ETOC

From the Field: New Frequency of Hemodialysis Local Coverage Determinations

Sarah Tolson Effective March 1, 2019, several Medicare Administrative Contractors (MACs) began processing claims for hemodialysis treatments under new Local Coverage Determinations (LCDs). These LCDs underwent massive revisions after the proposed LCDs released in 2017 would have essentially eliminated reimbursement for more than three treatments per week because they were so strict. Medicare, the largest payer in the United States ... Read More »

Stroke Risk and Predictors in Kidney Transplant Recipients

Kidney transplantation is the gold standard treatment for patients with end-stage renal disease (ESRD). The prevalence of mortality and major cardiovascular events in kidney transplant recipients has declined in recent years, and is lower among transplant recipients than in a matched chronic kidney disease (CKD) population. However, kidney transplant recipients continue to have an increased mortality and cardiovascular event risk ... Read More »

Examining Short-Term Within-Person Variability in Clinical Markers of Kidney Function

Chronic kidney disease (CKD) is defined by abnormalities in glomerular filtration rate (GFR) and/or albuminuria; CKD affects approximately 10% of the US population. Endogenous plasma or serum filtration markers, most commonly creatinine, are used to estimate GFR; albuminuria is quantified by measuring urinary albumin concentration (UAC) or urinary albumin-creatinine ratio (UACR). There are well established reference ranges for estimated GFR ... Read More »

Real-World Long-Term Effectiveness of Sucroferric Oxyhydroxide in Managing Hyperphosphatemia

Patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) often experience hyperphosphatemia. Due primarily to the progressive inability of the kidneys to appropriately excrete phosphorus, disrupted phosphorus homeostasis leads to phosphorus accumulation. There have been associations between high levels of serum phosphorus and increased risk of cardiovascular morbidity and mortality. In a previous large national study, the ... Read More »

From the Field: 40 Years of Lessons from Work and Life

After 19 years at Sceptre Management Solutions, the time has come for me to step aside. My wife and I sold the business last year to our oldest daughter, Jennifer Hicks, who has worked with us since 2001. She has an MBA and is incredibly smart and very talented. I stayed on during the past year to help during the ... Read More »

Using the Hume Formula to Estimate Body Composition

Aberrant body composition, notably muscle and protein-energy wasting, and elevated levels of adiposity, are common characteristics of chronic kidney disease (CKD). Malnutrition, reductions in physical function, and quality of life are negatively affected by abnormal body composition; in addition, there is an association between abnormal body composition and increased risk for adverse clinical outcomes and mortality. Estimates are that 9% ... Read More »

Metabolic Abnormality and Obesity Associated with Rate of CKD Progression

Obesity, a worldwide major health problem, is associated with increased risk for type 2 diabetes mellitus, cardiovascular disease, cerebrovascular events, and malignancy, resulting in increased rates of cardiovascular and all-cause mortality. Studies have also demonstrated an increased risk of developing incident chronic kidney disease (CKD); however, it is unclear whether obesity itself worsens kidney function in patients with CKD. Results ... Read More »

Scheduled versus Emergency-Only Dialysis in Undocumented Immigrants

Despite nearly universal coverage for scheduled dialysis in the United States via Medicare and Medicaid, in 40 of 50 states, undocumented immigrants receive emergency-only dialysis, defined as intermittent and provided in emergency departments (EDs) when patients present with imminently life-threatening indications including severe metabolic acidosis, hyperkalemia with impending fatal arrhythmia, uremia with altered sensorium,, or severe volume overload with hypoxia. ... Read More »

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 »