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Coaching and Financial Incentives May Reduce Phosphorus - Renal and Urology News PDF Print
August 13, 2015 Coaching and Financial Incentives May Reduce Phosphorus - Renal and Urology News
Patients with hyperphosphatemia lowered their phosphorus levels with a dietitian's guidance or cash incentive.

Employing novel health strategies, along with phosphate binder medication, may help hemodialysispatients reduce excess phosphorus, a small pilot study suggests.

Peter R. Reese, MD, of the University of Pennsylvania in Philadelphia and colleagues randomly assigned 36 hemodialysis patients to 3 groups—dietary and medication coaching, financial incentives, or usual care—for 10 weeks. Baseline serum phosphorus levels ranged from 5.6 to 7.6 mg/dl.

According to results published in the Journal of Renal Nutrition, patients' monthly serum phosphorus levels declined in all groups: 0.32 mg/dl for patients receiving a monetary reward, 0.4 in coached patients, and 0.24 in usual care patients.

“These findings suggest that a future trial might combine education (using a coach or a different delivery method) with financial incentives to give patients the knowledge and motivation to change nutritional and medication adherence habits,” the investigators explained.

Understanding and adopting the dietary restrictions necessary to limit phosphorus is challenging for patients, especially when labels fail to note phosphorus amounts. Patients also need to remember to take phosphate binders with every meal and phosphorus-rich snack. The renal dietitian bolstered patients' knowledge about both diet and phosphate binder therapy. Individualized coaching 3 times a week included assessments, goal setting, and practical tips, such as a shopping lists and recipes.

Patients in the financial incentives group received only a cash reward ($1.50 per day) when they lowered their phosphorus levels to a reasonable target of 5.5 mg/dl or below or when their serum phosphorus levels declined by at least 0.5 mg/dl from the prior reading. Successful patients also were entered into a lottery to win $50.

Motivational techniques played a role in both interventions. The dietitian used motivational interviewing to promote readiness for behavior change in patients. Patients in the financial incentives group likewise received messages to reinforce goal attainment and offset inaction.

Larger and longer studies are needed to investigate the magnitude and durability of improvements in phosphorus levels with these interventions, the investigators stated. This study was not powered to detect clinical differences between groups, but it determined the feasibility of using novel strategies and corroborated findings from similar research on phosphorus education. Other studies have shown that self-management and financial interventions improve medication adherence, smoking cessation, substance abuse, glycemic control, and weight loss.

Roughly half of eligible patients in the current study agreed to participate in the program and no one dropped out. All expressed interest in receiving similar support in the future.

  1. Reese, PP; Mgbako, O; Mussell, A; et al. Journal of Renal Nutrition; doi: 10.1053/j.jrn.2015.06.001.


Medical Dialysis Devices Market 2015 – Global Industry Trends,Share ... - Medgadget.com (blog) PDF Print

The report – Global Medical Dialysis Devices Industry presents an executive-level overview of the Global Medical Dialysis Devices market. The Global Medical Dialysis Devices market is expected to demonstrate a positive growth trend in the coming years. The market forces that will shape the growth of this market have been scrutinized in detail in this report.

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Comprehensive data related to the market trends has been included in this report. The market drivers that will fuel the growth of the market during the forecast period are mentioned in this report. Furthermore, the regulatory environment in the Global Medical Dialysis Devices market and its impact on the Global Medical Dialysis Devices industry performance has been assessed in this report. The restraining factors that will result in decline in popularity of certain product segments have also been covered in this report. The potential opportunities and their impact on the Global Medical Dialysis Devices market is also evaluated in the report.

The key players are expected to tap onto these market opportunities to penetrate the market. Furthermore, the untapped opportunities in emerging economies will provide a considerable impetus to the small, medium, and large companies operating in the Global Medical Dialysis Devices market. These opportunities in turn are projected to have positive impact on the Global Medical Dialysis Devices market. Players in the market are focusing on innovation, which has resulted in a lot of mergers, acquisitions, collaborations, and partnerships. The prominent market players are also focusing to offer a broader range of products. Competitors often are competing on the basis of the cost of the products in the Global Medical Dialysis Devices market.

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Half of American adults may have chronic kidney disease in their future ... - Managed Care magazine PDF Print

Chronic kidney disease (CKD) threatens to become a major health burden in coming years—and that may come as news to many of the Americans who will be affected, according to a study in the American Journal of Kidney Diseases. As the authors put it, awareness of CKD “remains low in the United States, and few estimates of its future burden exist.” In fact, according to federal government health surveys, less than 10% of Americans with the early stages of CKD are aware of their condition.

