Sensing Savvy

As a nephrology professional who has devoted countless hours of volunteer time to support the body of work reflected in the 2006 National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines on vascular access, it is difficult to witness the “march of time” with regards to the arteriovenous fistula (AVF) as the best access for patients on dialysis.

The same concerns over process of care related to the KDOQI VA proposed changes that reverse the momentum of the past guidelines and Fistula First (identifying early indications of assess dysfunction, staff assessment competency) also apply to hemodialysis catheters. The proposed guidelines suggest that hemodialysis catheters could be a viable long-term access choice. Similar to the limitations on assessment skills, many states restrict the accessing of a central venous catheter to a licensed nurse. Questions raised by the proposed guidelines include:

Dialysis facilities typically open early in the morning Monday to Saturday. The first shift of patients must get their treatments initiated to prevent delays for the later patient shifts. Commonly, limited licensed nursing staff is on duty to perform any needed early morning assessments. The One Minute Check has now been shortened to 10 seconds in some facilities in order to save time. Once the needles are placed, it is not safe to perform the check or a higher-level expert examination. Typically, the nephrologist and advance practice team members see dialysis patients once they are on their way to treatment. They may be able to assess later shift patients before their needles are inserted. However, routine process of care makes it very difficult for nephrologists to fully assess the AVF or AVG with an expert-level physical exam detailed in the current draft of the KDOQI Guideline updates.

A quick review of the process of care is critical to understand how the proposed KDOQI Vascular Access Guidelines will impact the dialysis facilities and thus the patients.

National Dialysis Accreditation Commission Gets Approval from the Centers for Medicare & Medicaid Services (CMS)

The National Dialysis Accreditation Commission (NDAC) has been approved by CMS to conduct dialysis facility surveys. It is the first independent company approved by CMS to do so. According to Nephrology News & Issues, “Dialysis providers successfully completing NDAC’s accreditation process may now be awarded Medicare certification from CMS based on their accreditation with recommendation for deemed status by NDAC.” Accreditation services will be offered in all 50 states and U.S. territories.

Source: Nephrology News & Issues

Home hemodialysis has several benefits for patients. Despite this, the modality remains underused among patients receiving hemodialysis. Here’s a look at some of the latest stats on home hemodialysis.

Did you know Medicare reimbursement for dialysis treatments has increased?

This past November, the Centers for Medicare and Medicaid (CMS) released its final rule for dialysis clinics, and the new stipulations, including the composite rate increase, went into effect Jan. 1. As a dialysis clinic professional, you’ll be responsible for managing these changes and updates in the year ahead.

To help you navigate the CMS final payment rule for 2019, here’s a breakdown of the three most significant changes.

Women May Have Lower Risk for Chronic Kidney Disease Progression

A recent study has revealed women have a lower risk of chronic kidney disease (CKD) progression and death than men, but men have a higher likelihood of progression to end-stage renal disease (ESRD). Researchers noted that the prevalence of CKD is higher among women, while men have a 50 percent higher lifetime risk of developing ESRD. The findings suggest that, compared to men, women could have a slower decline in kidney function or they’re more likely to die before progressing to ESRD.

Source: Nephrology News & Issues

As a hemodialysis nurse, you have probably performed cannulation on hundreds of hemodialysis patients. But, did you know researchers have noted that the ideal person to do the procedure is the patient? That’s because the patient is always there for his or her hemodialysis session.

Despite the fact many patients may not have had any medical training, most can quickly achieve expert-level skill with self-cannulation, which not only makes the patient more active in his or her care and reduces the risk for complications, it also frees nursing staff up to do other pre-dialysis and dialysis tasks.

Multiple Comorbidities Increases Risk of Early Dialysis Initiation
Patients who have CKD along with other comorbidities face an increased risk of early dialysis initiation, researchers found. Smoking, older age and proteinuria significantly increased the risk for  two or more comorbidities. The most common comorbidities found in these patients are diabetes, hypertension and hyperlipidemia.