#Disparities In Dialysis In Children

[pediatricnephrologyindia]

Disparities In Dialysis In Children

HYPOTHESIS: Acute kidney injury (AKI) is a common cause of morbidity and mortality worldwide, with a pediatric incidence ranging from 19.3% to 24.1%. Treatment of pediatric AKI is a source of debate in varying geographical regions. Currently CRRT is the treatment for pediatric AKI, but limitations due to cost and accessibility force use of adult equipment and other therapeutic options such as peritoneal dialysis (PD) and hemodialysis (HD). It was hypothesized that more cost-effective measures would likely be used in developing countries due to lesser resource availability.

METHODS: A 26-question internet-based survey was distributed to 650 pediatric Nephrologists. There was a response rate of 34.3% (223 responses). The survey was distributed via pedneph and pcrrt email servers, inquiring about demographics, technology, resources, pediatric-specific supplies, and preference in renal replacement therapy (RRT) in pediatric AKI. The main method of analysis was to compare responses about treatments between nephrologists in developed countries and nephrologists in developing countries using difference-of-proportions tests.

RESULTS: PD was available in all centers surveyed, while HD was available in 85.1% and 54.1% (p = 0.00), CRRT was available in 60% and 33.3% (p = 0.001), and SLED was available in 20% and 25% (p = 0.45) centers of developed and developing world respectively. In developing countries, 68.5% (p = 0.000) of physicians preferred PD to costlier therapies, while in developed countries it was found that physicians favored HD (72%, p = 0.00) or CRRT (24%, p = 0.041) in infants.

CONCLUSIONS: Lack of availability of resources, trained physicians and funds often preclude standards of care in developing countries, and there is much development needed in terms of meeting higher global standards for treating pediatric AKI patients. PD remains the main modality of choice for treatment of AKI in infants in developing world.

Tag: Disparities In Dialysis In Children, Best Pediatric Nephrologist in Delhi,

Nephrotic syndrome Specialist in India

[plannedparenthood]

Medicaid vs. Medicare

Disclaimer: Planned Parenthood believes in using gender-inclusive language. However, when we’re referencing government data and statistics, we have to use the data points they chose, which often don’t reflect the full range of gender identities. We hope that in the future, all research will better reflect and respect the diversity of gender. 

It’s easy to mix up Medicaid and Medicare. They sound super similar and they’re both well-known government programs that help people get health care across the country. But it’s important to know the difference so you and the people you care about can benefit.

The Difference Between Medicaid and Medicare

Although Medicaid and Medicare are complex, here’s the main difference: 

Medicaid is insurance that aids people of all ages who have low incomes. Medicaid covers 21% of the U.S. population.

Medicare is insurance that primarily cares for people ages 65 years and up (with any income).  Medicare covers 14% of the U.S. population.

Here’s where this gets tricky: Medicare also covers people of all ages who have disabilities or who are on dialysis — including people who need reproductive health care, such as birth control and pregnancy services. What’s more, people can be on both Medicaid and Medicare at the same time. (For these “dual eligible” beneficiaries, Medicare pays their claims first and Medicaid pays second.)

What Medicaid and Medicare Have in Common

Overall, Medicaid and Medicare provide health care for almost 108 million Americans. These federal programs also provide health care to a greater number of women than any other single source in America. 

Together, their coverage includes several reproductive and sexual health care services — like wellness exams, STD tests and treatment, cancer screenings and treatment, prenatal and postnatal care, and labor and delivery. 

Medicaid: America’s #1 Source for Reproductive Health Care

When you think of Medicaid, think of it as THE reproductive health care program in the United States. Here’s why:

Women and girls are the majority of Medicaid’s 75 million enrollees. 

Medicaid covers more women’s health care than any other payer.

Nationwide, Medicaid covers one in five (21%) of all women and girls of reproductive age. That’s 13.2 million people ages 15 to 44 years old. 

Medicaid covers nearly half of all births and 75% of family planning services.

Medicaid Serves People of Color

Due to racism and other systemic barriers that have contributed to income inequality, women of color disproportionately comprise the Medicaid population, or roughly 57% of women in the program overall. And they are also over-represented given their share of the general population. For example, 30% of African-American women and 24% of Hispanic women are enrolled in Medicaid, compared to only 14% of white women. 

Why is that important to know? Because any limits on Medicaid hurt women of color in particular. 

One example of a limit on Medicaid that hurts women of color: states refusing to adopt Medicaid expansion. As a result of the Affordable Care Act, adults who don’t have children and have incomes at or below 138% of the federal poverty level are entitled to Medicaid coverage if their states choose to expand Medicaid. To date, 37 states (including D.C.) have adopted the Medicaid expansion, and 14 states haven’t adopted the expansion. States that haven’t adopted Medicaid expansion lag behind in covering people with low incomes and vulnerable populations.

