DFC Dialysis Facility Compare g/dl UPR65% UPR BUN BUN/ BUN NEJM, March10,2005 Anemia of C
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1 HemodialysisReview Article: Medical ProgressNEJM, Nov.4, 2010 H Dialyser NEJM AV fistula Kt/V urea Vml t DFC: Dialysis Facility Compare
2 DFC Dialysis Facility Compare g/dl UPR65% UPR BUN BUN/ BUN NEJM, March10,2005 Anemia of Chronic Disease TFC: Hb odds Ht Hb Hb erythropoietin 25 Brookline Dialysis Massachusetts General Hospital 10 3 Massachusetts General Hospital 17 Brookline Dialysis Massachusetts General Hospital 0 % Brookline Dialysis 4 UPR65
3 96 Massachusetts General Hospital 100% Brookline Dialysis Massachusetts General Hospital Brookline Dialysis NEJM MIPPA: Medicare improvements for Patients and Providers Act bundled payment 2011 erythropoietin cherry-picking : NEJM 16
4 NEJM ml 400ml/ ml/kg/h 6. Kt/V urea Hb Kt/V urea Hemodialysis Review Article: Medical Progress NEJM, Nov.4, 2010 H23.1 Jonathan Himmelfarb, M.D. T.Alp Ikizler, M.D. Vanderbilt 50 Belding Scribner blood-access Scribner AV fistula 100
5 dialysatebicarbonate compartmentalized 2microglobulin p-cresol ultrafiltration 10ml/kg/h sorbent Dialyzer: hollow-fiber dialyzer High-flux membrane low-flux membrane 4 3 QOL 200ml 400ml/ blood-access dialysate 2
6 Ultrafiltration 10ml/kg/h Nasodium mmol/L Na Kpotassium 2 3mmol/L K K K 30 Ca mmol/L Ca Ca Mg 0.5mmol/LMg Mg flux Alkaline buffers 30 40mmol/L. Chloride alkaline buffer Glucose mg/dl D
7 single-pool Kt/Vurea>1.4 5 ultrapure 10 12g/dl AV fistula() Ca mg/dlP mg/dl Intact PTH 2 D phosphate binder PTH 4.0g /dl PKNa LDL 100mg/dl Quantifying the dose and adequacy of dialysis Kt/V urea K 1 mlt V urea Kt/Vurea Vml t high-flux
8 2microglobulin high-flux CaP QOL 1972 ESRD: End-Stage Renal Disease 1972
9 MIPPA: Medicare improvements for Patients and Providers Act (ESRD) bundled payment 2011 cherry-picking : 2003 CMSCenters for Medicare and Medicaid Services arteriovenous fistulas Fistula First fistula CMS DFC (Dialysis Facility Compare) Dialysis Facility Compare / 1 /
10 AV fistule() tunneled catheter 1970 NCDSthe National Cooperative Dialysis Study single-pool Kt/V urea V ml t higher permeability characteristics Kt/V urea 1.4 Homocysteine erythropoietin p-cresol sulfateindoxyl sulfate phosphate
11 NEJM ml 400ml/ ml/kg/h 6. Kt/V urea Hb Kt/V urea
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