Nutrition and Mortality in Hemodialysis1

Total Page:16

File Type:pdf, Size:1020Kb

Nutrition and Mortality in Hemodialysis1 Nutrition and Mortality in Hemodialysis1 Jonas Bergstrom2 sufficiently well proved. More and better data, gener- J. Bergstrom, Deparlment of Renal Medicine and Bax- ated in prospective, well-controlled studies, are obvi- ter Novum, Karolinska Institute, Huddinge University ously needed before intradialyfic parenteral nutrition Hospital, Stockholm, Sweden can be generally recommended as therapy for mal- (J. Am. Soc. Nephrol. 1995; 6:1329-1341) nourished HD patients. Key Words: Albumin. anorexia. cachexia. catabolism, malnu- fri/Ion ABSTRACT Protein-energy malnutrition is present in a large pro- I 960, Scribner et at. ( 1 ), in their first report on portion of maintenance hemodialysis (HD) patients, hemodialysis (HD) treatment of patients with and it is associated with increased morbidity and chronic renal failure, pointed out that malnutrition mortality. The protein requirements are increased be- may be a serious problem. Numerous studies pub- cause of the presence of endocrine and metabolic lished thereafter have demonstrated a high prevalence factors related to loss of renal function, the HD proce- of malnutrition in HD patients. In more recent years, dure, and comorbidity factors, which all stimulate net several reports have focused on the association be- tween nutritional Intake and nutritional status, on the protein catabolism. The intake protein and energy one hand, and morbidity and mortality on the other, are frequently reduced because of the underlying lending support to the supposition that nutritional disease, psychosocial factors, and uremic anorexia. inadequacies may be causally related to a fatal out- However, the extent to which underdialysis contrib- come. However, the role of nutrition In this regard has utes to anorexia and malnutrition is still not well de- not been clearly determined. Several morbidity factors fined. Malnutrition is generally not recognized as a that per se increase the risks of a poor outcome may common direct cause of death as reflected in health also cause malnutrition, which may not be the direct statistics, except in the highest age groups. Anthropo- cause of death, but rather a marker of illness. metric and biochemical signs of malnutrition are There are many causes of malnutrition in renal associated with increased mortality. A low serum failure patients who are treated with HD, some being related to endocrine and metabolic disturbances of albumin level is a strong predictive risk factor that uremia and some being related to the dialytic proce- may reflect not only or mainly protein malnutrition but dure. A controversial issue is the extent to which the also the influence of several other morbidity factors adequacy of dialysis may affect the nutritional intake (overhydration, infection, chronic disease and oth- of protein (and energy), especially If there exists a link ers) that may entail an increased risk of death. Low between underdialysis, malnutrition, and increased levels of serum creatinine (low muscle mass), serum morbidity/mortality. cholesterol (energy depletion), and BUN and low urea appearance rate (low protein intake) are also GENERAL ASPECTS OF NUTRITION AND correlated to increased mortality. For the prevention MORTALITY and treatment of HD-associated malnutrition, mea- In order for an individual to survive and thrive, sures should be taken to correct factors that may nutrients must be ingested in sufficient amounts to suppress appetite and increase net protein catabo- serve as metabolic fuel and a substitute for tissue lism (underdialysis, acidosis, low energy intake, co- growth and maintenance and to regulate the cellular morbid conditions, psychosocial and economic fac- and metabolic processes. If an essential nutrient (e.g., tors). Dietary advice should be given with the aim of a specific amino acid or a vitamin) or a macronutrient ensuring an adequate intake of protein- and energy- (protein, energy) is provided in insufficient amounts In giving products. Intradialyfic parenteral nutrition may relation to the requirements, this will sooner or later have positive effects on nutritional status when other have serious consequences for the Individual. How- measures fail. However, the indications for such treat- ever, a nutritional deficiency may be clinically unrec- ognizable for some time and may be detected only by ment have not yet been well defined, and the effects biochemical and physiologic studies or by metabolic on survival, morbidity, and quality of life are not experiments. As the deficiency becomes more severe, the altered biologic and physiologic functions in the 1 Received January 19. 1995. Accepted June 21. 