...The economics of end-stage renal disease Introduction According to the Centers for Disease Control and Prevention (CDC) 2010, 10% of adults in the United States have chronic kidney disease (CKD). That is estimated at about 20 million people. People with CKD may not feel any symptoms in the early stages, so treatment most likely has not been started. When a person often finds out they are in need of treatment, they may already be in kidney failure or end stage renal disease (ESRD). This paper will discuss the reimbursement mechanisms presented in the Sullivan article, the economics of providing ESRD treatment from the organization's point of view, patients options and potential trade-offs related to cost, quality, and access to treatment, and the ethical implications of treatment options based on cost evaluation. Reimbursement Mechanisms The major reimbursement mechanism presented in article End Stage Renal Disease Economics and the Balance of Treatment Modalities is Medicare. The system in place at this time is the fee for service with additional charges for medication and medical testing (Sullivan, 2010). The current reimbursement structure is based on a three times a week structure, because hemodialysis (HD) is the primary treatment for ESRD (Sullivan, 2010). According to Sullivan (2010) "The most ideal treatment for patients with ESRD is transplantation" (p.45). The reimbursement for peritoneal dialysis (PD) is the same as that of HD. With the passing of The Medicare...
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...Hemodialysis and Its Impact to end Stage Renal Disease Patients Student’s Name University Contents 1.0 Background to the Study.........................................................................................3 2.0 Introduction.............................................................................................................3 3.0 Problem Statement..................................................................................................4 4.0 Data Collection........................................................................................................4 5.0 Data Management and Analysis..............................................................................5 6.0 The Protection of Human Rights.............................................................................6 7.0 Interpretation of Findings........................................................................................7 8.0 Conclusion...............................................................................................................7 References.....................................................................................................................8 Hemodialysis and Its Impact to end Stage Renal Disease Patients 1.0 Background to the Study The final stage of chronic kidney diseases is when the kidneys can longer support their functions; this is the end stage where organs are pronounced to have failed completely (Esra, 2013)...
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...Chronic kidney disease Classification and external resources Uremic frost on the forehead and scalp of a young man who presented with complaints of chronic anorexia and fatigue with blood urea nitrogen and serum creatinine levels of approximately 100 and 50 mg/dL respectively. ICD-10 N18 ICD-9 585.9 585.1-585.5 403 DiseasesDB 11288 MedlinePlus 000471 eMedicine article/238798 MeSH D007676 Chronic kidney disease (CKD), also known as chronic renal disease (CRD), is a progressive loss in renal function over a period of months or years. The symptoms of worsening kidney function are non-specific, and might include feeling generally unwell and experiencing a reduced appetite. Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease. Chronic kidney disease may also be identified when it leads to one of its recognized complications, such as cardiovascular disease, anemia or pericarditis.[1] It is differentiated from acute kidney disease in that the reduction in kidney function must be present for over 3 months. Chronic kidney disease is identified by a blood test for creatinine. Higher levels of creatinine indicate a lower glomerular filtration rate and as a result a decreased capability of the kidneys to excrete waste products. Creatinine levels may be normal in the early stages of CKD, and the...
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...is a life-threatening condition called end-stage kidney disease” (Wingerd 322). From the name of the disease you can see that it is the last stage in renal failure. End-stage kidney failure is preceded by chronic renal failure that gets worse “until less than 10% of renal function remains” (Huether and McCance 1253). It can lead to death if it is not treated immediately. According to Bruce Wingerd, an “aggressive course of action” is required to save the patient’s life (322). This can include “hemodialysis and, if possible, kidney transplant” (Wingerd 322). The symptoms of end-stage kidney disease (ESKD) may vary from person to person. The most common symptoms are swelling, fever, weakness, muscle cramps, no or high urine output, and abdominal pain (Johns Hopkins Medicine). According to John Hopkins Medicine, high blood pressure, diabetic nephropathy, and cystinosis can cause kidney damage that may lead to the development of ESKD. When a person’s blood pressure is high for too long it puts pressure on the kidneys to filter more blood which causes stress. Stress causes damage that makes it harder for the kidneys to function adequately. The symptoms of kidney failure are similar to the symptoms of other common illnesses. Because of the similarities in symptoms, it is important to get a checkup with your doctor in order to know what is really going on....
