DOCSLIB.ORG

Prevention and Treatment of Protein Energy Wasting in Chronic Kidney

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Prevention and Treatment of Protein Energy Wasting in Chronic Kidney review http://www.kidney-international.org & 2013 International Society of Nephrology Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism T. Alp Ikizler1, Noel J. Cano2, Harold Franch3, Denis Fouque4, Jonathan Himmelfarb5, Kamyar Kalantar-Zadeh6, Martin K. Kuhlmann7, Peter Stenvinkel8, Pieter TerWee9, Daniel Teta10, Angela Yee-Moon Wang11 and Christoph Wanner12 1Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; 2CHU Clermont-Ferrand, Service de Nutrition, CRNH Auvergne, Clermont-Ferrand, France; 3Division of Nephrology, Department of Medicine, Emory University, Atlanta, Georgia, USA; 4Department of Nephrology, Hospital E.HERRIOT, Lyon, France; 5Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, USA; 6Division of Nephrology, Department of Medicine, University of California Irvine, Orange, California, USA; 7Division of Nephrology, Department of Medicine, Vivantes Klinikum im Friedrichshain, Berlin Germany; 8Department of Renal Medicine, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden; 9Department of Nephrology, Vrije University Medical Center, Amsterdam, The Netherlands; 10Department of Medicine, Service of Nephrology, University Hospital (CHUV), Lausanne, Switzerland; 11Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, People’s Republic of China and 12Department of Medicine, Division of Nephrology, University of Wuerzburg, Wuerzburg, Germany Protein energy wasting (PEW) is common in patients with improvement in biomarkers of nutritional status is associated chronic kidney disease (CKD) and is associated with with improved survival, there are no large randomized adverse clinical outcomes, especially in individuals receiving clinical trials that have tested the effectiveness of nutritional maintenance dialysis therapy. A multitude of factors can interventions on mortality and morbidity. affect the nutritional and metabolic status of CKD patients Kidney International (2013) 84, 1096–1107; doi:10.1038/ki.2013.147; requiring a combination of therapeutic maneuvers to prevent published online 22 May 2013 or reverse protein and energy depletion. These include KEYWORDS: dialysis; malnutrition; metabolism; nutrition; supplementation optimizing dietary nutrient intake, appropriate treatment of metabolic disturbances such as metabolic acidosis, systemic Among the many risk factors that affect outcomes of chronic inflammation, and hormonal deficiencies, and prescribing kidney disease (CKD) patients, especially ones with end-stage optimized dialytic regimens. In patients where oral dietary renal disease (ESRD) and on maintenance dialysis, a state intake from regular meals cannot maintain adequate of metabolic and nutritional derangements, more aptly nutritional status, nutritional supplementation, administered called protein-energy wasting (PEW) of chronic kidney disease, orally, enterally, or parenterally, is shown to be effective in plays a major role.1–3 Multiple studies now indicate that PEW replenishing protein and energy stores. In clinical practice, is closely associated with major adverse clinical outcomes and the advantages of oral nutritional supplements include results in increased rates of hospitalization and death in these proven efficacy, safety, and compliance. Anabolic strategies patients.4,5 such as anabolic steroids, growth hormone, and exercise, in A significant number of factors affect nutritional and combination with nutritional supplementation or alone, have metabolic status in CKD, leading to multiple adverse been shown to improve protein stores and represent consequences (Figure 1).6 Accordingly, prevention and potential additional approaches for the treatment of PEW. treatment of PEW of CKD should involve an integrated Appetite stimulants, anti-inflammatory interventions, and approach to limit protein and energy depletion, in addition newer anabolic agents are emerging as novel therapies. to therapies that will avoid further losses and replenish While numerous epidemiological data suggest that an already wasted stores.7 This article aims to provide a broad approach for the management of PEW, with a specific Correspondence: T. Alp Ikizler, Vanderbilt University Medical Center, Division of Nephrology, 1161 21st Avenue South, S-3223 Medical Center emphasis on interventions targeted on etiological factors of North Nashville, Tennessee 37232-2372, USA. PEW in CKD patients. The overarching aim is to describe E-mail: [email protected] methods to counteract the catabolic processes leading to Received 14 February 2013; revised 28 February 2013; accepted 7 March PEW in CKD and provide means