1995. body and clinical signs and symptoms occur, leading 2 correspondence to Dr. J. Bergstrom, Department of Renal Medicine K56, to morbidity and, finally, the death of the subject (2). Huddinge University Hospital, 5-14186 Huddinge. Sweden. Only then is the consequence of malnutrition reflected 104&6673/0605-1 329$03.00/0 in vital statistics. It should be emphasized that even Journal of the American Society of Nephrology copyright © 1995 by the American Society of Nephroiogy less severe deficiencies may (Indirectly) have a nega- Journal of the American Society of Nephrology 1329 Nutrition and Mortality in HD tive effect by sensitizing the individual to other morbid because it measures both the bone mineral content factors. For instance, protein malnutrition may result and the body fat mass, measurements from which the in an impaired immune response, carrying an in- lean body mass is calculated. The lean body mass, as creased risk of severe or even fatal infections (3). The calculated by DEXA or by total body water determina- regeneration of cell number and function, e.g. , after tion (by monofrequency bioimpedance or isotope dilu- an acute illness, and wound healing may also be tion or from nomograms) is, by definition, equal to the impaired in states of malnutrition (4). body weight minus the amount of body fat. Therefore, it is not a reliable index of total cell mass (body ASSESSMENT OF PROTEIN-ENERGY MALNUTRITION protein) in overhydrated dialysis patients, whose lean body mass consists largely of excess water, mainly in To diagnose malnutrition in maintenance dialysis the extracellular space ( 1 2). Multifrequency bioimped- patients, it is important to assess correctly their nu- ance may turn out to be more useful by enabling tritional status (see recent review articles [5,6]). The compensation for extracellular overhydration in the validation of nutritional status may be based on din- calculation of body cell mass. Creatinine is generated ical evaluation, diet history, anthropometric measure- largely by the nonenzymatic breakdown of creatine ments, and various biophysical and biochemical present in the phosphocreatine-creatine pool in skel- methods (Table 1). etal muscle, which is the largest pool of cellular tissue The more precise methods for calculating body com- in the body ( 13). In addition, 10 to 30% of creatmnine position (total water, potassium and nitrogen determi- generation may be derived from the ingestion of crea- nations, protein/DNA determination in muscle bi- tine and creatinine in meat ( 1 4). Potassium, alkali- opsy, dual x-ray photon absorptiometry [DEXA], soluble (cell) protein, and total creatine in the skeletal nuclear magnetic resonance, bioelectrical impedance, muscle of normal individuals are strongly correlated etc.) require equipment that is not available in most ( 15). The total creatinine output has been shown to centers, some of which is complicated and expensive. correlate well with the total body K in normal and Among the new noninvasive methods, DEXA (7) and continuous ambulatory peritoneal dialysis (CAPD) pa- multifrequency bioimpedance (which can distinguish tients, and it may be a more reliable index ofbody cell between total body water and extracellular water) (8) mass and nutritional status in dialysis patients than are now under evaluation for use in patients on main- the techniques that are based on total water determi- tenance dialysis (9-1 1 ). DEXA may be advantageous nations ( 16). However, the determination of the total creatine output in HD patients requires the collection TABLE 1. Methods to assess nutrition used in HD of an aliquot of the total spent dialysate during the patients dialysis session, which is not easily accomplished. Today, most centers must rely on dietary histories, Evaluation of Nutritional Intake evaluation of body weight indices, and other simple Dietary history and dietary records anthropometric parameters and serum protein deter- Urea appearance (estimation of protein intake) minations to investigate nutritional status and detect Simple Anthropometric Methods signs of protein-energy malnutrition. A simple and Body weight, body mass index, weight loss reliable method appears to be the Subjective Global Skinfold thickness (triceps and other sites) Assessment, a technique by which the nutritional Midarm muscle circumference status is rated by the clinician in a systematic way Muscle strength (handgrip) Body Composition based on medical history and physical examination DEXA ( 1 7). Although originally used to classify surgical pa- Nuclear magnetic resonance tients, this nutritional classification system has Computed tomography proved to be a reliable tool for assessing the nutri- Ultrasonography tional status of dialysis patients ( 1 8, 19). Bloelectrical impedance Total body H20 (isotope dilution), K (40K-count), N PREVALENCE OF MALNUTRITION IN HD PATIENTS (neutron activation
Recommended publications
  • Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines
