Laboratory tests in end-stage renal disease patients undergoing dialysis

Patients with advanced chronic renal failure develop uremia, which is uniformly fatal if not treated by either RT or RD. At this time in the United States, there are about 200,000 individuals receiving dialysis at a cost of $7 billion a year. The precise biochemical reasons why uremia develops and why dialysis is partially successful are not fully understood. Many tests are performed on uremic patients to monitor their clinical course and the success of dialysis. The tests to judge the adequacy of dialysis and the amount and type of dialysis for individual patients (the DP) may not be optimal and are the subject of further study and modification. Some of these tests are classified in HCFA's Medicare Coverage Issues Manual as "other than routinely performed." Among these are NCTs, ECGs, chest x-rays, and tests for the presence of hepatitis B antigens and antibodies. At this time, HCFA allows reimbursement for the routine performance of these tests at specified frequencies. There is no reliable evidence to support the usefulness of such tests performed routinely in patients with ESRD. Only in the case of NCT is there a substantial literature that addresses the usefulness of this type of test in a manner specific for ESRD.