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...1) Nephrosclerosis is the hardening of the walls of the arterioles and small arteries as well as a tightening or blocking of the lumina of the blood vessels in the kidneys. Over time, this change in the blood supply will cause the kidneys to become ischemic which will become grounds for the destruction of the renal tissue. The kidneys will also become atrophic which will deteriorate the overall function that they possess. With the kidneys being deprived of the adequate blood supply and decline in health/function, the body will try to compensate for this by increasing the blood pressure in order to get the proper amount of blood to the kidneys. This will all happen in a slow and gradual manner, but by the time a person realizes that there is something wrong, the damage has already been done (Gould & Dyer, 2011). 2) Mr. H. has been experiencing edema and weight gain due to the fact that he has been losing protein in his urine and just the fact that his kidneys are not functioning properly. The loss of protein in the urine causes the concentration of album in the blood to drop as well. A drop in albumin will cause a drop in blood volume in the blood vessels. The kidneys will sense this drop in blood volume and begin to retain salt. Fluid will then start to move into the interstitial spaces in the body, thus causing Mr. H. to become swollen. Another cause of the edema may be due to impaired kidney function and they can’t effectively excrete sodium into the urine. If Mr. H. is...
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...high blood pressure is a symptom of kidney disease. He also has fatigued, his urine output has changed, loss his appetite and he is losing weight. These four symptoms are also signs of serious kidney problems. Acute kidney issues are most often diagnosed during a hospital stay for another cause. Acute renal failure happens quickly whereas chronic renal failure develops over time. 2. The normal RBC in men: 4.7 to 6.1 million cells per microliter (cells/mcL). George’s is 3.8 millions cells/mcL which is fairly low. His Hgb is 11.0. This is lower than the normal range of 12.4/14.9. These results from the blood test are symptoms of mild anemia. The low RBC and the low Hbg is usually caused by an abnormality or a disease. Cancer and aplastic anemia can cause the body to produce fewer red blood cells. 3. All of George’s urine test results were abnormal. When the kidneys are damaged, they fail to discharge excess creatinine and urea nitrogen, serum creatinine and blood urea nitrogen level increase. In patients with damaged Chronic Kidney Failure, their glomerular filtration membrane is damaged seriously and large amounts of protein leak into urine, causing proteinuria. For his age, his GFR is low. This shows moderate decrease in renal function. 4. By stage II, 78-80 percent nephron function is lost and replaced by scare tissue. During End Stage Renal Disease only 10% of nephrons remain functioning. At this stage the GFR is significantly diminished. For...
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...is to look at the issue of end of life care in dialysis satellite units, as these areas tend to be nurse led units. My interest in palliative and end of life care has arisen from the growing number of poorly patients we continue to dialyse, this has proved distressing especially for the patient, who often has unmanaged symptoms and for their families, it is also upsetting for the staff involved in their care, as it is felt nobody is acting as the patients’ advocate and helping the decision to facilitate the withdrawal of what is now an ineffective and unnecessary treatment. One of the latest developments by the Government and Department of health is the concept of Advance Care Planning. I have looked at this from various perspectives and would like to be involved in introducing the process to Sheffield Kidney Institute. In 2004, the number of patients receiving renal replacement therapy in England, Scotland and Wales was 33,511, this figure is sourced from data which has been made available to them from participating renal units throughout the country, the number of patients receiving dialysis since 2000 has risen by 7% (Ansell et al 2005) with it projected to rise by a further 10 percent over the next 5 years (Ansell et al 2005). About 15-29 percent of deaths of patients with end stage renal disease results from a decision to discontinue dialysis (Davison 2006). Importantly we need to explore which patients especially those reaching the end of their lives are choosing...
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...Chronic Kidney Disease Abstract Chronic kidney disease is a progressive disease that destroys the function of the human kidneys. This purpose of this research paper is to present an introductory profile of the disease. The profile includes a description of the disease, leading causes, how it is diagnosed, and its stages. Current statistics of the individuals impacted by the disease and mortality are provided. This paper will also explain the progressive nature of the disease and how the kidneys are damaged. Finally, the treatment goals and actions for the different stages of the disease are laid forth. Chronic Kidney Disease Kidneys are vital organs that regulate the body’s fluid level, filter toxins, control blood pressure, and more. A human cannot live without at least one functioning kidney. Chronic Kidney Disease (CKD) is a progressive disease that destroys the operating capacity of the kidneys. CKD impacts millions of Americans and is often undiagnosed until it is in an advanced stage. The human body attempts to compensate for the disease and, in doing so, worsens the condition. CKD is usually caused by another underlying cardiovascular condition. Treatment for CKD seeks to slow the progression of the disease by relieving the underlying condition. Once CKD has reached its final stage, kidney function is insufficient and renal replacement therapy is required. Chronic Kidney Disease (CKD) was formerly known as chronic renal failure (Haynes & Winearls...
