Sunday, February 21, 2021

Draft: Book Review: How To Survive Outpatient Hemodialysis

BOOK REVIEW: HOW TO SURVIVE OUTPATIENT HEMODIALYSIS: A GUIDE FOR PATIENTS WITH KIDNEY FAILURE

BY: STEVE BELCHER

REVIEWED BY: JAMES MYERS 

PUBLISHED BY: WATERS PUBLISHING FROM BLUE ARTISTS, LLC 

ISBN13#: 9798584036089 

 "I wrote this guide to help eliminate or lesson any fears experienced by patients starting outpatient dialysis treatment for the first time, and to give you the information needed to remain healthy on hemodialysis...to provide you with information and knowledge on ways to manage what's going on with your dialysis treatment...what to expect from the outpatient dialysis center as a new patient." (p. 9-10) Steve Belcher


 Link to interview with Steve about the book: https://www.facebook.com/UrbanHealthOutreachmedia/videos/422529782387580/

 Introduction 

 This Book is a one of a kind, special book. If you have ever had the experience of being a first time in-center dialysis patient, then you know that anxiety that accompanies you once you cross into the door of a dialysis lab. The confusion, the paperwork, the life and death questions by the lab director, the strange pre-dialysis procedures, the uncomfortable feeling of seeing all of the other dialysis patients and now the fear of COVID-19. Not to mention that incredible anxiety of being connected to the machine and watching your own blood float in and out of the dialysis machine during a cleansing. All too often it is a lonely feeling accompanied by the dread of how am I ever going to survive this? The reason this book is so great is addresses all of those concerns that many times an overwhelmed staff does not have time to discuss with you. This short, concise, easy-to-read book is the perfect companion for anyone, patient, caretaker, family member or friend who has questions about hemo or parenteral dialysis. This book is a must read for the newbie to dialysis. Chronic Kidney Failure 
 The first thing this book discusses is about how we ended up on dialysis in the first place; as a result of kidney failure. Patient choice plays a primary role in this book. Pre-emptive transplant, hemodialysis or parenteral dialysis are all topics that were extensively discussed in the interview. If you are a patient who has questions about your options, the book very clearly lays those choices out for you. 
Introduction to Hemodialysis 

 There is a complete discussion of what hemodialysis is and how it works in the book. How you do it and how long it takes & how often you do it are all discussed here. What the dialysis machine does, the path the cleansing takes and it's purpose are made clear for us. Just as important is the disclosure of who is on your renal team and what you can expect each member of that team to do. 
Medical complications that occur during hemodialysis are openly and clearly discussed. Things like problems and solutions for issues with your vascular access, muscle cramps, hypotension, fevers, chills, skin are hair problems are written about in clear terms. 

 The concept of adequate dialysis is made very clear and how do we know when we are getting enough dialysis is the key topic here. Scientific measurements like URR and kt/v (kt over v) are very important concepts, known only to most staff members as opposed to most patients.

 Preventing infections plays a central role in the care of dialysis patients and the steps taken to avoid infections are carefully outlined.

 The First Day of Dialysis 

 My favorite chapter in the book is what precisely will happen to the patient on the first day of dialysis. This is a very well written, detailed step-by-step guide of what you can expect on your very first day of renal replacement therapy. From the type of clothing you should wear to the exact first to last step procedure is described in this book. 


 Taking your weight, washing your vascular access, taking you to your chair, taking your vitals, all the things you can expect to happen with the treatment itself is described here. 

 Of particular importance is the difference between the procedures taken between a session with a fistula, graft or heart catheter are. Steve does a brilliant job of making those differences crystal clear.

 The book also tells us the type of issues we should let our dialysis nurse know about before, during and after treatment. 

 There is a vivid description of what happens when your treatment ends. Most importantly here there is a candid discussion of what you must do if there is bleeding after your treatment, even if you have left the dialysis lab. This could save your life! 

 The Rights and Responsibilities of the Dialysis Patient 

 Did you know that as a dialysis patient, you have certain rights in your dialysis lab that protects you from mistreatment and environmental hazards? Privacy of your medical records and information? Meeting your entire renal team to help plan you treatment? Meet with your dietitian, and social worker? Choose your treatment options? Expenses you pay & Medicare pays? Available financial help? Your right to refuse or accept treatment? Center's individual rules? Can I be part of research studies? 
One of the issues Steve emphasized in the past is dialyzer reuse, and your right to know if the lab engages in that practice.

 The book makes very clear you have responsibilities, too like treating other patients and staff respectfully, paying bills on time, making clear I am refusing treatment, that I don't understand my medical condition or treatment plan or have issues with transportation? 

 Patient Grievance Procedures

 If you want to find a topic that most authors run from, filing a grievance against your dialysis lab. Not Mr. Belcher. There is an entire chapter dedicated to educating the kidney patient about their rights in filing a grievance with their ESRD Networks. 

The book details how this is done, timeframes that may apply, and how your regional network. This chapter is great reading. 

 Treatment Options for Kidney Failure 

 The book does an excellent job of discussing the ins and outs of both hemodialysis and peritoneal dialysis, disclosing the advantages and disadvantages of each. This also includes a breakdown of the types of PD. 

 Particularly important is Steve’s discussion concerning whether or not dialysis is a cure for kidney disease. Straightforward disclosure tells us it is not, but it is a life sustaining form of renal replacement therapy. 

 The book also makes very clear you can refuse or withdraw from dialysis treatments at anytime. The continuing theme of patients' choice is evident throughout the book! 

 Kidney Transplants

 This book even discusses Kidney Transplant as a treatment option for patients. From the initial intake to transplant evaluation, to being placed on the waiting list, to taking steps to prepare for transplant, to transplant surgery, the hospital stay and follow-up care, all the major aspects of kidney transplants are discussed here. Even post-transplant care and possible transplant complications are fully discussed. 

