Home Dialysis Central update
[Vol.5, No.4, April 30, 2008]
Here in Wisconsin, it's ALMOST stopped snowing (finally). Hope you're all staying warm and enjoying spring! Tell dialyzors and colleagues about the lifestyle benefits of PD and daily and nocturnal home HD with our DVD—order your copy today! Be sure to send for your FREE postcard handouts for your new dialyzor packets, health fairs, education days, etc.
New Conditions for Coverage support PD & home HD!
When Medicare talks, people listen. The new Conditions for Coverage for dialysis centers require that patients be educated and assessed for ALL modalities (not just the ones the center offers)—including PD and home HD. We advocated for this change with YOUR help, and it worked! We expect that home treatments will be growing even more in the near future...
New CPMs include patient options education & health-related quality of life (HRQOL)
Clinical Performance Measures (CPMs) are Medicare benchmarks for quality dialysis care. The newest set of CPMs approved on April 1, 2008, requires that patients be taught about ALL treatment options. And, the KDQOL-36 tool must be given to patients once a year to measure physical and mental functioning (HRQOL). What's one thing that improves HRQOL? Home dialysis!
Travel time to HD predicts HRQOL, adherence, & death
A new paper from the Dialysis Outcomes and Practice Patterns (DOPPS) study of 20,994 patients reports that patents whose one-way travel to HD was longer than 60 minutes had significantly higher mortality and lower quality of life. Patients noted, "I feel as if it rules all my time." The authors suggest home dialysis as an option for those who live far from the nearest center. Read the abstract.
No kidding: daily HD has better quality of life than standard in-center HD
Okay, we're not surprised to find that a metaanalysis of 17 papers comparing daily HD to standard HD found that folks using daily treatment had fewer access problems, better blood pressure control, less LVH, better anemia control, needed fewer phosphate binders—and had better quality of life. Read the abstract.
MYTHBUSTERS: microwaving PD fluid does NOT create glucose degradation products (GDPs)
While the belief persists that microwaving PD bags creates harmful GDPs when sugars are caramelized, the literature does not bear this out:
- A study in the ANNA Journal analyzed PD solution and found no changes, even when the fluid was superheated. The authors concluded that microwaving could be done safely.
- Very similar results were found in a study from PD International.
GDPs are a concern with PD fluid, but these are created when the fluid is manufactured, not when it is heated by the user. Of course, "hot spots" are still a concern. Anyone using a microwave to heat PD fluid should flip the bag from side to side to mix the contents well and use a thermometer strip to reduce the risk of burns.
Shane was at the end of her rope—until she found daily HHD
After six years of going to the dialysis clinic three times a week, Shane was at the end of her rope. "I was so depressed going to the clinic, being in that atmosphere of sickness," she remembers. "I was 38 years old, and I needed a change. I wanted some normalcy in my life, so I prayed for some other way I could get my dialysis." Read her story.
Topic of the month: Saying yes to PD - separating myth from fact
Is it possible to do peritoneal dialysis (PD) if you can only use one arm? If you're blind? You can't hear? What if you have a hernia? If you're 87 years old? A transplant failed? The answer to all of these (and more!) is YES. Read more.
Innovative papers: daily hemofiltration
If daily HD is good, is daily hemofiltration (replacing some blood volume with sterile fluid so more wastes and water can be removed) even better? Maybe so, finds a new pilot study by Zimmerman et al. Seven patients did a week of standard HD and then switched to daily hemofiltration using a NxStage System One machine for a month. At the end of that time, beta-2 microglobulin levels were lower, blood pressure was better, and quality of life was higher. Read the summary.
Is a patient who hires a home dialysis helper still considered a home (or self-care) dialysis patient?
Click here to learn the answers to this & other questions about Medicare payment for PD and home hemo.
Read All About It!
Review home dialysis-related news, courtesy of Nephrology News & Issues. This week's stories include:
- RPA releases analysis of Conditions for Coverage
- CDC recognizes CKD as major public health issue
- Creatinine increase in elderly means increased renal disease, mortality
- Muscle mass might not fully explain higher creatinine in blacks with CKD
Featured link: kidney health tools for YOU
The National Kidney & Urologic Diseases Information Clearinghouse (NKUDIC—now there's a mouthful!) offers FREE podcasts, vodcasts, streaming audio, tutorials, tools, and more. You can even watch videos of surgery. Check it out!
Find the site or this eNewsletter helpful? FORWARD THIS E-MAIL and encourage others to sign up for our free eNewsletter.