Kidney Function

Specific reasons some people may elect not to start dialysis treatment (as they approach end stage renal failure) or choose to stop dialysis (even if they have done well on it in the past) are as follows:

• The presence of development of unrelated disease that causes unrelenting pain and suffering (such as widespread cancer), extreme physical disability (such as severe stroke or multiple amputations), or will cause a difficult death in a very short period of time.
• Such severe dementia that they are unable to relate to others or to understand their own illness and the necessary dialysis treatment (e.g., dementia from Alzheimer’s disease or as a result of multiple strokes)
• The occurrence of such severe brain injury that they are permanently unconscious (e.g., from an automobile accident or from a cardiac or pulmonary arrest).

Fortunately, these various conditions, with rare exception (such as a stroke in a dialysis patient with uncontrolled hypertension or blindness and amputations in a severe diabetic), are no more common in patients with end-stage renal disease. They do occur, however, just as they do in other people or in otherwise healthy individuals, and one should prepare for unexpected as well as for foreseeable problems.

In general, hemodialysis is performed in a dialysis center by technicians trained in the care of patients who are supervised by nurses. Medicare pays three hemodialysis treatments per week. If you choose to undergo treatment at a center, it will be for a fixed schedule, three times a week, on Mondays, Wednesdays and Fridays or Tuesdays, Thursdays and Saturdays. If you get the schedule of your choice, you may request to be put on a waiting list for a schedule of your choice. In special cases, you may exchange your time with someone else. You will need to plan well your dialysis program if you work or have children to care. Some centers provide dialysis treatments during the night in the middle. This treatment is done over a longer period at night, while sleeping in the middle. This type of dialysis reduces the limitations on food and fluid intake, and also it provides more time during the day to work, care for their children and do hobbies and other activities.

You can choose to learn to make their own hemodialysis treatments at home. When you are the only patient, it may become more frequent dialysis treatments or lasting almost replaced the normal work performed by healthy kidneys. Daytime hemodialysis at home (DHHD for short in English) is performed 5-7 days a week for 2 to 3 hours per session and you organize the schedule. If your health insurance plan would pay more than three treatments, you could be brief treatments during the morning or afternoon. Nocturnal home hemodialysis (NHHD by its acronym in English) is done in 3-6 nights a week while you sleep. Whether you choose the DHHD or NHHD, this will allow food and a normal fluid intake, with fewer blood pressure medications and other health problems. Most programs ask patients to do home hemodialysis have a skilled attendant during treatments. Learning to be hemodialysis is like learning to drive a car: it takes a few weeks and, initially, is alarming but then becomes a routine. The dialysis center provides the equipment and training, and assistance by phone 24 hours if you have any questions or problems. New machines for home dialysis are smaller and easier to use than the equipment used in schools.

You have options of dialysis centers and many cities have more than one site to choose from. You can visit a center to see if there are treatments you want or the time it needs. Some centers allow the use of laptops or cell phones or receive visits, others not. Medicare has a list of all centers in the United States on its Web site at www.medicare.gov / dialysis (in English), which shows the quality ratings of each school. Your health plan may have a list of sites where you can go. If you choose a treatment option in a school, it must be near your home to reduce your travel time. If the treatment is done at home, once you are trained, you should only go to the center once a month. So, the center can be as far as you want to travel once a month.

Possible Complications of Dialysis
Vascular access problems are the most common reason for hospitalization among people receiving hemodialysis. Some common problems include infection, blockage by clotting and poor circulation. These problems may prevent their treatments to succeed. You might have to undergo repeated surgeries to achieve a properly functioning access.

Other problems may be caused by rapid changes in water and chemical balance of your body during treatment. Muscle cramps and hypotension (a sudden drop in blood pressure) are two common side effects. Hypotension can make you feel weak, dizzy or sick to your stomach.

Probably need a few months to adjust to hemodialysis. Side effects can often be dealt with swiftly and easily, so you should inform your doctor and dialysis staff suffered any side effects. You can avoid many side effects if you follow a proper diet, limiting fluid intake and taking medications as directed.

Part B medical insurance helps pay for outpatient maintenance dialysis treatments in any approved dialysis facility, including the costs of laboratory tests, supplies, equipment, and other services associated with treatment. Charges for maintenance dialysis vary from one approved facility to another. Medicare pays the facility based on a per treatment rate that is set in advance. This rate is known as the composite rate. Medicare pays 80% of the composite rate minus any part of the Part B deductible they have yet to meet. You are responsible for any unmet Part B deductible plus the remaining 20% of the composite rate. The facility may never charge more than the unmet Part B deductible plus 20% of its Medicare composite rate.

Physicians’ services also are covered while you are receiving dialysis treatment. Medicare pays for these services via a monthly capitation payment. The amount is paid regardless of whether a patient dialyzes as an outpatient in a dialysis facility, or at home. Under this method, Medicare pays 80% of a physician’s monthly payment less any unmet Part B deductible. A patient pays any unmet Part B deductible plus the remaining 20% of the monthly payment. If a physician accepts assignment, Medicare will pay them directly, and you may not be charged more than the unmet Part B deductible plus 20% of the monthly capitation payment. (Assignment means that a doctor accepts the payment approved by Medicare as the total payment). If a physician does not accept assignment, you receive the payment and there is no limit on the amount that can be charged.

If you’re admitted to a hospital because you medical condition requires the availability of other specialized hospital services on an inpatient basis, the maintenance dialysis treatments would be covered by hospital insurance (Part A), as part of the costs of the covered inpatient hospital stay. While you are hospitalized, a physician may elect to be paid for each individual service that they provide. In such a case, a physician receives a prorated portion of the monthly capitation payment, reduced in proportion to the total number of days that you are hospitalized.

Medicare and Self-Care Dialysis

If people participate in a self-care training program within the first three months after treatment has begun with the intention of doing self-care (aka “home”) dialysis, Medicare benefits will start during the month that the self-care training begins.