 The book does a great job of spelling out the pros and cons of getting a kidney transplant. This is a great chapter to help you decide if kidney transplantation is right for you. 

 Care of Your Access 

 When you are on kidney dialysis, your access is your lifeline. It is the way you connect your body to the dialysis machine, so your blood can be cleared of impurities, much like your natural kidneys were intended to do. Without your access, you are nor getting a cleaning, and without a good cleaning you could become very sick or even die.
 The book goes into great detail, taking about each type of access, the advantages and disadvantages of each, problems to avoid like infection, blockage & injury. There is a terrific section on the Do's and Don'ts of access care in this book, that is must reading for the dialysis patient or caretaker. 

Making Wise Food Choices on Dialysis

 This is one of the most informative chapters in the whole book: What are the smartest food choices you can make as a dialysis patient. Dialysis diet is discussed in simple, detailed terms with concrete examples. Common kidney dialysis diet issues like protein, potassium, phosphorus, & triglycerides are all discussed here.

 Also issues that are particularly unique to dialysis are in the book, clearly written by an experienced insider, like fluid intake, fluid control, and great tips for helping the patient achieve better fluid control. This is a constant struggle for most dialysis patients, but Steve makes it very simple with wonderful examples to follow. 

 Unique Information and Advice for the Dialysis Patient 

 The book and it's author was not satisfied to give cursory advice. Steve wanted you to have all the information needed at your fingertips. The book includes a discussion about special dialysis medicines you may be asked to take like phosphate binders, vitamins and supplements, laxatives, antibiotics, blood pressure medications to avoid the results of high blood pressure.

 There is also a section on unique dialysis issues like anemia, iron deficiency and vitamin B group deficiency. 

 One section in this book that is frequently overlooked is the affect dialysis may have on sex and intimacy. Possible causes and solutions are discussed here.

 Facts about the flu vaccine and who should take it are likewise disclosed in some detail here. Vaccine safety is the highlight of this section of the book.

 The connection and importance of dental work are also disclosed as well as issues with renal bone disease. 

 There is a lot of detail on the things we can do to keep our bones healthy. There is an entire chapter in the book dedicated to things we can do to stay healthy. 

 Coronavirus and Kidney Disease 

 The final chapter in this book is about the Coronavirus and the impact it has had on Kidney Patients, and specifically on dialysis patients. This is must-read material! The chapter discusses in some detail the ways in which you can protect yourself at your dialysis facilities and at home. This includes preparation for those on dialysis, going out in public, prevention and treatment and much more.

 Conclusion

 This is a magnificent primer for any person affected by kidney dialysis, especially patients, caretakers, family and friends of a dialysis patient. Written by Steve Belcher, he is clearly someone who has 'been there.' It is obvious the know-how and experience that went into this book. It's greatest strength is that it is written in simple, direct understandable terms, making it very easy to read. 

 The book is brutally honest and pulls no punches, but maintaining it's optimistic stance. The feeling you get when you read the book is that you can overcome any dialysis-related obstacle and ask the right questions of the people who are helping you.



 I have never seen or dealt with any instructional dialysis book for kidney patients quite like this book. For it's simplicity, it's breath and scope are unmatched. From his dedication to teaching us through his Urban Kidney Alliance and the Urban Health Outreach Media Network, Steve has shown us that he is tireless in his dedication to raising awareness of kidney disease and educating kidney patients in all aspects of the disease. This book is more evidence of that. I heartily recommend this book. It is a special book written by a special Kidney Advocate.  

Monday, February 15, 2021

Book Review: THE COOKING DOC'S KIDNEY-HEALTHY COOKING, A Modern 10-Step Guide to Preventing & Managing Kidney Disease

 Book Review and Summary of Dr Blake Shusterman's Appearance on Kidney Stories 2: THE COOKING DOC'S KIDNEY-HEALTHY COOKING, A Modern 10-Step Guide to Preventing & Managing Kidney Disease




Written by: Dr Blake Shusterman
Reviewed by: Jim Myers

Published by: Cooking Doc, LLC, The (October 12, 2020)

Website: https://www.thecookingdoc.co

Book Design: Danielle Foster
Photography: Andrew Meade
Food and People Styling: Clair Perez
ISBN: 978-1-7356793-0-3 (paperback)
ISBN: 978-1-7356793-1-0 (e-book)
ISBN: 978-1-7356793-2-7 (Adobe PDF version)

Disclaimer: This book is for reference only and it is not a medical manuel. Always consult your physician before making changes to your diet.

To purchase: https://www.amazon.com/dp/1735679305/ref=cm_sw_r_em_api_i_K2yHFb8281DJ0 (Amazon )

https://payhip.com/b/Lq6u. (Digital Copy)

Introduction
On Friday, February 5th, 2021, I had the pleasure of interviewing Blake Shusterman, M.D. concerning his new book and his philosophy on Kidney Healthy Cooking for Kidney Patients. https://www.facebook.com/UrbanHealthOutreachmedia/videos/2489057124736073/.

I read the following introduction:

"Dr. Blake Shusterman is President and Physician Partner at Carolina Nephrology, a twenty-two provider practice in Greenville, SC. He is also the creator and host of The Cooking Doc (www.thecookingdoc.co), and author of the book The Cooking Doc’s Kidney-Healthy Cooking: A Modern 10-Step Guide to Preventing and Managing Kidney Disease.
A board certified nephrologist, Dr. Shusterman serves as the medical director at multiple dialysis units. He is a Clinical Assistant Professor at the USC School of Medicine in Greenville and oversees the medical student nephrology rotations.
In the past he has served on the Medical Advisory Board for US Renal Care and currently he is a board member of the Carolina Kidney Alliance. He is passionate about home dialysis, patient education and the importance of diet in the management of chronic kidney disease. His interest in diet and kidney disease led him to his role as an ambassador for the American Kidney Fund’s Kidney Kitchen.
Dr. Shusterman earned his medical degree from The Ohio State University and went on to complete his internal medicine residency and nephrology fellowship at the University of Virginia where he served as chief fellow. He holds a BA in Anthropology from Tufts University.