    This PDF is available from The National Academies Press at http://www.nap.edu/catalog.php?record_id=9953 Gulf War and Health: Volume 1. Depleted Uranium, Pyridostigmine Bromide, Sarin, and Vaccines ISBN Carolyn E. Fulco, Catharyn T. Liverman, Harold C. Sox, Editors, 978-0-309-07178-9 Committee on Health Effects Associated with Exposures During the Gulf War, Division of Health Promotion and Disease Prevention 432 pages 6 x 9 PAPERBACK (2000) Visit the National Academies Press online and register for... Instant access to free PDF downloads of titles from the NATIONAL ACADEMY OF SCIENCES NATIONAL ACADEMY OF ENGINEERING INSTITUTE OF MEDICINE NATIONAL RESEARCH COUNCIL 10% off print titles Custom notification of new releases in your field of interest Special offers and discounts Distribution, posting, or copying of this PDF is strictly prohibited without written permission of the National Academies Press. Unless otherwise indicated, all materials in this PDF are copyrighted by the National Academy of Sciences. Request reprint permission for this book Copyright © National Academy of Sciences. All rights reserved. Gulf War and Health: Volume 1. Depleted Uranium, Pyridostigmine Bromide, Sarin, and Vaccines Gulf War and Health Volume 1. Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines Carolyn E. Fulco, Catharyn T. Liverman, Harold C. Sox, Editors Committee on Health Effects Associated with Exposures During the Gulf War Division of Health Promotion and Disease Prevention NATIONAL ACADEMY PRESS Washington, D.C. Copyright © National Academy of Sciences. All rights reserved. Gulf War and Health: Volume 1. Depleted Uranium, Pyridostigmine Bromide, Sarin, and Vaccines NATIONAL ACADEMY PRESS •• 2101 Constitution Avenue, N.W. •• Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Insti- tute of Medicine.
    [Show full text]
  • The History of Military Toxicology
    HISTORICAL ARTICLE THE HISTORY OF MILITARY TOXICOLOGY Jiří Bajgar, Josef Fusek Military Medical Academy, Hradec Králové; (Rector: doc. MUDr. S. Bùma, CSc.) However, the name of the Department as well as the term ãmilitary“ were excluded from the title. The Institute was designated as the Medical Research Institute for foreign journals only. On the other hand, in the Czech journals which were freely circulated abroad, the word ãmilitary“ was present as well as other specifications such as military rank. At this time, the Department was equipped with tech- niques on very sophisticated basis, e.g. fluorimeter Farrand, Auto Analyzer Technicon, ultracentrifuge MSE etc. The staff of the Department was also on high level able to cover the research of toxic substances from synthesis and analy- sis (Ing. F. Ornst, CSc.) later on through toxicity testing COL Assoc. Prof. J. Bajgar, (1944) COL Prof. J. Fusek (1945) (MUDr. M. Krejcar, CSc.; MUDr. V. Hrdina, CSc.), inclu- ding percutaneous route of administration (MUDr. V. Research on protection against CWA was very intense Vondráček, CSc.), biochemical characterization in vitro in the former Czechoslovakia. As early as pre-WW II, this and in vivo (MUDr. Tulach, CSc. and MUDr. A. Jakl, research was conducted at the Military Technical Institute CSc.), histochemical evoluation (MUDr. R. Urban, CSc.) in Prague. In the fifties, the medical and technical topics and development of antidotal treatment (Dr. J. Vachek). In were separated and the medical aspects were delegated to the year 1968, Prof. Fink was named the Head of the who- the Department of Toxicology (DTOX), Military Medical le institute (Purkyně Military Medical Research and Academy (MMA), Hradec Králové.
    [Show full text]
  • Conditional NF-L Transgene Expression in Mice Forin Vivo Analysis of Turnover and Transport Rate of Neurofilaments
    The Journal of Neuroscience, May 2, 2007 • 27(18):4947–4956 • 4947 Cellular/Molecular Conditional NF-L Transgene Expression in Mice for In Vivo Analysis of Turnover and Transport Rate of Neurofilaments Ste´phanie Millecamps,1,2 Genevie`ve Gowing,1 Olga Corti,3 Jacques Mallet,2 and Jean-Pierre Julien1 1Centre de Recherche du Centre Hospitalier de l’Universite´ Laval, Department of Anatomy and Physiology of Laval University, Quebec, Canada G1V 4G2, 2Centre National de la Recherche Scientifique Unite´ Mixte de Recherche 7091, Universite´ Pierre et Marie Curie-Paris 6, Hoˆpital de la Pitie´-Salpeˆtrie`re, 75013 Paris, France, and 3Institut National de la Sante´ et de la Recherche Me´dicale U679, Hoˆpital de la Pitie´-Salpeˆtrie`re, 75651 Paris, Cedex 13, France We generated mice with doxycycline control of a human neurofilament light (NF-L) transgene in the context of the absence (tTA;hNF-L; NF-L Ϫ/Ϫ) or presence (tTA;hNF-L;NF-L ϩ/Ϫ) of endogenous mouse NF-L proteins. Doxycycline treatment caused the rapid disappear- ance of human NF-L (hNF-L) mRNA in tTA;hNF-L mice, but the hNF-L proteins remained with a half-life of 3 weeks in the brain. In the sciatic nerve, the disappearance of hNF-L proteins after doxycycline treatment occurred in synchrony along the sciatic nerve, suggesting a proteolysis of NF proteins along the entire axon. The presence of permanent NF network in tTA;hNF-L;NF-L ϩ/Ϫ mice further stabilized and extended longevity of hNF-L proteins by several months. Surprisingly, after cessation of doxycycline treatment, there was no evidence of leading front of newly synthesized hNF-L proteins migrating into sciatic nerve axons devoid of NF structures.
