You Caring for Twin Daughters

Please share this.  We need these sisters to move forward with their lives and their children.  Thank you & Blessings.  Share*Share*Share*

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Nephrology News & Issues (NN&I) Article on Advance Directives with ESRD patients

Many ESRD patients lack advance directives near the end of life

Among nursing home residents in the last year of life, patients with kidney failure were less likely to have advance directives that put limitations on treatments and designated surrogate decision makers compared with other nursing home residents with serious illnesses

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NN&I STAFF — JANUARY 6, 2017

 iStockphoto

A new study published in the Clinical Journal of the American Society of Nephrology indicates that many nursing home residents receiving dialysis do not have advance directives that sufficiently address end-of-life treatment decisions. Those with advance directives that put limitations on treatments and designated surrogate decision makers had fewer hospitalizations, intensive procedures, and inpatient deaths, and they were more likely to use hospice and discontinue dialysis prior to death. The study found that nearly all patients with an advance directive requesting treatment limitations received end-of-life care that was in line with their preferences.

Read also: Study shows US is dialyzing older, comorbid patients more often than other developed nations

Advance directives outlining individuals’ preferences related to end-of-life care are often promoted for patients with serious illnesses such as kidney failure as a means to avoid interventions that are unwanted or of limited benefit. Little is known about the relation between the content of advance directives and later treatment decisions among kidney failure patients, however.

To investigate, Manjula Kurella Tamura, MD, MPH from VA Palo Alto Health Care System and Stanford University and her colleagues examined the prevalence and content of advance directives among 30,716 nursing home residents with end-stage renal disease, and 30,825 nursing home residents with other serious illnesses during the year before death. The investigators also linked the content of advance directives to Medicare claims to determine which treatments ESRD patients received in the last month of life.

In the last year of life, 47% of patients with ESRD vs. 59%-70% of patients with other serious illnesses had any form of advance directive. In addition, 36% of nursing home residents with ESRD had a treatment-limiting directive, 22% had a surrogate decision maker, and 13% had both. These estimates were 13%-27%, 5%-11%, and 6%-13% lower, respectively, than for patients with other serious illnesses.

For patients with ESRD who had both a treatment limiting directive and surrogate decision maker, the frequencies of hospitalization, intensive care unit admission, intensive procedures, and inpatient death were lower by 13%, 17%, 13% and 14%, respectively, and hospice use and dialysis discontinuation were 5% and 7% higher compared with patients with ESRD who lacked both components.

Read also: New program will develop best practices for conservative, palliative care of kidney disease patients

“We found that advance directives indicating treatment limitations and/or documenting surrogate decision makers were associated with less intensive end-of-life care among nursing home residents with ESRD, but these were in place much less often than for nursing home residents with other serious illnesses,” said Dr. Tamura. “Because the vast majority of patients with a treatment limiting directive received care that was consistent with their advance directive, our findings suggest that efforts to increase engagement in advance care planning and expand the use of advance directives among patients receiving dialysis may offer untapped opportunities to

Read the full study.

Proposed Legislation Expands Option For Home Clinic Visits By Telehealth This blog post was made by Beth Witten, MSW, ACSW, LSCSW on January 5th, 2017.

Proposed Legislation Expands Option For Home Clinic Visits By Telehealth

This blog post was made by Beth Witten, MSW, ACSW, LSCSW on January 5th, 2017.

What Is This Bill?

On December 6, 2016, Senator Orrin Hatch (R-UT) introduced in the Senate S. 3504, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2016.1 Starting in 2018, the bill proposes to make it possible for home dialysis patients to use telehealth for some clinic visits—from the comfort of their homes or from a dialysis clinic—as long as they see a doctor face-to-face once every 3 months.

What Is Telehealth?

Medicare says that Telehealth is “services, like office visits and consultations that are provided using an interactive 2-way telecommunications system (with real-time audio and video) by a doctor or certain other health care provider who isn’t at your location.”2

Why Does This Matter?

Now, home patients must visit their clinics once a month, where they can be seen by the nurse, social worker, dietitian, and doctor. Many home dialysis patients have lives outside of dialysis…that’s one of the reasons why they chose to do dialysis at home vs. coming to a clinic! Because they have jobs, families, and other obligations, and some live far away from their home clinics, some patients don’t keep all their clinic appointments.

Medicare does not yet allow a patient’s home or a dialysis clinic to be an “originating site” for telehealth, and Medicare only covers telehealth from certain provider types, such as a doctor’s office, hospital, or skilled nursing facility. At this time, only those in rural areas or outside metropolitan areas can receive telehealth under Medicare.

What Can You Do?

This bill was introduced at the end of the 114th session of Congress. Bills that were not passed during a congressional session do not carry over. They can only be heard and passed if they are re-introduced. The 115th session of Congress starts on January 3, 2017 and ends 2 years later. Call or write your senator and representative about how much a bill like this would help you or your patients. Find out how to contact your senator or representative here. You can find tips for writing your federal legislator here.

