ETOC

From the Field: Patient Payments Part 2

Last issue I mentioned that a social worker commented to me that she wishes providers would stop trying to collect from patients. She said providers “make enough money” and wondered why they feel the need to collect from patients who cannot afford their large coinsurances and deductibles. She pointed out that increasing pressure on patients to pay for coinsurances and ... Read More »

Prognostic Importance of Atrial Fibrillation in Kidney Transplant Recipients

Atrial fibrillation (AF) affects three to six million people in the United States, and nearly 30 million people worldwide. AF is associated with higher risk of mortality and adverse cardiovascular events including stroke. Among patients with end-stage renal disease (ESRD), the prevalence of AF is particularly high compared to the general population. In addition, the 1-year mortality risk of patients ... Read More »

High Comorbid Condition Burden Associated with Withdrawal from Dialysis Therapy

Over the past decade, annual rates of dialysis therapy initiation have been relatively stable. Dialysis patients are living longer than before, creating an interest in issues such as conservative care for end-stage renal disease (ESRD), palliative care in nephrology, and withdrawal from dialysis therapy. Withdrawal from dialysis therapy is a cause of death in ~10% to 20% of patients in ... Read More »

Mortality Rates in Medicaid Expansion States among Patients Initiating Dialysis

The Affordable Care Act (ACA) expanded eligibility for Medicaid to include nonelderly citizens and permanent residents with incomes below 138% of the federal poverty level in participating states. As of September 2018, Medicaid expansion had been adopted in 33 states and the District of Columbia. There are data showing an association between Medicaid expansion and improved coverage, access to care, ... Read More »

Low-Level Lead Exposure Associated with Decreased Kidney Function

Although exposure to lead has decreased in recent decades, environmental exposure to lead remains a public health problem. Even at low levels of exposure, adults and children experience adverse health effects. Lead exposure occurs through ingestion of contaminated food and drinking water, and through inhalation of polluted air. Dietary contributors in Europe and the United States include cereals, leafy vegetables, ... Read More »

Low Protein Intake Associated with Higher Mortality Risk

Glomerular filtration rate (GFR) is a key index of kidney function. Protein intake is a major dietary modulator of GFR and standard practice calls for low protein intake to slow the progression of chronic kidney disease (CKD). Results of studies on low protein intake in kidney disease have been inconsistent regarding decline in kidney function and/or mortality over time. Massimo ... Read More »

Growing Pressure on Renal Patients to Pay Out-of-Pocket

By Rick Collins At a conference I attended recently, a social worker lamented how much grief is placed on dialysis patients due to the large bills they receive from renal providers. She openly wondered why providers feel they need to bill patients since they already are paid “a lot” by Medicare and commercial insurance companies. When I first entered the ... Read More »

INTENT Trial Examines Intervention to Prevent Excessive Weight Gain Post-Transplant

Recipients of kidney transplant have markedly improved outcomes compared with patients on dialysis; however, survival among kidney transplant recipients is significantly reduced compared with age-matched general population. The reduction in survival is due, in large part, to an increase in the risk of cardiovascular disease. Weight gain, obesity, and diabetes are risk factors for cardiovascular disease, and there is an ... Read More »