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Extracorporeal Removal of Drugs: Peritoneal Dialysis and Hemodialysis01:30

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Patients with end-stage renal disease (ESRD) or those experiencing drug overdose often require extracorporeal methods to eliminate accumulated drugs and metabolites. Hemoperfusion, hemofiltration, and dialysis are the primary techniques to rapidly remove harmful substances without disrupting the patient's fluid and electrolyte balance. For those with compromised renal function, dosage adjustments of concurrent medications may be necessary during extracorporeal drug removal.Dialysis is a process...
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Continuous Renal Replacement Therapy (CRRT) is an essential intervention for patients experiencing severe kidney dysfunction. This therapy offers a continuous mechanism for removing fluids and toxins from the bloodstream, leveraging the patient’s blood pressure to facilitate filtration through a specialized filter. This method contrasts with intermittent dialysis, providing a gentler and more consistent removal of waste products and excess fluid, which is particularly beneficial in critically...
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Chronic Kidney Disease III: Interprofessional Care

Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
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Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
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Peritoneal dialysis, or PD, utilizes the peritoneal membrane as a filter to eliminate excess fluid and waste products. Effective nursing management is essential for ensuring patient safety, preventing complications, and promoting optimal function of the peritoneal dialysis process.Assessment and MonitoringNurses must thoroughly assess the patient before, during, and after each dialysis session. Regular monitoring includes vital signs, daily weight, fluid intake and output, and laboratory values...
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Is there "cherry picking" in the ESRD Program? Perceptions from a Dialysis Provider Survey.

Amar A Desai1, Roger Bolus, Allen Nissenson

  • 1Department of Medicine, StanfordUniversity School of Medicine, Stanford, California, USA.

Clinical Journal of the American Society of Nephrology : CJASN
|April 3, 2009
PubMed
Summary

Dialysis facilities are perceived to commonly engage in "cherry picking" of patients, particularly in the Northeast and Midwest regions. This practice, especially related to patient adherence and attendance, may impact vulnerable populations if reimbursement policies change.

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Published on: July 20, 2022

Area of Science:

  • Nephrology
  • Healthcare Policy
  • Healthcare Quality

Background:

  • End-stage renal disease (ESRD) reimbursement policy changes, including bundled payment, raise concerns about dialysis facility patient selection.
  • Dialysis facilities may practice "cherry picking" to attract healthier, better-insured, or more adherent patients.

Purpose of the Study:

  • To assess healthcare providers' perceptions of cherry picking in dialysis facilities.
  • To identify factors influencing these perceptions and the perceived impact on dialysis outcomes.

Main Methods:

  • A national survey was conducted among nephrology nurses, nephrologists, key opinion leaders, and physicians.
  • Respondents reported on the frequency and strategies of cherry picking and its perceived effects.

Main Results:

  • Three-quarters of respondents perceived cherry picking as occurring "sometimes" or "frequently."
  • Perceived cherry picking was significantly higher in the Northeast (2.8-fold) and Midwest (3.5-fold) compared to the West.
  • Strategies like low thresholds for dismissing non-compliant or non-attending patients were most associated with outcomes.

Conclusions:

  • Dialysis providers widely perceive cherry picking as a common and significant practice under current reimbursement.
  • Understanding cherry picking is crucial for protecting vulnerable patients, especially with potential shifts in reimbursement strategies.