    [Show full text]
  • Data Collection on Kinetic Parameters of Substances Pilot Phase – a Methodological Report
    Methodological report - December 2008 CCR.IHCP.C432921.XO Data collection on kinetic parameters of substances Pilot phase – A methodological report Cornelle Noorlander Marco Zeilmaker Jan van Eijkeren François Bourgeois Rob Beffers Esther Brandon Jos Bessems Contact: Jos Bessems Centre for Substances and Integrated Risk Assessment (SIR) [email protected] This investigation has been performed by order and for the account of European Commission, Direc- torate-General Joint Research Centre, Institute for Health and Consumer Protection, European Centre for the Validation of Alternative Testing Methods (ECVAM). © RIVM 2008 Parts of this publication may be reproduced, provided acknowledgement is given to the 'National Institute for Public Health and the Environ- ment', along with the title and year of publication. 2 Abstract Data collection on kinetic parameters of substances The European Centre for the Validation of Alternative Methods (ECVAM) commissioned the RIVM to develop a pilot database with kinetic parameters of compounds used as refer- ence substances in various in vitro toxicity testing (pre)validation programs. The toxicoki- netic properties of compounds can form valuable information in human risk assessment. In vivo as well as in vitro , biological targets are exposed to concentrations of the compounds or their metabolites. Concentrations and their time course, mostly determined in blood or plasma, provide the most direct link between the observed or predicted in vivo effects and the effects observed in vitro . Accurate quantitative knowledge of the in vivo concentra- tion-time relationship is therefore a prerequisite for the correct interpretation of in vitro toxicity testing results. Classical compartmental modelling parameters were chosen to de- scribe the in vivo kinetic properties as they fulfil the needs for prediction of in vivo con- centration time profiles under linear conditions.
    [Show full text]
  • Lu's Basic Toxicology: Fundamentals, Target Organs and Risk
    Lu’s Basic Toxicology Lu’s Basic Toxicology Fourth Edition Fundamentals, target organs and risk assessment Frank C. Lu Consultant in Toxicology Miami, Florida U.S.A. Sam Kacew Professor of Pharmacology University of Ottawa, Ontario Canada London and New York First published 2002 by Taylor & Francis 11 New Fetter Lane, London EC4P 4EE Simultaneously published in the USA and Canada by Taylor & Francis Inc, 29 West 35th Street, New York, NY 10001 Taylor & Francis is an imprint of the Taylor & Francis Group This edition published in the Taylor & Francis e-Library, 2003. © 2002 Frank C. Lu and Sam Kacew All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Every effort has been made to ensure that the advice and information in this book is true and accurate at the time of going to press. However, neither the publisher nor the authors can accept any legal responsibility or liability for any errors or omissions that may be made. In the case of drug administration, any medical procedure or the use of technical equipment mentioned within this book, you are strongly advised to consult the manufacturer’s guidelines. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record has been requested ISBN 0-203-36143-1 Master e-book ISBN ISBN 0-203-37399-5 (Adobe eReader Format) ISBN 0-415-24856-6 (PB) ISBN 0-415-24855-8 (HB) Contents About the authors xiii Preface xv PART I General principles of toxicology 1 1 General considerations 3 Definition and purpose of toxicology 3 Scope and subdisciplines 4 Early developments 5 Recent developments 5 Some challenges and successes 7 Toxicity vs.
