Free dialysis in Nepal: Logistical challenges explored
Abstract Nepal's Ministry of Health began offering free lifetime hemodialysis (HD) in 2016. There has been a large growth in renal replacement therapy (RRT) services offered in Nepal since 2010, when the last known data on the subject was published. In 2016, 42 HD centers existed (223% increase since 2010) serving 1975 end stage renal disease patients (303% increase since 2010); 36 nephrologists were registered (200% increase since 2010), 12 were trained in transplantation, and 790 transplants had been performed to date. We estimate the incidence of end stage renal disease to be 2900 patients (100 per million population). With an annual cost of approximately US$2300 per dialysis patient, offering free dialysis could potentially cost the government US$6.7 million per year, suggesting that 2.1% of the annual health budget would be allocated to 0.01% of the population. The geographic zone surrounding the capital city, Kathmandu, contains 50% of HD centers, but only 14.5% of Nepal's population. Forty‐eight percent of the population lives within zones without HD service, therefore infrastructure challenges exist in providing equitable access to RRT. The aim of this article is to summarize the current statistics of RRT in Nepal.
AbstractThe immunoglobulin (Ig) D type is a rare variant of multiple myeloma (MM), that accounts for 1 –2% of all cases. Compared to the more common types of MM, IgD MM is known to have more severe symptoms at presentation, and a poorer prognosis. A woman was admitted to our hospital for severe acute kidney disease and disorder (AKD) and back pain, and was started on hemodialysis. The renal biopsy revealed light chain cast nephropathy. She was diagnosed with IgD-λ MM based on Bence-Jones protein expression and high IgD serum levels, and started bortezomib therapy with plasma exchange (PE). After three sessions...
TUESDAY, Jan. 14, 2020 -- For hemodialysis patients, use of an online portal is associated with an increased likelihood of receiving a kidney transplant at four or five years, according to a study published online Jan. 8 in the Journal of the...
The objectives of the conservative treatment for chronic kidney disease are to slow down the progression of kidney dysfunction, treat complications (anemia, bone diseases, cardiovascular diseases), vaccination for hepatitis B, and preparation for kidney replacement therapy.
ConclusionsAortic stiffness could be improved after KT. Meanwhile, age, BMI, systolic blood pressure, pulse pressure, length of KT and BUN were independent predictors of the increase of CF-PWV in KTRs.
Online patient portal use is associated with decreased time to renal transplantation in patients on hemodialysis. Increased number of logins per month is positively correlated with decreased time to renal transplantation.
Abstract In 2015, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA), a policy intended to transition Medicare away from pure fee-for-service care to value-based care. MACRA does this by evaluating the cost and quality of providers, resulting in financial bonuses and penalties in Medicare reimbursement. MACRA offers two tracks for participation, the Merit-based Incentive Payment System and the Advanced Alternative Payment Models. Although the payment rules are different for each of the tracks, common to both is an emphasis on holding providers accountable for high-quality, cost-efficient care...
ConclusionsResuming PD after severe peritonitis requiring PC removal is feasible but a high proportion of patients do not restart PD for non-medical reasons, usually older patients with higher Charlson index. A properly structured interview would be a useful tool that could improve return to technique in these patients.
ConclusionIn a real-life scenario, HCV seroconversion is observed in 15% of the patients initiated on hemodialysis. Isolation of both dialysis machine and personnel was associated with lower seroconversion.
ConclusionThe study showed a high HEV seropositivity among HD patients in Croatia, with significant variations between geographical regions. Continental area of residence and RBC transfusion were the most significant risk factors for HEV seropositivity. Due to the high seroprevalence, routine HEV screening among HD patients, especially in transplant candidates should be considered.
A novel endovascular device is a new alternative to surgery for the creation of an arteriovenous fistula for hemodialysis access in those with kidney disease, and has a high level of patient satisfaction.Medscape Medical News