to treat the problem in 2013; published online 22 May 2013 patients already with PEW. In doing so, the rationale and 1096 Kidney International (2013) 84, 1096–1107 TA Ikizler et al.: Prevention and treatment of PEW in CKD patients review efficacy of nutritional interventions in CKD will also be Several strategies can be employed to prevent inadequate discussed. This review is focused on stage 3–5 CKD and nutrient intake in CKD patients (Table 1). In clinically stable ESRD patients on maintenance dialysis, with literature patients with stage 3–5 CKD who are not on dialysis, dietary selection and interpretation mostly based on the opinion of protein and energy intakes of 0.6–0.8g/kg of ideal body the authors and is not a systematic review of the literature. weight per day and 30–35kcal/ kg of ideal body weight per day, respectively, are able to preserve their protein stores 19–21 PREVENTION OF PEW IN CKD throughout the progression of kidney disease. However, Dietary nutrient intake in CKD patients these levels should be adjusted when hypermetabolic A frequent and important cause of PEW in CKD patients, conditions such as acute illness and hospitalizations occur. especially those on maintenance dialysis, is inadequate In ESRD patients on maintenance dialysis, there are dietary protein and energy intake.8–12 A major contributing additional protein catabolic stimuli such as the unavoidable factor to inadequate dietary intake in these patients is loss of amino acids and albumin into the dialysate and anorexia. Anorexia may develop as a result of retention of the inflammatory stimulus associated with the dialysis uremic toxins,13 dialysis procedure, intercurrent illness, procedure. Accordingly, the minimum protein and energy inflammation,4,14 acidemia, and/or cardiovascular disease. requirements for patients on maintenance hemo- and Inadequate nutrient intake may also occur secondary to comor- peritoneal dialysis are 1.2 g/kg of ideal body weight per day bid illness that affects gastrointestinal function, depression, and 30–35kcal/kg of ideal body weight per day based poor socioeconomic situation, or early satiety feeling with on physical activity level, respectively. Furthermore, it is peritoneal fluid infusion, and peritoneal glucose absorption important that at least 50% of the protein intake should be of in peritoneal dialysis (PD).15,16 Furthermore, additional nutrient high biological value. In elderly CKD patients who tend to loss during dialysis such as amino acids, some peptides, blood, lead a sedentary lifestyle, an energy intake of 30 kcal/kg body vitamins, trace elements, and glucose may further predispose weight per day is acceptable. In addition to conventional these patients to an increased risk of PEW.17,18 strategies to improve dietary nutrient intake, monitored, Causes of PEW Consequences of PEW Dietary nutrient intake Loss of kidney function Infection Uremic toxins (–) (+) (–) Comorbid conditions (–) (IR, diabetes, CVD Protein (+) depression) energy (–) (–) wasting Dialysis-associated (–) catabolism (–) (+) (–) Metabolic derangements Cardiovascular (HPT, metabolic acidosis, disease hypogonadism, GH resistance) Inflammation Frailty, depression Figure 1 | The conceptual model for etiology and consequences of protein energy wasting (PEW) in chronic kidney disease. CVD, cardiovascular disease; GH, growth hormone; HPT, hyperparathyroidism; IR, insulin resistance. Table 1 | Recommended minimum protein, energy, and mineral intakes for chronic kidney disease (CKD) and maintenance dialysis patients Nondialysis CKD Hemodialysis Peritoneal dialysis Protein 0.6–0.8 g/kg/day 41.2 g/kg/day 41.2 g/kg/day Illness 1.0 g/kg Peritonitis 41.5 g/kg Energy 30–35a kcal/kg/day 30–35a kcal/kg/day 30–35a kcal/kg/day including kcal from dialysate Sodium 80–100 mmol/day 80–100 mmol/day 80–100 mmol/day Potassium o1 mmol/kg if elevated o1 mmol/kg if elevated Not usually an issue Phosphorus 800–1000 mg and binders if elevated 800–1000 mg and binders if elevated 800–1000 mg and binders if elevated Greater than 50% of high biological value protein (that is, complete protein sources, containing the full spectrum of essential amino acids) is recommended. aBased on physical activity level. In sedentary elderly adults, recommended energy intake is 30 kcal/kg/day. All recommendations are based on ideal body weight. Regular follow-up supports compliance. Kidney International (2013) 84, 1096–1107 1097 review TA Ikizler et al.: Prevention and treatment of PEW in CKD patients in-center provision of high-protein meals or supplements beyond these targets has not been shown to improve the during hemodialysis is a feasible strategy and should be nutritional status any further. advocated
Load more

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]