet, energy level, work, travel, sexuality and fertility, sleep, and survival. Comprehensive and fully referenced, this book is a must-read if you face the life-changing choices that come with kidney failure.


 
 
 
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