    [Show full text]
  • Kdoqi2000nutritiongl.Pdf
    K/DOQITM Disclaimer These guidelines are based on the best information available at the time of publication. They are designed to provide information and assist in decision making. They are not intended to define a standard of care, and should not be construed as one. Neither should they be interpreted as prescribing an exclusive course of management. Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every healthcare professional making use of these guidelines is responsible for evaluating the appropriateness of applying them in the setting of any particular clinical situation. K/DOQI is a trademark of the National Kidney Foundation. The Official Journal of the National Kidney Foundation VOL 35, NO 6, SUPPL 2, JUNE 2000 American Journal of AJKD Kidney Diseases FOREWORD ROM ITS RUDIMENTARY beginnings in 1994. Following a series of nationwide town hall Fthe 1960s, renal replacement therapy has meetings held to obtain input into the recommen- become a lifesaving treatment that can provide dations made at the Consensus Conference, the end-stage renal disease (ESRD) patients with a NKF issued an ‘‘Evolving Plan for the Contin- good quality of life. As a result, the number of ued Improvement of the Quality of Dialysis ESRD patients who receive renal replacement Care’’ in November 1994. A central tenet of the therapy has risen, and their survival has in- plan was recognition of an essential need for creased, but considerable geographic variability rigorously developed clinical practice guidelines exists in practice patterns and patient outcomes.
    [Show full text]
  • Mathematical Models of Pattern Formation in Cell Biology
    MATHEMATICAL MODELS OF PATTERN FORMATION IN CELL BIOLOGY DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of the Ohio State University by Xige Yang, B.S, Mathematics Graduate Program in Mathematics The Ohio State University 2018 Dissertation Committee: Dr. Chuan Xue, Advisor Dr. Avner Friedman Dr. Janet Best ©Copyright by Xige Yang 2018 ABSTRACT This thesis provides a study of mathematical models about pattern formation phenomena in cell biology. Chapter2 introduces necessary background on mathematical methods of develop- ing and analyzing mathematical models at the cellular and molecular scales. I then considered two detailed cases related to pattern formation in cell biology, chemotaxis of bacterial popu- lations which generates wave-like patterns, and axonal cytoskeleton segregation which exhibits peak-valley patterns. In Chapter3, we derived a PDE model for E. coli chemotaxis that incorpo- rates detailed intracellular signaling. Unlike previous PDE models, the new model can approxi- mate the population dynamics accurately even if the external signal changes rapidly. In Chapter 4, we developed and analyzed a nonlocal PDE model for the polymer segregation phenomena. Reaction-diffusion equations have been widely used to describe biological pattern formation. In Chapter5, we developed numerical methods for computing multiple steady-state patterns of reaction-diffusion models. For that we combined homotopy tracking method in numerical alge- braic geometry and multigrid method, and as an example, we computed multiple patterns for the Gray-Scott model. ii VITA 1992 . Born, Chengdu, China 2014 . B.S. in Mathematics, Zhe- jiang University, China 2014-2018 . Graduate Associate, The Ohio State University, USA FIELDS OF STUDY Major Field: Mathematics Specialization: Mathematical Biology iii To my parents, You always support me to do whatever I like.
    [Show full text]
  • Quality Assurance Guidelines for Hemodialysis Devices," Is an Integral Part of the Center's Educational Program in Hemodialysis
    QUALITY ASSURANCE GUIDELINES for Hernodialysis Devices U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Food and Drug Administration Center for Devices and Radiological Health CDRH PUBLICATIONS - MEDICAL DEVICES Publications of the Center for Devices and Radiological Health (CDRH) are available as paper copies from either the U.S. Government Printing Office (GPO) or the National Technical Information Service (NTIS) as indicated by the GPO or PB prefix, respectively, on the ordering number. Publi- cations are also available in microfiche from NTIS at $8.00 per copy. To receive all CDRH reports in microfiche, at $1.40 each, you may establish a deposit account with NTIS and request automatic distribution of "FDAIHFZ" reports under the "Selected Research in Microfiche" program. Publica- tions without GPO or PB numbers are available only from the Center for Devices and Radiological Health. Addresses for ordering are: Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402; National Technical Information Service, Springfield, VA 22161 (outside North America, prices are double those listed); and Center for Devices and Radiological Health, Food and Drug Administration (HFZ-2651, 5600 Fishers Lane, Rockville, MD 20857. All prices are subject to change. FDA 86-4201 Problem Definition Study: Rubella Antibody Testing (PB 86-131935/AS, $9.95, 40 pp.). FDA 86-4202 To Cement or Not to Cement? or Has the FDA Approved the Use of This Device? (flyer). FDA 86-4204 An Interlaboratory Comparison of Analytical Methods for Ethylene Oxide (PB 86- 181856/AS, $9.95). FDA 86-4205 Accidental Breathing Systems Disconnections (January 1986lFinal Report) (PB 86- 185204/AS, $22.95).