"I love food. I love eating it, making it, sharing it and eating it again as leftovers. In my family, many of our daily decisions revolve around food. We plan day trips, vacations and nightly excursions around what foods we wish to experience. We spend lots of time—sometimes too much time according to my wife–identifying which restaurants we want to go to and what things we need to buy at the grocery store to prepare our meals. To my family food is not only sacred but also downright fun. To me it is a beautiful blend of art and science.

During my years of practice, I have come to realize that many of my patients and their families live equally food-focused lives. So, I understand the furious looks I get from my patients when I tell them to give up their favorite foods.

Many of you may be in that same position, hearing similar pleas from your doctor advising you to stop eating your favorite foods because they are damaging to your kidneys, making your diabetes more difficult to control or preventing you from losing weight.

Thus was born The Cooking Doc. Can you imagine having your doctor right next to you in the kitchen, telling you what delicious foods you need to try? Well, that’s me. I won’t tell you what tasty foods you need to give up, instead I’ll help you find creative ways to use new ingredients and together we’ll make them taste amazing. (Check out this summer squash soup with white wine and leeks)

We will have special guests, outings to your favorite restaurants and entertaining cooking videos featuring fresh and healthy ingredients, all cooked up by a doctor.

During our training as doctors,we don’t receive a lot of education on nutrition and diet, and so this often translates into specialists that can give generic advice like, “eat a healthier diet,” “eat less food” or “eat a low sodium diet” but can’t tell patients exactly how to make this happen. I am hopeful that I can inspire a new generations of doctors that know how to provide recipes, cooking lessons and practical advice to their patients.

Join me and let’s #ChangeYourBuds!"

He tells a story in his book that explains why he became the Cooking Doc. On his first day at his new job at a rural dialysis clinic. He arrived early to your the facility before his patients arrived. The last stop on the tour was the lobby, where there were two large vending machines containing salty snacks and sugary drinks, "the same foods that likely contributed to many patients' kidney failure were presented as food options in the lobby of the health-care facility providing them with lifesaving treatment! "

He told us about story about his patient, "Clara," a stage 3A chronic kidney disease patient, who asked him about staying healthy with a good kidney diet. He told her what he had been taught, that her kidneys were in good shape and she needed worry about diet. She fired him on the spot. He wrote the book and because the Cooking Doc, in large part, because of these two events. He now wants Kidney Patients in all stages of the disease, including post-transplant to take control of the situation and protect their kidneys with a unique diet suitable to their kidney situation.

10 Steps: The Fundementals of the Cooking Doc's Kidney Diet

To help us achieve proper kidney diet goals, the Doc has outlined 10 basic steps:

1. Understand Your Kidneys
2. Choose Your Beverages Wisely
3. Uncover Hidden Salt and #Change Your Buds to Prefer Less Salt
4. Embrace Plant-based Eating
5. Get Potassium Right
6. Avoid High-Protein Pitfalls
7. Discover Alkaline-Rich Foods
8. Identify and Eliminate Sneaky Phosphorus
9. Integrate the DASH, Mediterranean and Diabetic Diets Into Your Routine
10. If You Are Starting Dialysis, Forget Everything You Learned and Start From Scratch

Understand Your Kidneys

This chapter is the essential foundation to understanding your Kidney Diet needs. The Kidney Doc points out here that in order to help a doctor or dietitian advise you, you first have to be familiar with your kidney numbers like:
• Your eGFR
• Stage of CKD
• Potassium level
• Protein in Urine
• Blood Pressure
• Phosphorus level
• Fluid limitations/ Fluid consumption
• Diabetes
During our interview, we specifically discussed why Polycystic Kidney Disease is different than other forms of kidney disease for diet concerns. Drinking extra water may slow the growth of cysts. Please consult with your physician before drinking a few extra glasses of water every day.

Choose Your Beverages Wisely

What we learn in this chapter is that it is the choices you make for your beverages, not just the amounts that you drink. Many of us when we chose beverages that are not water, choose sugary drinks that are not healthy for our kidneys. Doc told us that flavored water is much better for us and in the book, he lists flavored beverages you can make at home or water with fizz we can use as a substitute. Many types of beverages are discussed in this chapter and there is even a weekly-monthly-annual chart to help week yourself off of canned soda.

There is a very interesting seaction on coffee. When I was first diagnosed with PKD at the age of 25, I was told to drop all caffeine products, because caffeine raises your blood pressure which in turn enlarges your cysts. Interestingly, the Cooking Doc says, "keep the coffee." Many studies have shown coffee is safe for your kidneys and may provide some protections, including decreasing the risk of kidney disease while slowing it's progression. Coffee is safe even if you have chronic kidney disease.

There are some restrictions however:

• Only 3 6-ounce cups of coffee each day
• Make it black, no sugars, sweeteners or creams
• If you have high blood pressure or an irregular heartbeat, the caffeine may make these conditions hard to control
• Maintain your fluid restrictions while on dialysis.
Other areas of discussion here include smoothies and avoiding kidney cleanses. There is even a recommended beverage schedule for patients with stages 1-3 CKD.

Uncover Hidden Salt and #Change Your Buds

Many kidney patients do not realize how much salt they consume every day because salt is hidden in processed foods, fast foods, and restaurant food. What we learn in this chapter is how to avoid those hidden sources, what is helpful sodium vs harmful sodium and how to find the correct balance to best protect your kidneys. Doc recommends many flavorful substitute for salt that we can use in our home cooking.

