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Hemodialysis II: Procedure and Complications01:24

Hemodialysis II: Procedure and Complications

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DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
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Hemodialysis I: Introduction01:25

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Hemodialysis (HD) is a medical treatment that artificially removes waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. In this process, blood is filtered through a semipermeable membrane, allowing for the selective removal of waste while preserving necessary components like blood cells and proteins. Hemodialysis is typically performed in patients with end-stage renal disease (ESRD) or severe kidney...
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Hemodialysis III: Nursing Management01:25

Hemodialysis III: Nursing Management

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The nursing management of a patient undergoing hemodialysis includes several critical steps, starting with a thorough assessment before the procedure.Before the Hemodialysis ProcedureFirst, record the patient's vital signs—blood pressure, heart rate, respiratory rate, and temperature—to establish a baseline. This baseline is essential for detecting conditions such as hypotension that could impact the patient's response to dialysis. Document the patient's pre-dialysis weight, as this...
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Continuous Renal Replacement Therapy01:30

Continuous Renal Replacement Therapy

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Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...
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Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications01:25

Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications

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Peritoneal dialysis (PD) is a medical process that removes waste products and excess fluid from the body using the peritoneal membrane as a natural filter.Peritoneal Dialysis MethodsSeveral methods can be used for peritoneal dialysis, including Acute Intermittent Peritoneal Dialysis, Continuous Ambulatory Peritoneal Dialysis, and Automated Peritoneal Dialysis, also known as Continuous Cyclic Peritoneal Dialysis.Acute Intermittent Peritoneal Dialysis (AIPD) is used for patients with uremic...
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Chronic Kidney Disease III: Interprofessional Care

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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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Related Experiment Video

Updated: Oct 30, 2025

A Murine Model of Hemodialysis Access-Related Hand Dysfunction
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CMS ESRD quality incentive program has not improved patient dialysis vascular access.

Sapan Shah1, Paul J Feustel2, Christina E Manning3

  • 1Albany Medical College, Albany, NY, USA.

The Journal of Vascular Access
|July 5, 2021
PubMed
Summary

The Centers for Medicare & Medicaid Services (CMS) End Stage Renal Disease (ESRD) Quality Incentive Program (QIP) did not increase arteriovenous fistula (AVF) rates or decrease long-term tunneled hemodialysis catheter (TDC) rates. Disparities in race and income impacted access rates.

Keywords:
Dialysisarteriovenous fistuladialysis accessend stage renal diseasequality improvementtunneled hemodialysis catheter

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Area of Science:

  • Nephrology
  • Public Health
  • Health Services Research

Background:

  • Over 468,000 patients in the U.S. rely on hemodialysis for End Stage Renal Disease (ESRD).
  • Dialysis access type significantly impacts patient outcomes and healthcare costs.
  • Optimizing vascular access is a key goal in ESRD management.

Purpose of the Study:

  • To evaluate the impact of the ESRD Quality Incentive Program (QIP) on dialysis access.
  • To determine if CMS Clinical Performance Measures (CPMs) increased arteriovenous fistula (AVF) rates.
  • To assess if CMS CPMs decreased long-term tunneled hemodialysis catheter (TDC) rates.

Main Methods:

  • Retrospective observational study of 4804 dialysis facilities from Payment Year (PY) 2014-2020.
  • Analysis of reported AVF and long-term TDC rates within the ESRD QIP framework.
  • Examination of disparities based on facility service areas (race, income).

Main Results:

  • Mean AVF rates initially increased but declined by PY 2020, near program inception levels.
  • Long-term TDC rates decreased initially but then rose significantly above initial levels by PY 2020.
  • Facilities in majority Black or low-income areas showed lower AVF rates.
  • AVF rates positively correlated with facility star ratings; TDC rates negatively correlated.

Conclusions:

  • The ESRD QIP has not met its goals of increasing AVF rates above 68% or reducing long-term TDC rates below 10%.
  • Systemic disparities related to race, socioeconomic status, and geographic region hinder goal attainment.
  • Addressing these disparities is crucial for improving dialysis access quality.