    [Show full text]
  • University of California Sales and Use Tax Manual
    University of California Sales & Use Tax Manual July 2019 University of California Sales and Use Tax Manual Table of Contents Section 1: General Overview Section 2: Campus Activities – University As Seller Section 3: Medical Center As Seller Section 4: University As Purchaser Section 5: Medical Center As Purchaser Section 6: Campus Specific Issues Section 7: Compliance Section 8: Definitions Section 9: Exhibits Section 10: Addendum – UC Guidelines California Partial Sales and Use Tax Exemption Section 1: General Overview Section 1: General Overview I. INTRODUCTION ..................................................................................................................................... 2 II. WHAT IS SALES TAX ............................................................................................................................... 3 A. Imposition of Sales tax ...................................................................................................................... 3 B. California Retailer ............................................................................................................................. 3 C. Out-of-State Retailer Engaged in Business in California ................................................................... 3 D. UC Transaction/District Tax Responsibility For Sales Outside Its District ......................................... 4 III. SALES FOR RESALE ............................................................................................................................. 5 A.
    [Show full text]
  • NKF CM07 Abstracts and Summary Papers
    Abstract Author Index A Arora, Robin Bilbrew, Daphne Arruda, Jose Billecke, Scott Abbas, Elhadi E. Arvold, Lisa Bitzer, M. Abbott, Kevin Ashgar, A. Blair, Andrew Abboud, Hanna E. Asnani, Alpna Blakesley, Vicky Abdulle, Abdishakur M. Audhya, Paul Bleyer, Anthony Abramova, Liana Avram, Morrell M. Block, Geoffrey Acharya, Anjali Awad, Ahmed Block, Karen Adams, Nancy D. Awdishu, Linda Blokker, Cees Agarwal, Anil Azhar, Saba Bloom, Michelle Aggarwal, Nidhi Bob, F. Ahlin, Thomas B Bolin, Paul Ahmed, Basil Bookhart, Brahim K. Ahmed, Maliha Babbar, Nidhika Borkan, Steven C. Ahmed, Mohammed S. Baggett, Michael Borker, Rohit Ahmed, Ziauddin Bahuva, Rubin Botla, Venugopal Ahya, Shubhada Bakris, George Bowen, James Akai, Yasuhiro Balakrishnan, V S Bozdog, G. Alam, Muhammad G. Balamuthusamy, Bradbury, Brian Albright, Robert Saravanan Bradwell, Arthur Alexander, Marcus Balarezo, Fabiola Brahmbhatt, Yasmin AlHakeem, Moushen Banerjee, Satyaki Brandt, Michael Allen, Scott Banos, A. Braun, Mauro Allon, Michael Bansal, Vinod K. Breitbar, R. Alrabadi, Anmar Baptista, Jovanna Brenner, Louis Alumit, Genevieve Baramidze, George Breunig, F. Alzebdeh, Rami Barber, Beth Brewster, Ursula C. Amatya, Arun Barlev, Arie Brooks, John M. Amer, Hatem Bashir, Khalid Brophy, Gretchen Anatchkova, Milena D. Batarse, Rodolfo Brown, Mathew Anderson, Herman Batlle, Daniel Brown, Wendy Andrews, William Battistella, Marisa Browne, Teri Angeletti, RH Batwara, Ruchika Bugaj, Vladislav Angerosa, Margarita Belman, N. Burr, Lana Anis, Kisra Belozeroff, Vasily Burrows, Nilka Rios Anjum, Ehteshamul Benz, Robert L. Burton-Fikar, Tammy Ansari, Naheed Berhane, Zecharias Buss, M. Apivatanagul, Piyaporn Bernardo, Marializa Butcher, David Arduino, Matthew Besarab, Anatole Byham-Gray, Laura Arif, Farhan Beswick, Richard Arif, Iram Mahmood Beto, Judith A. C Arita, Kazuko Bhaduri, Sarbani Arnaout, M.