Embrace Plant-Based Eating

This chapter emphasizes that a diet that highlights fruits and vegetables is good for the body while protecting your kidneys.

Cooking vegetables can be tricky. During the broadcast, The Cooking Doc suggested roasting vegetables. Almost any vegetable can be roasted, & this helps to maintain their nutrients over and above boiling them. Additionally, roasting deepens their flavor, making them
delicious. It also makes them last and become very versatile. If you roast vegetables over the weekend, you can then use them all week in pastas, salads and side dishes.

Getting Potassium Right

Did you know there is helpful potassium vs harmful potassium? For example if you have high blood pressure or are a high stroke risk, a high-potassium diet may help you lower your blood pressure and add to the alkaline in your diet. It may reduce your risk of kidney stones and reduce water in the body.

Harmful potassium may cause the kidneys to have problems filtering blood, particularly if you are between stage 4 & 5 CKD and your filtration rate drops below 30%. This could affect your heart.

Doc told us in the broadcast, that because of the personal nature of potassium, the one size fits all "everyone with kidney disease needs to limit their potassium, " may be inappropriate for your actual needs. Dr. Schusterman strongly recommend you consult with a dietitian and/or your physician to help you with this potassium diet issue.

Avoid High-Protein Pitfalls

Doc's advice here was simple: avoid high- protein diets and substitute plant-based protein for animal proteins whenever you can. According to Dr Blake, you can only learn what the idea protein intake for your kidneys and your body only from a dietitian. One of the big themes for the Cooking Doc is that having a relationship with a dietitian is vital for your individual kidney diet needs.

Discover Alkaline-Rich Foods

Foods that are high in alkaline and lower in animal protein or processed foods are feature in the Cooking Doc's Kidney Diet Requirements. Diets with higher amounts of fruits and vegetables fit the bill here. They are just better for your kidneys. Alkaline foods benefit kidney health by keeping the body running smoothly and in balance which in turn helps your kidneys maintain their balance.

Identify & Eliminate Sneaky Phosphorus

Dr Shusterman tells us that there are some hidden sources of phosphorus are additives contained in sodas, processed and fast foods. Particularly in Stages 4-5 CKD, you have to be very aware of these additives and hidden sources. The Cooking Doc does not reccomend to avoid all high-phosphorus foods, but to use a priority scale to determine what phosphorus foods to avoid & to consult with a dietitian or physician for what adjustments if any are needed in your case.

Integrate the Dash, Mediterranean & Diabetic Diets Into Your Routine

You do not need to settle on any one of these unique diets. That could adversely affect your other medical conditions, particularly if you suffer from diabetes, kidney disease, heart failure, coronary artery disease or high blood pressure. The Doc recommends we use the best parts of each diet for us to reach our correct individual balance. He reccomend that we focus on the similarities the diets share.

Keep An Open Mind If You Start Dialysis

This may be the most surprising chapter in the book. Doc advises, "Remember everything you were told about healthy eating when you had early-stage kidney disease? Now you can forget most of it."

Here are the keys:
• The moderate/low protein diet you've been following will now focus on eating as much protein as you can;
• You may now have to avoid a lot of fruits and vegetables;
• You are no longer permitted to drink all the water or fluid you want;
• You doctor or dietitian may tell you to avoid whole grain.
Your best bet is to follow your doctor's or dietitian's advice!

Conclusion

This is the best kidney diet book I have ever read! It is written in big print, understable language with lots of practice pointers, charts and photographs that really help. It is a very up-to-date scientific approach to kidney cooking. With The Cooking Doc's Website you get new recipes, blogs and cooking demonstrations that actually show you how to prepare food. The combination of the two make Dr Shusterman's 10 Step approach unbeatable. I highly recommend this book!












Friday, February 12, 2021

1st Draft: CJASN ARTICLE on Home Dialysis

  A REVIEW: THE DEVELOPMENT AND CONTENT VALIDITY OF A PATIENT REPORTED EXPERIENCE MEASURE FOR HOME DIALYSIS BY JIM MYERS BOD AT LARGE FOR THE AMERICAN ASSOCIATION OF KIDNEY PATIENTS

 Introduction 

I have been asked to review Dr. Matthew Rivera, et al recent paper on Development and Content Validity of a Patient Reported Experience Measure for Home Dialysis, https://www.asn-online.org/education/kidneyweek/2020/program-abstract.aspx?controlId=3437240 (October 2020) 

Background and Objectives 

The number of kidney patients utilizing home dialysis has been growing rapidly and it appears that it will continue to grow in the immediate future. Although there are scientific numbers to quantify the quality of care and actual patient experience with in center hemodialysis, there are no corresponding scientific numbers to quantify the quality of home dialysis modalities from home dialysis patients. How kidney patients feel about their experiences with home dialysis has not been reduced to a quantifiable, uniform, verifiable set of scientific terms. The purpose of this paper was to suggest some repeatable, objective terms to help define how home dialysis patients feel about their home dialysis experiences. The authors used what they referred to as a "mixed method multiple stakeholder approach." 


Design, Setting, Participants, and Measurements 

They did a precise literature search, conducted special topic oriented focus group interviews, and interviewed 65 participants, including 21 home dialysis patients, 33 home dialysis nurses, 3 patient care partners, and 8 nephrologists. This helped them come up with a list of possible measurement items. They ran the measurement list candidates past a nationwide group including, 91 home dialysis patients and 39 providers using a web-based platform. The group was requested to prioritize the items on the list in the order of importance. From these interviews, they create the Home Dialysis Care Experience (Home-DCE) standards. Then they conducted cognitive debriefing interviews to evaluate item interpretability, order, and structure. The measures were reevaluated and refined based on interview findings. 