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...CHRONIC KIDNEY DISEASE Helen T. Ocdol, MD, FPCP, FPSN Chronic Kidney Disease (CKD) is a dreaded condition . CKD includes a continuum of kidney dysfunction from mild kidney damage to end-stage renal disease (ESRD). Chronic renal disease is interchangeably used for CKD but to be unifom in usage, we will use the term Chronic Kidney Disease or CKD. In the U.S., there are 20 million adults who have chronic disease and over 400,000 persons have ESRD and require dialytic or transplantation therapy. In the Philippines, annually we have about 6,ooo patients started on dialysis most of which are caused by diabetis mellitus. Complications of this condition have also made this the 9th cause of death in our country. This is how important this disease entity has become over the last decade. Each of us has 2 kidneys, one on each side of our flanks. Chronic kidney disease is a permanent damage to both kidneys that persists for at least 3 months. If the kidney damage is temporary and has occurred less than 3 months, this is referred to as acute kidney or renal failure. Acuteness does not refer to the severity of the condition, but to a recent and temporary event, therefore, almost always reversible. Chronicity implies long-term event that is permanent and irreversible. This is probably why most patients fear to hear that they have kidney disease and would need dialysis. CKD has five (5) stages based on the kidney function as estimated by the glomerular filtration rate (GFR).The best overall...
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...bloodstream, it excretes them through urine (McDonnell & Mallon, 2005). Various conditions can damage your kidneys, including both chronic kidney disease and other conditions that affect the kidneys. If kidney damage becomes too severe, your kidneys lose their ability to function normally. This is called kidney failure or end-stage renal failure. According to the National Kidney Foundation (2005), more than 378,000 Americans suffer from chronic kidney failure and need dialysis or kidney transplantation to stay alive. End-stage renal disease is the name for kidney failure so advanced that it cannot be reversed. Renal is another word for kidney. The “renal” name is appropriate due to the fact that the kidneys in end- stage renal disease functions so poorly that they can no longer keep you alive (McDonnell & Mallon, 2005). End-stage renal disease cannot be treated with conventional medical treatments such as drugs. In chronic kidney disease only two treatments allow you to continue living when your kidneys stop functioning: dialysis and kidney transplantation, but only one offers a longer chance of survival. Dialysis is the term for several different methods of artificially filtering the blood (McDonnell & Mallon, 2005). Dialysis is a procedure that replaces some of the kidney’s normal functions, but does not cure the disease or prevent possible complications. It may even cause those complications and even reduce one’s quality of life. Dialysis is performed when a person’s...
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...Progression of Chronic Kidney Disease Keywords: Chronic kidney disease, self-management, patient education, end-stage renal disease The Effects of Self-Management on the Progression of Chronic Kidney Disease Kidney disease is one of the leading causes of death in the United States and was the 8th leading cause in 2010 (Arialdi M. Miniño, 2012). Approximately 20 million U.S. adults who are over 20 years of age have chronic kidney disease (CKD), and most of them are unaware of their condition ("CDC, National chronic kidney disease "). This number continues to grow every year due to an increase in the incidence of hypertension, diabetes, obesity, and the aging population. CKD can develop into end-stage renal disease (ESRD) rapidly without intervention, and the only treatment currently available is renal replacement therapy or kidney transplant. The cost of treating those in the United States with ESRD in 2009 was approximately $40 billion dollars, and this cost continues to grow each year ("National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) "). Moreover, patients who develop kidney disease pay an even higher price with their life. Studies have shown that CKD is associated with a higher rate of cardiovascular disease as well as all other related mortalities (Kurth, de Jong, Cook, Buring, & Ridker, 2009). An adult with CKD is 16-40 times more likely to die before reaching ESRD than an adult without the disease ("CDC, National chronic...
