Q&A
Clinicians Are Asking: Dialysis Patients Requiring Surgery
Renal practitioners tackle three common questions from their primary care colleagues, including input on the renal diet.
Your renal practitioners/department editors have chosen three typical situations you might encounter in practice.
• Nutrition and diet help control kidney disease, but also heart disease, diabetes, and other comorbid states.
• Renal patients, like many others, often require surgeries; what specific concerns exist for surgical patients requiring dialysis?
• The Medicare education benefit has been a particular bonus for advanced practitioners, as we teach many of the classes.
We welcome your questions and comments.
Q: Our practice received a flyer for kidney disease education classes offered by the local nephrology group. Can you tell me more about these classes?
Patient education in kidney disease has been shown to delay disease progression and improve patient outcomes. 4 Because of this, the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 5 provided for classes for patients with stage 4 CKD (GFR, 15 to 29 mL/min/1.73 m 2) to receive six hours of education over their lifetime.
Classes can be taught by a physician or an advanced practitioner (a PA, an NP, or a clinical nurse specialist). Four broad areas are covered: management of comorbidities that occur with CKD; prevention of complications, including an explanation of how the kidneys work and a review of medications; renal replacement modalities, including hemodialysis, peritoneal dialysis, and transplantation; and opportunities to empower the patients as active partners in their own health care. 6 Classes also include information on managing anemia, hypertension, and bone mineral disease. 7
Class structure is up to the provider. Most practices offer classes to all stage 4 CKD patients, regardless of Medicare status. Classes can be taught on a one-to-one basis or in a group setting. 8
Some practices design their own format, while others use programs designed for CKD education. The National Kidney Foundation developed a slide set called Your Treatment, Your Choice ,8 while the Cleveland Clinic, the Mayo Clinic, and the University of Alabama at Birmingham (among others, no doubt), have developed their own in-house programs. All these programs have a prepared Power Point slide deck, and most include evaluation tools.
Tricia Howard, MHS, PA-C
South University, Savannah, Georgia
REFERENCES
1. National Kidney Foundation Kidney Disease Outcome Quality Initiative (NKF-K/DOQI) Clinical Practice Guidelines for Nutrition in Chronic Renal Failure (2000). www.kidney.org/professionals/kdoqi/guidelines_updates/doqi_nut.html. Accessed February 16, 2012.
2. Medicare.gov. Medical nutrition therapy. www.medicare.gov/navigation/manage-your-health/preventive-services/medical-nutrition-therapy.aspx?AspxAutoDetectCookieSupport=1. Accessed February 16, 2012.
3. Soundararajan R, Golper T. Medical management of the dialysis patient undergoing surgery. www.uptodate.com/contents/medical-management-of-the-dialysis-patient-undergoing-surgery. Accessed February 16, 2012.
4. Young HN, Chan MR, Yevzlin AS, Becker BN. The rationale, implementation and effects of the Medicare CKD education benefit. Am J Kidney Dis . 2011;57(3):381-386.
5. H. R. 6331: Medicare Improvements for Patients and Providers Act of 2008. www.govtrack.us/congress/bill.xpd?bill=h110-6331. Accessed February 16, 2012.
6. §410.48. Kidney disease education services. Federal Register . 2009;74(226):62003.
7. Lazarus JM. National health care policy and its effect on renal care. Presented at: NKFI Multi-Disciplinary Conference; September 24, 2009; Chicago, IL.
8. National Kidney Foundation. MIPPA Kidney Disease Education Benefit. Your Treatment, Your Choice (2010). www.kidney.org/professionals/KLS/YTYC.cfm. Accessed February 16, 2012.