Results 

As a result of the interviews and studies, they were able to create 15 domains of home dialysis care experience in 6 areas: • Communication and education of patients; • Concern and helpfulness of the care team; • Proficiency of the care team; • Patient-centered care; • Care coordination; and • Amenities and environment. Focus groups results showed that what patients thought was the most important were: • Patient education and communication, • Care coordination, and personalization of care. The Prioritization exercise results confirmed focus group findings. Also, concluding debriefing with patients indicated that the final measures was easily understood and supported content validity.

 Conclusions

 The group accomplished it's goal in discovering an objective, scientific method to quantify the patients' home dialysis experience. The Home-DCE toolbox is a 26-item patient-reported experience measure for use in peritoneal dialysis and home hemodialysis. The Home-DCE instrument represents the first of it's kind for the assessment of patient-reported experience of care in home dialysis. Get Outlook for Android

Friday, February 5, 2021

Why Medical Nutrition Therapy is Important to Kidney Patients (Hope Version)

 



WHY MEDICAL NUTRITION THERAPY IS IMPORTANT TO KIDNEY PATIENTS

https://kibowhope.com/why-medical-nutrition-therapy-is-important-to-kidney-patients/


 


By The Hope

February 5, 2021



These statements have not been evaluated by the US Food and Drug Administration. This information is not intended to diagnose, treat, cure, or to prevent any disease. Always consult with a qualified healthcare professional prior to beginning any diet or exercise program or taking any dietary supplement. The content on our website is for informational and educational purposes only.


Written By: James Myers


On December 4, 2020, I did a live broadcast on the Urban Health Outreach Media Network (Steve Belcher’s Network) with Dr. Melissa Prest, Foundation Dietitian for the National Kidney Foundation of Illinois and Marsha Schofield, the Senior Director of Governance and Nutrition Services Coverage for the Academy of Nutrition and Dietetics. https://www.facebook.com/UrbanHealthOutreachmedia/videos/400367248068313/


I did this at the request of Dr. Holly Kramer, Past President of the National Kidney Foundation. I wanted to share with you some of the things that I learned about Medical Nutrition Therapy.


What is Medical Nutrition Therapy?


Medical Nutrition Therapy, often abbreviated as MNT, is an evidence-based medical approach to treating certain chronic conditions through the use of an individually-tailored nutrition plan based on a comprehensive nutrition assessment conducted by a Registered Dietitian. A physician may refer an individual to a Registered Dietitian for this service.


What is the Goal of MNT?


The goal of Medical Nutrition Therapy is to prevent, delay or manage diseases or conditions like Chronic Kidney Disease.


Who Needs Medical Nutrition Therapy?


Diet is an important part of everything we do. Food gives our bodies and our minds the fuel to think clearly and execute daily tasks. Registered Dietitians believe that everyone should see a dietitian every year, in the same way that you see the dentist or general practitioner every year. Diet affects every facet of our lives, from how we look, to how we feel, to how we sleep, to how we move, and even to how we think. With diet affecting our lives in so many ways, it’s important to have regular check-ups and interventions with a dietitian to assure that your diet is in good condition in the same way that you have check-ups and interventions with a doctor to make sure your body is in good condition.


Medical Nutrition Therapy is Important for People who have Kidney Disease


MNT can play a life-changing role in reducing complications associated with certain chronic conditions, such as Type 2 Diabetes and Chronic Kidney Disease (CKD). Registered Dietitians from the Academy use the Academy of Nutrition and Dietetics’ Evidence-Based Nutrition Practice Guidelines to counsel patients on lifestyle changes and self- management skills.


“A person may prevent or delay some health problems from chronic kidney disease (CKD) by eating the right foods and avoiding foods high in sodium, potassium, and phosphorus. Learning about calories, fats, proteins, and fluids is important for a person with advanced CKD. Protein foods such as meat and dairy products break down into waste products that healthy kidneys remove from the blood.


As CKD progresses, nutritional needs change. A health care provider may recommend that a patient with reduced kidney function choose foods carefully.”

https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/eating-nutrition/nutrition-advanced-chronic-kidney-disease-adults


Common considerations for Kidney Patients who work with a Registered Dietitian Nutritionist for MNT would include:


• Calorie intake;

• Protein intake;

• Meat Portion Size;

• Fat content in foods;

• Sodium Content;

• Potassium Content;

• Phosphorus Content;

• Fluid Intake for pre-dialysis, dialysis and kidney transplant patients;

• Keeping track of Lab Reports;

• Help with making healthy meals choices depending on your kidney disease situation;

• Keeping informed of Clinical Trials that could assist the Kidney Patient.


What is a Registered Dietitian Nutritionist?


This is not just a person who took a nutrition course her sophomore year in college. According to the Academy of Nutrition and Dietetics, a Registered Dietitian Nutritionist is, “Registered Dietitian Nutritionists (RDNs) are food and nutrition experts who have met the following criteria to earn the RDN credential:


• Completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work accredited or approved by the Accreditation Council for Education in Nutrition and Dietetics (ACEND) of the Academy of Nutrition and Dietetics.


• Completed an ACEND-accredited supervised practice program at a health-care facility, community agency, or a foodservice corporation or combined with undergraduate or graduate studies. Typically, a practice program will run six to 12 months in length.


• Passed a national examinationadministered by the Commission on Dietetic Registration (CDR). For more information regarding the examination, refer to CDR’s website at www.cdrnet.org.


• Completed continuing professional educational requirements to maintain registration.”

https://www.eatrightpro.org/about-us/what-is-an-rdn-and-dtr/what-is-a-registered-dietitian-nutritionist.


As you can see for a Registered Dietitian Nutritionist, they go through an extensive training and educational program similar to what a Board Certified Physician may go through to become a specialist in a medical field, like a Board Certified Nephrologist.