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...Marcia Derby RN, MSN, Asst Prof. October 15, 2008 Many people develop renal disease and once they become diagnosed with End Stage Renal Disease many have only a few choices when it comes to renal replacement modalities. According to Chapman, M., Fink, N., Finkelstein, F., Marsh, J., Meyer, K., Powe, N., Wu, A. (2004), every year in the United States, nearly 90,000 patients with chronic kidney disease progress to ESRD and begin renal replacement therapy. Most patients optimally would prefer a kidney transplant, but many may not have the ability to find a donor and must get on a transplant list. So while they wait for a suitable kidney donor their only option is dialysis. End Stage Renal Disease patients have two choices of dialysis, either hemodialysis or peritoneal dialysis. Chronic dialysis can impose a considerable burden on patients and their families, with regards to health care and their quality of life. Many statistical studies have been done to compare the qualities of life with ESRD patients who are on hemodialysis and peritoneal dialysis. According to Lausevic, M., Nesic, V., Stojanovic, M., Stefanovic, V. (2006), health-related quality of life is a multidimensional concept that includes physical functioning, social functioning, mental health, and general health perceptions. This paper will discuss certain nursing issues, with regard to ESRD patients and their choice of renal replacement modalities, and review the literature from which this information was...
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...DATE: February 14, 2013 SUBJECT: Lakeside Hospital Renal Dialysis Unit Analysis Introduction Dr. Peter Lawrence noted that as a result of an alteration in Medicare’s payment policies for hemodialysis treatments, the Renal Dialysis Unit in Lakeside Hospital will be terminated unless he can show that the unit covers its costs in addition to an adequate portion of the overhead costs. In the memorandum, I will explain the pros and cons of retaining the dialysis unit, an assessment of the results of the CVP analysis, and offer you recommendations. Renal Dialysis Unit Mission The mission of the Renal Dialysis Division is to provide hemodialysis treatment for the increasing number of patients with chronic kidney disease. Because Medicare’s policy has recently changed, the number of patients in the renal dialysis unit has dropped to fifty percent; as a result, the unit has been only providing 3120 treatments to patients with end-stage renal disease. In dialysis, part of the patient’s blood is cleaned as it circulates in an artificial kidney machine. Advantages And Disadvantages of Retaining The Dialysis Unit Based on the analysis, if the dialysis unit continues to operate as it is currently or even consolidates patients to a single shift, the unit will continue treating its patients with chronic kidney disease. If Lakeside Hospital retains the unit, this is advantageous because the patients with end-stage renal disease are in dire need of this dialysis treatment. Without...
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...Polycystic Kidney Disease This paper is about polycystic kidney disease (PKD). It will describe a case scenario about a newly diagnose patient with end-stage kidney failure. The reader will learn about the kidney and function. What would happen if the kidneys stop working correctly? Continue to read to find the answer. A 40-year-old white well-nourished pleasant male presented with nausea, fatigue, shortness of breath has bilateral lower leg edema with chief complains of not urinating on two days. He and his supportive wife have come to the emergency department. John Doe has not been to the doctors in 20 years. He denies smoking or alcohol abuse. He could not give any family history because he came from a closed adoption at birth. He is usually in good health but has been not feeling well the last couple of months. He currently works at a labor ware house as a manager who has worked there for the past 20 years. Him and his family have health insurance provided threw his place of employment. He and his married have two young children. His educational background is high school equivalent. After blood tests, urinalysis, and a computed tomography scan, confirmed he has PKD. I would further assess his and his wife’s needs after the Nephrologists has come firm his diagnoses with him. Some of the teaching methods for John Doe and his wife to learn about PKD would be to explain the anatomy of the human body and what the disease is all about. I would give him a packet he could take...
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...surplus of cystine into the body’s system. Recognizing signs and symptoms and properly diagnosing is a key factor in treating this disorder. Individuals with infantile cystinosis experience both tubular dysfunction (renal Fanconi syndrome) and glomeralular deterioration. The renal Fanconi Syndrome usually occurs within the first year of life. Glomeralular deterioration progresses throughout the first decade of life, resulting in end-stage renal failure unless patients are treated with cysteamine (The importance of early diagnosis of nephropathic cystinosis to limit tissue and organ damage by treating it with specific medication, and if left untreated patient can develop renal failure by the age of 10. The prevalence of the infantile form of cystinosis transpires in 1 in 100,000 – 200,000 live births and in the North American population there is a carrier frequency of 1 in every 200. Europeans from the United Kingdom, France, and Germany have a higher prevalence of infantile cystinosis. Cystinosis is prone to but not limited to European descendants with blue eyes, fair skinned and pale blond hair (Rahkeja, Wooten &et al, 2005). Without treatment, infantile cystinosis can lead to advancement of renal failure that requires dialysis or renal transplant by approximately 10 years of age. A kidney...
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