Researchers at RTI International, a not-for-profit research group, used their own previously developed CKD Health Policy Model to make their predictions. By their reckoning, more than half (54%) of Americans ages 30 and older who don’t currently have CKD will develop the condition some time in their lives.

Lifetime incidence risk for common causes of morbidity when no disease is present at age 30, U.S. population

*Index age 45.
CKD=chronic kidney disease.
Sources: SEER Cancer Statistics Review, JAMA.

They also forecast a ramping up of CKD prevalence from the current level of 13.2% to 14.4% in 2020 (28 million Americans). By 2030, their model projects the prevalence will reach 16.7% (38 million Americans).

Estimated prevalence, CKD, U.S. population, 2015–2030

Source: Hoerger TJ et al., American Journal of Kidney Diseases, March 2015.

Lead author Thomas Hoerger, PhD, tells Managed Care that the group’s results argue for “interventions to control the conditions that increase the risk of CKD (primarily, tight glycemic control for persons with diabetes and better blood pressure control for persons with hypertension), and [also] partly for the development of new interventions to slow progression among persons in the early stages of CKD.”

The main risk factors for CKD include diabetes, hypertension, and age. Early detection and treatment of CKD can forestall or delay heart disease and kidney failure. Likewise, early treatment of diabetes and hypertension can prevent CKD from developing.

However, as Hoerger and his colleagues point out, the clinical significance of early stage CKD among the elderly with borderline numbers is somewhat debatable, partly because of competing health problems.

Even if these CKD forecasts come true, there’s good news about one of its most dire consequences, end-stage renal disease (ESRD).


Dialysis beneficiaries want scheme to reach more people - The Hindu PDF Print

Sixty-year-old Lalita from Madikeri was virtually in tears while narrating her experience of peritoneal dialysis, which she has been undergoing for the past one year since being trained at the Government Wenlock Hospital.

“I am really indebted to Health Minister U.T. Khader for including me in this (pilot) scheme. (Following peritoneal dialysis) I am now spending good time with my family members,” said Ms. Lalitha.

“I want this scheme to reach far more beneficiaries,” she said.

Ms. Lalita was one of 20 beneficiaries of peritoneal dialysis undertaken on a pilot basis by the State government at the Government Wenlock Hospital last year.

The beneficiaries here are those with chronic renal failure. The beneficiary or his or her family members, have been trained for a week to perform peritoneal dialysis in their house. The State government bears the expense of Rs. 24,000 per month included by each beneficiary.

The beneficiaries on Wednesday had come to share their experience of doing peritoneal dialysis for over a year.

“I had lost hope in life following problems I faced with haemodialysis. Peritoneal dialysis has given me a new lease of life,” said Praveen Kumar, a resident of Puttur. Mr. Kumar said haemodialysis sessions had made him weak.

“Peritoneal dialysis has brought turnaround in my life,” said Mr. Kumar, who now runs a grocery shop.

Following peritoneal dialysis, Henry Pinto from Belthangady said that he has been driving an autorickshaw, which he stopped following haemodialysis.

“Each session of peritoneal dialysis lasts for about thirty minutes and it has to be done thrice a day. I space out these sessions and earn,” he said.

Mr. Pinto said the news of the government stopping supply of Dialysis liquid, which was used in Peritoneal Dialysis, did cause him concern.

Baby Shetty from Mandarthi in Udupi asked the Minister to ensure that there will not be any discontinuity in providing Dialysis liquid and medicines to beneficiaries. She also sought services of doctors at the Wenlock Hospital once a month.

Hearing the beneficiaries, Mr. Khader said the State government was considering extending peritoneal dialysis to more people with chronic renal failure.

There will not be any shortfall in availability of Dialysis liquid and medicines required for the beneficiaries, he said.

20 beneficiaries with chronic renal failure have been taken

on a pilot project by the government

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Nephrology Dialysis Transplantation Reports Phase 2 Data of Investigational ... - Nasdaq PDF Print

Nephrology Dialysis Transplantation Reports Phase 2 Data of Investigational ...
SAN FRANCISCO, Aug. 12, 2015 (GLOBE NEWSWIRE) -- FibroGen, Inc. (Nasdaq:FGEN), a research-based biopharmaceutical company, today announced that Nephrology Dialysis Transplantation has published encouraging Phase 2a safety and efficacy ...

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