Can a Registered Dietitian Nutritionist Obtain a Board Certification in a Specialized Field of Nutrition


A Registered Dietitian Nutritionist (RDN) can obtain a Board Certification in a specialized area of nutrition like Pediatrics, Oncology, or Sports Nutrition. This includes a specialization in Renal (Nephrology) as well. Dr. Melissa Prest is a Registered Dietitian Nutritionist and board certified specialist in renal nutrition, specializing in kidney diet issues. This educational and practical experience is what makes a RDN a credible source for nutrition and diet information. Roughly half of the RDs from the Academy have advanced academic degrees.


What Types of Things Does a Registered Dietitian Nutritionist Do for Their Patients?


As a Kidney Patient your best bet is to ask a registered dietitian to give you advice on your diet. They can tailor you diet plan to meet your goals and needs.


What is a visit with a RD like? The goal is to come up with a realistic plan to improve your health and lifestyle, tailored to your individualized needs.


Things they look at include:

• Family and Medical History, Do you eat alone, together as a family, or separately

• Where & what do you grocery shop for

• Do you Eat out frequently?

• What are your exercise habits?


There are some amazing things you and your Registered Dietitian Nutritionist may do together including:

• Plan meals:

• Tour the grocery store;

• Reading labels on products;

• Tracking your progress;


The key here is that a RD will help you understand how good nutrition helps benefit your health and lifestyle. Part of this is changing habits over the course of the long run. Meeting with the RD on a regular basis helps you meet challenges and find successful solutions. You will meet every 2 weeks for 2-3 month’s and then monthly for another 3-4 months to track your progress.


Critical for Kidney Patients, a registered dietitian helps you manage chronic diseases, like HBP, diabetes, high cholesterol, kidney disease or cancer.


Other things a RDN helps you with include:

• Understanding your lab results and how that affects your diet plan;

• To create a personalized eating plan;

• To provide guidance on food allergies, sensitivities and intolerances;

• To teach you how to read food labels, teach you which ingredients to avoid;

• To help you find good healthy & tasty substitutes for the food you cannot eat.

Coverage for the RD are included in most insurance plans, including private insurance, Medicare, & State Medicaid within certain limits. Be sure to check with your carrier.


How Do I Find A Registered Dietitian Nutritionist Me?


It is very simple to find a RDN near you. Check out this link on the Academy’s website: https://www.eatright.org/find-an-expert


Can I Just Schedule An Appointment With A RDN Or Do I Need A Referral From My Doctor?


Under Medicare Part B, a referral from a physician is required for a patient to utilize your MNT benefits and work with a RDN. Only doctors can make such a referral under current law. Others are barred from making referrals.


https://www.eatrightpro.org/payment/coding-and-billing/referral-requirements-for-coverage-for-nutrition-services


The Best Kept Secret in Kidney Advocacy: You Can Consult With An RDN At No Costs to You


If you are covered by Medicare, you can see an RDN for free since all cost-sharing (deductible, copays) are waived for MNT services. According to the Academy, “Medical nutrition therapy is covered by Medicare for diagnoses of diabetes, non-dialysis kidney disease, and 36 months post kidney transplant when a Medicare beneficiary has been referred by a physician, and when provided by an RDN who is enrolled as a Medicare Provider. Medicare covers 3 hours of MNT the initial year of referral and up to 2 hours of MNT for subsequent years. Hours are based on calendar year and cannot be carried over from year to year.


Additional coverage is available in the same calendar year with a second referral when more MNT is medically necessary. There could be many reasons why individuals may need more care, including but not limited to a change in diagnosis, medical condition or treatment regimen. Medicare Advantage (Medicare Part C) plans may also offer additional benefits, including coverage beyond these diagnoses covered by traditional Medicare. Registered dietitian nutritionists must become credentialed with each Medicare Advantage plan in order to provide and get paid for MNT to patients enrolled in Medicare Advantage.”

https://www.eatrightpro.org/payment/medicare/mnt


How Do Registered Dietitian Nutritionists Help Kidney Doctors and Nurses?


Doctors and Nurses often speak to patients about what they should and should not eat. This is helpful, but not enough for patients with CKD.


“Dietitians work closely with Registered Nurses and Certified Nursing Assistants in a variety of settings. Whether it is the clinical setting, a long-term care facility, or even in a health clinic in a school district, RNs and RDs can greatly support one another in the work that they do. Because a RN is at the forefront of patient care, they are able to provide RDs with a wealth of information to help RDs asses a patient’s nutrition status. Whether it is enteral or parenteral nutrition tolerance, food and supplement intake, family concern for appetite or weight loss prior to admission, or other clinical information, RNs play a vital role in helping the RD come up with a clinical plan of care for the patient.


In many health care settings, there is a screening tool completed by the nurse when a patient is admitted that indicates whether the patient has lost weight or had a poor appetite prior to admission, if they have any difficulties with eating, or if they have any past medical history of need for nutrition support, among other indicators. While this screening tool is different based on the facility, the purpose of the tool is universal: to help facilitate a conversation among the RDs, RNs, physicians, auxiliary staff, and family to help create the best plan of care for the patient’s nutritional well-being.


RDs and RNs work together with open, honest communication to collaborate the best care for the patient. If nurses have questions regarding the appropriateness of a diet or supplement, enteral or parenteral tolerance, or diet consistencies, they should contact the RD available on staff. As the experts, RD’s will be able to help streamline any problems and create the best nutrition plan for patients. Nurses’ help is invaluable to the care registered dietitians provide. They could not do their jobs without nurses!”


According to Dr Holly Kramer, because of a CKD patient’s unique individual needs, kidney patients should see a dietitian in addition to a doctor or a nurse. This would include before dialysis, during dialysis and after transplant.