    [Show full text]
  • EBPG Guideline on Nutrition
    Nephrol Dial Transplant (2007) 22 [Suppl 2]: ii45–ii87 doi:10.1093/ndt/gfm020 EBPG Guideline on Nutrition Denis Fouque1, Marianne Vennegoor2, Piet Ter Wee3, Christoph Wanner4, Ali Basci5, Bernard Canaud6, Patrick Haage7, Klaus Konner8, Jeroen Kooman9, Alejandro Martin-Malo10, Lucianu Pedrini11, Francesco Pizzarelli12, James Tattersall13, Jan Tordoir14 and Raymond Vanholder15 1De´partement de Ne´phrologie, JE 2411- Universite´Claude Bernard Lyon1, Lyon, France, 2Department of Nephrology, Nutrition and Dietetics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK (retired), 3Department of Nephrology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands, 4Department of Medicine, Division of Nephrology, University Hospital, Wu¨rzburg, Germany, 5Department of Medicine, Division of Nephrology, Ege University Medical Faculty, Izmir, Turkey, 6Nephrology, Dialysis and Intensive Care Unit, Lapeyronie University Hospital, Montpellier, France, 7Department of Diagnostic and Interventional Radiology, Helios Klinikum Wuppertal, University Hospital Witten/Herdecke, Germany, 8Medical Faculty University of Cologne, Medicine Clinic I, Hospital Merheim, Germany (retired), 9Department of Internal Medicine, Division of Nephrology, University Hospital Maastricht, The Netherlands, 10Nephrology Department, Reina Sofia University Hospital, Cordoba, Spain, 11Division of Nephrology and Dialysis, Bolognini Hospital, Seriate, Italy, 12Nephrology Unit, SM Annunziata Hospital, Florence, Italy, 13Department of Renal Medicine, St. James’s University Hospital, Leeds, UK, 14Department of Surgery, University Hospital Maastricht, The Netherlands and 15Nephrology Section, Department of Internal Medicine, University Hospital, Ghent, Belgium Outline Guideline 1. Prevalence of malnutrition and outcome Guideline 1. Prevalence of malnutrition and outcome Guideline 2. Diagnosis and monitoring of malnutrition Nutritional status should be assessed at the start 2.1. Diagnosis of malnutrition of haemodialysis (Opinion). 2.2.
    [Show full text]
  • MVP Health Care® Policy and Procedure Guidelines
    2020 Payment Policies MVP Health Care® policy and procedure guidelines. Updated September 1, 2020 MVP Payment Policies Table of Contents Click on a policy name to view. After-Hours Modifier Policy for Physician Allergy Testing and Serum Preparation Claims Multiple Surgery – VT Facilities Only Anesthesia NDC Policy Article 28 Split Billing Nurse Practitioner (NP)/Physician Assistant (PA)/ Clinical Nurse Specialists (CNS) Billing in a Skilled Audiology Services Nursing Facility, Nursing Facility, Inpatient Setting Behavioral Health and Substance Use Disorder Observation Status for Facility and Provider Consistency of Denials Occupational Therapy (OT) Contrast Materials Physical Therapy (PT) Default Pricing Preoperative Lab Testing Diabetic Management and Nutritional Counseling Preventive Health Care Diagnosis Matching Edits Radiology Durable Medical Equipment Radiopharmaceuticals Elective Delivery for Providers and Facilities Services Not Separately Reimbursed Emergency Department - Physician Shared Split-Visit Guidelines Endoscopy Speech Therapy (ST) Evaluation and Management Surgical Supplies Eye Wear Coverage Telehealth Home Infusion Telemental Health Services Incident to Guidelines Transitional Care Management Infusion Policy Unlisted CPT Code Interpreter Services Urgent Care JW Modifier Vaccine Administration (Vermont Only) Laboratory Services Virtual Check-ins and Interpersonal Telephone/ Locum Tenens Internet/Electronic Health Record Consultation Mid-Level Payment Policy MVP Health Care Payment Policy AFTER-HOURS After-Hours Policy Reimbursement Guidelines Last Reviewed Date: 10/15/2018 Notification/Prior Authorization Requests References History Policy After-hour codes are used when a provider performs services in the office outside of normal business hours. MVP has determined normal business hours as 8:00 am – 6:00 pm. In accordance with Centers for Medicare and Medicaid Services (CMS) guidelines, MVP considers the following after-hours codes inclusive with the Evaluation and Management code that is billed.
    [Show full text]