Nutritional Predictors of All-Cause Mortality in Hemodialysis Patients

Washington, DC—Patients with end-stage renal disease require close monitoring of nutrition. However, in patients on hemodialysis, obtaining adequate nutritional status while avoiding fluid overload, hyperphosphatemia, and hyperkalemia is difficult. Researchers in Korea, led by Eunjin Bae, MD, PhD, conducted a retrospective cohort study to examine the clinical significance of serum albumin and other nutritional markers in patients on maintenance hemodialysis. ... Read More »

The Ins and Outs of Partial Month Billing for the MCP

Sarah Tolson The Ins and Outs of Partial Month Billing for the MCP In recent months, I have received many questions with a common theme—billing for a partial month of nephrology services for dialysis patients. In this issue, we will examine these questions and their solutions. The questions keep this column relevant, and I appreciate all of you who read ... Read More »

Donor Kidney Acceptance Practices and Wait-listed Patients

Each year, nearly 5000 people in the United States and more than 3000 in Europe die while waiting for a kidney transplant. The shortage of organs available for transplant is a major public health issue, due to wait-listed patient mortality as well as increased healthcare costs of maintaining patients with end-stage renal disease (ESRD) on chronic dialysis. However, more than ... Read More »

IDEAL Trial Results and Changes in Dialysis Initiation Timing in Canada

The optimal time to initiate dialysis for the treatment of kidney failure remains uncertain. Renal recovery is rare following dialysis initiation and patients receiving dialysis treatments are at high risk for morbidity and mortality and a diminishing quality of life. Further, early initiation of dialysis increases healthcare costs and may not provide optimal value from a health system perspective. Results ... Read More »

Sodium Zirconium Cyclosilicate for Management of Predialysis Hyperkalemia

Renal potassium excretion is severely reduced in patients with end-stage renal disease (ESRD), requiring hemodialysis or peritoneal dialysis to maintain normal serum potassium levels. However, despite receiving dialysis, many patients experience persistent predialysis hyperkalemia, a condition that is potentially life-threatening and associated with cardiac arrhythmias and death. There is an association between a serum potassium concentration of ≥5.6 mmol/L and ... Read More »

From the Field: Monthly Capitation Payment Breakdown

By Sarah Tolson In recent months, I’ve received an influx of questions from readers about the Medicare Monthly Capitation Payment (MCP). Many of these questions are related to the increasing utilization of physician assistants (PAs) and nurse practitioners (NPs), in addition to questions about CMS regulation changes at the beginning of the year that allow free-standing dialysis facilities and patient ... Read More »

HCV Status and Kidney Transplantation Outcomes

In the general population in the United States, the prevalence of hepatitis C virus (HCV) is ~1%; the prevalence among patients on hemodialysis ranges between 3% and 14%. Current US practice guidelines call for screening of all dialysis patients for HCV infection by testing for anti-HCV antibody and, more recently, HCV RNA to confirm chronic infection. For many patients with ... Read More »

Postdialysis Hypokalemia and All-cause Mortality in Patients on Hemodialysis

Among patients on hemodialysis, the mortality rate is 13.6 per 100 person-years, higher than in the general population. Sudden cardiac death is the leading cause of death in patients on hemodialysis, caused primarily by hyperkalemia, making serum potassium of particular interest in the management of dialysis patients. Serum potassium levels during dialysis are determined on the basis of the predialysis ... Read More »

From the Field: Tips for Successful Appeals

Sarah Tolson The word appeal is frequently considered a dirty word within the walls of Sceptre Management. Generally, by the time a payers’ requirements for appeal submission have been met, the claim in question is past due and the chances for obtaining full reimbursement have decreased. The entire appeal process is labor intensive, and success rates are generally not in ... Read More »