Subject(s)
Arteriovenous Shunt, Surgical/adverse effects , Hospitalization , Renal Dialysis , Adolescent , Adult , Arteriovenous Shunt, Surgical/methods , Cardiovascular Diseases/complications , Female , Humans , Kidney Diseases/complications , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/therapy , Male , Middle Aged , Statistics as TopicSubject(s)
Kidney Failure, Chronic/diet therapy , Adult , Diet , Dietary Proteins/administration & dosage , Evaluation Studies as Topic , Forecasting , Humans , Infant , Kidney Failure, Chronic/metabolism , Kidney Transplantation , Nutritional Requirements , Renal Dialysis , Research Design , Transplantation, HomologousABSTRACT
Since the passage of the renal disease provisions of the Social Security Law, the percentage of patients in the United States utilizing self-care treatment has declined from 40% to about 15%. The background and provisions of the Rostenkowski Bill, H.R. 8423, are summarized. Primary aims of the bill are to remove disincentives for use of self-dialysis, remove certain disincentives to transplatation, and to provide for peer review and goal setting for network use of various treatment modalities. Studies of the Health Standards and Quality Bureau, and activities of the Veterans Administration and the Artificial Kidney - Program of the National Institute of Arthritis, Metabolism, and Digestive Diseases relevant to self-care dialysis are briefly summarized.
Subject(s)
Hospital Units/legislation & jurisprudence , Legislation, Medical , Renal Dialysis , Self-Care Units/legislation & jurisprudence , Hemodialysis, Home , Humans , Kidney Failure, Chronic/therapy , Peritoneal Dialysis , United StatesABSTRACT
As research develops better dialysis techniques, the dietitian's input in the management of patients with renal disease is vital, for their protein status must be "fine tuned" with individualized treatment and counseling. Her pivotal role is being demonstrated in the National Cooperative Dialysis Study of the National Institutes of Health, one phase of which is being conducted by three hospitals in San Francisco. In that study, close monitoring of the protein catabolic rate (PCR) and blood urea nitrogen (BUN) in predialysis patients, coupled with adjustments in therapeutic dietary regimens and counseling as indicated, shows promise of bringing such patients into good control, targeted at 80+/-10 per cent bun with a PCR of 1.1+/-0.3 gm. per kilogram per 24 hr. Various dietary techniques, either singly or in combination, are being employed in an attempt to control dietary intake.
Subject(s)
Dietetics , Kidney Diseases/therapy , Renal Dialysis , Urea/blood , Acute Kidney Injury , Blood Urea Nitrogen , Dietary Proteins , Energy Intake , Humans , Kidney Diseases/blood , Kidney Diseases/diet therapy , Kidney Failure, Chronic , Kinetics , Patient Education as Topic , Proteins/metabolismABSTRACT
A study of dialysis costs in five major dialysis centers throughout the United States was conducted in 1973. When available, home, home training, limited care, satellite and in-hospital-full-care dialysis were included. The study's objective was to determine the cost per dialysis for each separate dialysis modality. All costs associated with the dialysis procedure were included. Using a uniform methodology, costs were collected on four care levels which vary significantly from each other in the use of direct labor. They are as follows: home, home care training, limited care and full care. Costs were also segregated into five expenditure categories: personnel, supplies, travel, equipment and other. They study was designed to show the range of costs in five "representative" centers throughout the country, but not to provide statistical "average" of dialysis costs. Cost per dialysis ranged from $33 to 66 for the home patient group, $100 to 116 for limited care, $144 to 172 for in-hospital and $146 to 259 for the home training units.