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1. S. 3504, Section 102, pages 3-6. https://www.congress.gov/114/bills/s3504/BILLS-114s3504is.pdf. Accessed December 20, 2016.↩
2. Medicare Telehealth. https://www.medicare.gov/coverage/telehealth.html. Accessed December 20, 2016↩

Renal & Urology News Article

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A Life Worth Living by Amy G Staples

As we creep towards the end of 2016 and thoughts of this year ramble in my mind and after someone had commented on another group, someone on dialysis that "because a life on a machine is not really living". I hear it a lot from people who've never been on dialysis like nurses, techs or even dialzors themselves. But, I am hear to tell you that for me that statement is W R O N G. Dialysis is *not* for the weak. Every year of my life extended by dialysis absolutely has been "really living". For every day of treatment it strengthens my resolve. I've watched my younger children grow up and leave the nest. I found a job and worked nearly 7 years of those almost 15 years. I made new friends, learned new things, traveled around the country, watched both our sons graduate from basic training, volunteered in D.C. with the National Kidney Foundation, accepted as a BOD member and volunteered nearly 2 years for Home Dialyzors United. I've welcomed a daughter in law and 9 grandchildren into this family and world. I've watched and helped them develop, grow, learn and understand what the world is about. I've rocked grandchildren to sleep, read them stories, sung them songs, watched them in performances at school, gone to the Zoo together (several times) and helped them with homework. I've loved on many dogs, cats and farm animals. I've found joy in the newness of springs' hope, the brightest of snows, the summer lightning bugs and the colors of fall. I continue in my research. Through books, books and more books I've discovered true imagination and a plethara of worlds and heroines and learned to form my own voice. I've knitted (close to 50 scarves), sewn and crafted gifts, found freedom through movies and shows both old and new. Seen a tornado destroy, watched it lightly sprinkle and soak with torrential rains. I delight with each new unique snowflake and watch the trees dance as the wind flow through them. I've found enchantment in the flits of the hummingbirds and the songs of the wintering birds outside our windows and the squirrels who compete for food. I've grieved at the death of my mother, 2 brothers, 2 sisters and more friends than I care to count. I've worried about my ill sister, nieces, nephews and friends who also contend with their own battles. I've laughed until it hurts, cried to exhaustion. I've overcome 7 episodes of sepsis requiring weeks of hospitalizations, transfusions and sometimes learning how to walk again. I've survived dozens of procedures a dozen major surgeries (including having both kidneys removed) and over 27,000 hours doing dialysis. I've comforted children, grandchildren, friends, strangers and others through many hurdles. I'm aware of the sun rising and setting each and every day, finding joy each morning and contentment each night. I try to find the positive in every situation, every day, every struggle. I love and am loved. I don't need to be a CEO, own my own business, have a college degree or travel the world to know or be reminded that my life still has value. Still has meaning. Still has worth. Is every day grand? No. Is every day torture? No. Is it an easy life? Nope. Is it a simple life? Again no. Does my life still have value? Absolutely. Am I worthy to continue living, loving and receiving love? You betcha! Is that not living in any sense of the word? It is to me. What more could I ask of life beyond coping with the hurdles, loving and being loved and finding wonder in all that surrounds me? I have shelter, heat, cooling, food, clothing, healthcare, clean water, love of family and friends, the purr of my cats and the wag of many tails. To me, it IS living and I am blessed beyond measure. Blessings from Amy G Staples

Awareness products

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The BEST Medical ID's, Sports ID's and MORE

These are THE best Medical ID's and Sports ID's I have yet to find.  The medical profile is free "forever" and can be updated as often as you want for free.  For instance you can get the "pod" for the Hive bracelet (or necklace or keychain) and customize it to fit your own needs such as "Dialysis Patient" or "Diabetes T2" or "Limb Alert L Arm".  Or with the Sleek or Luxe you can also order a custom slider to your specific needs.  They can be scanned by EMS or physicians, Emergency Rooms etc. and access your complete medical profile online.

ENDEVR - Innovative Sports and Medical ID.

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Please check these out and share with family and friends and get the protection you need in an emergency.

Blessings
Amy Staples

Nephrology News & Issues "MRI scans of dialyzing patients"

MRI scans of dialyzing patients shows stress treatment puts on heart

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REBECCA ZUMOFF — DECEMBER 2, 2016

 Getty Images/iStockphoto/ThinkStock

Researchers at the University of Nottingham have carried out MRI scans on patients while they dialyze to study their heart function during treatments, and found left ventricular dysfunction and a decrease in blood flow to the small capillaries in the heart muscle in all patients.

The study aimed to investigate stress on the heart during kidney dialysis and to compare two different types of dialysis: standard hemodialysis (HD) and hemodiafiltration (HDF).

Experts from the University’s Sir Peter Mansfield Imaging Centre (SPMIC) and the Centre for Kidney Research and Innovation (CKRI) carried out MRI scans on 12 kidney dialysis patients who were each allocated to receive both standard HD and HDF in a random order.

The study found significant cardiovascular effects with both standard HD and HDF, but no differences between the two. Results demonstrate that cardiac MRI can be a vital tool for evaluating future improvements to dialysis treatment.

“This is the first time that MRI has been used to look at heart function while the kidney patient is actually undergoing dialysis,” said Professor of Physics, Sue Francis. “There were several hurdles to overcome to achieve this. We had to set up a dialysis machine in our MRI research center, change the metal needles that go into the patient to non-magnetic silicone ones, extend and insulate the lines that connect the patient to the dialysis machine and position the equipment using our knowledge of the magnetic fields in the MRI unit.”

Researchers measured the volume of blood pumped per minute by the left ventricle of the heart, how well the heart muscle was able to contract, blood flow in the coronary artery, and myocardial perfusion to check the efficiency of blood flow to the capillaries.

“Interestingly, we found all measures of systolic contractile function fell during both standard haemodialysis and haemodiafiltration with partial recovery after dialysis, said Professor of Medicine (Nephrology), Maarten Taal. “All patients showed some degree of left ventricular dysfunction and blood flow to the small capillaries in the heart muscle decreased significantly during both types of treatment. Our observations confirm the need for interventions to reduce the negative impact of dialysis on the heart.”

Having successfully tested this method, the research team is now aiming to test the effects of other dialysis treatments using MRI.