Current Legislation Supported by the National Kidney Foundation and the Academy of Nutrition and Dietetics


There is current legislation that was first introduced to Congress in 2020, The Medical Nutrition Therapy Act (H.R. 6971/S. 4504).


What does the Bill Do?


The bill amends the Social Security Act to:

• Provide Medicare Part B coverage of outpatient MNT for prediabetes, obesity, high blood pressure, high cholesterol, malnutrition, eating disorders, cancer, celiac disease, HIV/AIDS and any other disease or condition causing unintentional weight loss;


• Authorize the Secretary of Health to include other diseases based on medical necessity; and


• Allow nurse practitioners, physician’s assistants, clinical nurse specialists and psychologists to refer their patients for MNT.


So the Bill does two things:


1. It increases the types of professionals who can make referrals to a RDNs under Medicare Part B, currently only physicians can make such a referral;


2. The current law only covers MNT for CKD and Diabetes. The proposed changes expand the Chronic Diseases covered beyond those two.


Key Points for Legislators


• Medical nutrition therapy is nutritional diagnostic, therapy, and counseling services furnished by a registered dietitian for the purpose of disease prevention, management, or treatment;


• MNT is an evidence-based, cost-effective component of treatment that can help combat many of the nation’s most prevalent and costly chronic conditions, including conditions that are contributing to poor COVID-19 outcomes;


• Access to MNT is especially critical for communities of color that suffer from chronic disease health disparities driven by reduced access to care, healthy foods and safe places to be active; and


• CMS does not have the authority to expand MNT in Medicare; passage of the MNT Act is a necessary step to providing adequate care to seniors.


https://documentcloud.adobe.com/link/review?uri=urn:aaid:scds:US:3d6b79ff-ed8c-4214-959e-a0e647722be4


Conclusion


Medical Nutrition Therapy goes above and beyond normal diet planning for Kidney Patients. Registered Dietitians are highly educated and trained in the field, making them uniquely qualified to advise Kidney Patients on issues of diet, shopping lable reading and replacement foods for better kidney health. They do more than your doctor or nurse by giving you a Kidney Diet Plan that is unique to your individualized needs. You can consult with a RDN under Medicare within certain limits for free, without any co-pay or deductible. There is legislation that you can support in Congress that will increase who can make referrals to a Registered Dietitian Nutritionist and the types of conditions that will be covered beyond CKD & Diabetes. You should give very serious consideration to consulting a Registered Dietitian Nutritionist!


From The Author James Myers


To learn more about James follow this link


My name is James Myers. I live in Hammond, Indiana. I graduated from Valparaiso University Law School and I have 2 MBA’s in Business and Healthcare Administration. Polycystic Kidney Disease runs in my family. I’ve lost 5 members of my family to PKD, including my Father. I have PKD. I was fortunate. Because of my family’s history, I was diagnosed at the age of 25, and was able to put off dialysis until the age of 58. I was on dialysis for 4 years and was transplanted on April 27th, 2016. I named my new kidney Woody. Woodrow is a family name, so I did this to honor my father and my grandfather.


My advocate nickname is Uncle Jim. If you have a kidney question or issue you need help with, please do not hesitate to contact me at kidneystories@hotmail.com. I thank the NKF for all the opportunities they have given to me.


References:


MNT Versus Nutrition Education


https://www.eatrightpro.org/payment/coding-and-billing/mnt-vs-nutrition-education


Medical Nutrition Therapy


https://www.cdc.gov/diabetes/dsmes-toolkit/reimbursement/medical-nutrition-therapy.html


What is Medical Nutrition Therapy(MNT)?


https://www.dietitiansathome.com/medical-nutrition-therapy-mnt


What Is Medical Nutrition Therapy? All You Need to Know


https://www.healthline.com/nutrition/nutrition-therapy


RDNs and Medical Nutrition Therapy Services


https://www.eatright.org/food/resources/learn-more-about-rdns/rdns-and-medical-nutrition-therapy-services


5 BENEFITS OF MEDICAL NUTRITION THERAPY


https://www.sunhealthwellness.org/articles/5-benefits-of-medical-nutrition-therapy


Medical Nutrition Therapy: A Key to Diabetes Management and Prevention


https://clinical.diabetesjournals.org/content/28/1/12


Definition of Medical Nutrition Therapy


https://www.cancer.gov/publications/dictionaries/cancer-terms/def/medical-nutrition-therapy


The Goals of Medical Nutrition Therapy


https://www.sciencedirect.com/topics/medicine-and-dentistry/medical-nutrition-therapy


New Review: Medical Nutrition Therapy Provided by RDNs Can Help Slow the Progression of Chronic Kidney Disease


https://www.eatrightpro.org/media/press-releases/new-in-food-nutrition-and-health/medical-nutrition-therapy-for-kidney-disease


Medical Nutrition Therapy for CKD


https://www.kidneynews.org/kidney-news/clinical-care/medical-nutrition-therapy-for-ckd


Nutrition for Advanced Chronic Kidney Disease in Adults


https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/eating-nutrition/nutrition-advanced-chronic-kidney-disease-adults


Medical Nutrition Therapy for Patients with Non–Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions


https://jandonline.org/article/S2212-2672(18)30801-3/fulltext


CRN SPECIAL ARTICLE: Medical Nutrition Therapy (MNT) Referrals to Nephrology Registered Dietitian Nutritionists (RDNs) for Non-Dialysis Chronic Kidney Disease (CKD) Patients is Limited


https://www.kidney.org/newsletter/crn-special-article-medical-nutrition-therapy-mnt-referrals-to-nephrology-registered


Medical Nutrition Therapy Underutilized in CKD


Medical Nutrition Therapy Underutilized in CKD


What is a Registered Dietitian Nutritionist?


https://www.eatrightpro.org/about-us/what-is-an-rdn-and-dtr/what-is-a-registered-dietitian-nutritionist


Every Registered Dietitian Is a Nutritionist, but Not Every Nutritionist Is a Registered Dietitian


https://www.eatrightpro.org/about-us/what-is-an-rdn-and-dtr/what-is-a-registered-dietitian-nutritionist/every-registered-dietitian-is-a-nutritionist-but-not-every-nutritionist-is-a-registered-dietitian


Qualifications of a Registered Dietitian Nutritionist


https://www.eatright.org/food/resources/learn-more-about-rdns/qualifications-of-a-registered-dietitian-nutritionist


What’s the Difference Between a Dietitian and a Nutritionist?


https://www.healthline.com/nutrition/dietitian-vs-nutritionist


REGISTERED DIETITIAN (RD) OR REGISTERED DIETITIAN NUTRITIONIST (RDN)* CERTIFICATION


https://www.cdrnet.org/certifications/registered-dietitian-rd-certification


Certified Nutritionist vs. Registered Dietitian: What’s the Difference?


https://www.afpafitness.com/blog/certified-nutritionist-vs-registered-dietitian-whats-the-difference


Work Settings and Areas of Expertise for RDNs


https://www.eatrightpro.org/about-us/what-is-an-rdn-and-dtr/what-is-a-registered-dietitian-nutritionist/work-settings-and-areas-of-expertise-for-rdns


Dietitian Nutritionist


What does a registered dietitian nutritionist do?


https://www.careerexplorer.com/careers/registered-dietitian-nutritionist/

How to Find a Nutritionist


https://www.healthgrades.com/right-care/food-nutrition-and-diet/how-to-find-a-nutritionist


Find An Expert


https://www.eatright.org/find-an-expert


Referring Patients to an RDN


https://www.eatrightpro.org/about-us/what-is-an-rdn-and-dtr/work-with-an-rdn-or-dtr/referring-patients-to-an-rdn


Medicare MNT


https://www.eatrightpro.org/payment/medicare/mnt


The Registered Dietitian’s Role in Health Promotion


Medical Nutrition Therapy Act Issue Brief

https://documentcloud.adobe.com/link/review?uri=urn:aaid:scds:US:0ccc78ab-31eb-4bc7-8083-4b6b9bcecb99


Medical Nutrition Therapy Act Leave Behind


https://documentcloud.adobe.com/link/review?uri=urn:aaid:scds:US:d3c58459-263f-4f1c-bce7-a87f9ce2ffde


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Monday, February 1, 2021

NKF VERSION: WHAT KIDNEY PATIENTS NEED TO KNOW ABOUT MEDICAL NUTRITION THERAPY

 What Kidney Patients Need to Know About Medical Nutrition Therapy 

Posted by nkf _advocacy 

By Jim Myers, NKF patient-advocate 


 Medical Nutrition Therapy (MNT) is an evidence-based medical approach to treating certain chronic conditions through the use of an individually-tailored nutrition plan based on a comprehensive nutrition assessment conducted by a Registered Dietitian (RD). A physician may refer an individual to a RD for this service. The goal of Medical Nutrition Therapy is to prevent, delay or manage diseases or conditions like Chronic Kidney Disease (CKD).

 The Best Kept Secret in Kidney Advocacy: You Can Consult With An RDN At No Cost to You 


If you are covered by Medicare, you can see an RD for free since all cost-sharing (deductible, copays) are waived for MNT services. According to the Academy of Nutrition and Dietetics, MNT “is covered by Medicare for diagnoses of diabetes, non-dialysis kidney disease, and 36 months post kidney transplant when a Medicare beneficiary has been referred by a physician, and when provided by an RDN who is enrolled as a Medicare Provider. Medicare covers 3 hours of MNT the initial year of referral and up to 2 hours of MNT for subsequent years. Hours are based on calendar year and cannot be carried over from year to year. Additional coverage is available in the same calendar year with a second referral when more MNT is medically necessary. There could be many reasons why individuals may need more care, including but not limited to a change in diagnosis, medical condition or treatment regimen. Medicare Advantage (Medicare Part C) plans may also offer additional benefits, including coverage beyond these diagnoses covered by traditional Medicare. Registered dietitian nutritionists must become credentialed with each Medicare Advantage plan in order to provide and get paid for MNT to patients enrolled in Medicare Advantage.” 

 Current Legislation Supported by the National Kidney Foundation and the Academy of Nutrition and Dietetics 

The Medical Nutrition Therapy Act (H.R. 6971 / S. 4504 in the previous Congress) amends the Social Security Act to: Provide Medicare Part B coverage of outpatient MNT for prediabetes, obesity, high blood pressure, high cholesterol, malnutrition, eating disorders, cancer, celiac disease, HIV/AIDS and any other disease or condition causing unintentional weight loss; Authorize the Secretary of Health to include other diseases based on medical necessity; and Allow nurse practitioners, physician’s assistants, clinical nurse specialists and psychologists to refer their patients for MNT. This would increase the types of professionals who can make referrals to RDNs under Medicare Part B (currently only physicians can make such a referral) and expand the Chronic Diseases covered beyond CKD and Diabetes. Those wishing to advocate in favor of this bill should be sure to explain to their lawmakers that MNT includes a nutritional diagnostic, therapy, and counseling services furnished by a registered dietitian for the purpose of disease prevention, management, or treatment; that MNT is an evidence-based, cost-effective component of treatment that can help combat many of the nation’s most prevalent and costly chronic conditions, including conditions that are contributing to poor COVID-19 outcomes; and that access to MNT is especially critical for communities of color that suffer from chronic disease health disparities driven by reduced access to care, healthy foods and safe places to be active. The National Kidney Foundation plans to continue finding ways to advocate for expansion of the MNT and looks forward to working with patients and providers alike to help federal lawmakers understand the urgency in doing so this Congress.


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