Medicare: Meeting Your Health Care Needs Later in Life

Similar to Medicaid, the majority (56%) of Medicare’s older enrollees are women. That’s 24 million women, ages 65 and up.

Medicare covers some of the same sexual and reproductive health services as Medicaid, but not all. Whereas Medicaid always covers birth control, only some Medicare plans do. That’s because Medicare focuses on the needs of older adults. To that end, Medicare covers special services for older women — like bone density screenings and medication for post-menopausal osteoporosis. 

Because of the gender pay gap throughout their lives, older women are more likely to live in poverty and qualify for Medicaid than older men. Of the 50 million Medicare users age 65 and up, more than half (56%) are women. The gender disparity grows larger as people age: Two of every three Medicaid beneficiaries age 85 and up are women.

Who Pays for Medicaid & Medicare?

Medicaid is a jointly-run federal and state health insurance program.  This means both state and federal tax dollars pay for Medicaid. 

Medicare isn’t a joint federal-state program. Instead, Medicare is a federal insurance program. So, your federal tax dollars mostly pay for Medicare.

Do Planned Parenthood Health Centers Take Medicaid and Medicare?

Most Planned Parenthood health centers accept Medicaid, and some providers at Planned Parenthood health centers accept Medicare. Find a Planned Parenthood health center near you to learn what insurance plans they accept. You can also call 1-800-230-PLAN to speak with a Planned Parenthood staff member who can help you figure out coverage and costs. 

Whether you have Medicaid, Medicare, any other insurance, or no insurance at all, you can always visit your local Planned Parenthood health center for the care you need, when you need it.

Can Medicaid and Medicare Cover Abortion?

No, in most cases, you can’t use Medicaid, Medicare, or any other federal health insurance program for abortion. 

An unfair policy called the Hyde Amendment blocks federal funding for abortion with three narrow exceptions: when the pregnancy could kill the patient, or when the pregnancy results from rape or incest. Federal health programs cannot cover abortion even when a patient’s health is at risk and their health care provider recommends they get an abortion.

Still, 16 states with pro-reproductive health leaders have taken the bold step to cover safe, legal abortion with state funds for people who use Medicaid. That includes 15 states already covering it and Maine, whose coverage law will go into effect March 2020.

Failed Efforts to “Defund” Planned Parenthood Have Targeted Medicaid Beneficiaries 

Anti-abortion politicians in the Trump-Pence administration, Congress, and certain statehouses across the country are trying to put safe, legal abortion out of reach. One of their key tactics is attempting to shut down Planned Parenthood through legislation they misleadingly named “defunding.” They made up that misnomer to confuse people about how funding works at Planned Parenthood. 

“Defunding” policies block patients who use public health care programs — like Medicaid and Medicare — from accessing preventive health care at Planned Parenthood health centers. Preventive health care includes birth control, STD testing and treatment, and cancer screenings.

The politicians behind “defunding” don’t care that their policies make Planned Parenthood patients lose access to lifesaving preventive care. “Defunding” has one goal: to shut down Planned Parenthood and make safe, legal abortion harder to access (along with a lot of other sexual and reproductive health services).

Getting Political

The U.S. Department of Health and Human Services (HHS)’s Centers for Medicaid and Medicare Services (CMS) oversees the two programs. How you get your health care in the United States depends on what HHS prioritizes. And changes politicians make to Medicaid, Medicare and CHIP mean the difference between millions of people getting reproductive and sexual health care — or not. 

Right now, CMS is overseen by Seema Verma, a former corporate health care consultant who thinks maternity coverage should be optional and made millions of dollars dismantling Medicaid in Indiana. Meanwhile, the Trump administration has forced Planned Parenthood out of the Title X program through a dangerous gag rule. 

If you care about health care access in America, stay up-to-date on the politics behind Medicaid and Medicare. Visit PlannedParenthoodAction.org to learn more and get involved. 

Open Enrollment

You may qualify for low-cost or free health insurance through Medicaid or the Children’s Health Insurance Program (CHIP), depending on your income and what state you live in. If you qualify for either program, you can enroll anytime without waiting for the enrollment period. To find out if you’re eligible for Medicaid or CHIP, visit your state’s Medicaid agency. 

-Miriam at Planned Parenthood

[bestpediatricnephrologistinindia]

Disparities in dialysis in children | Dr. Sidharth Kumar Sethi

Disparities In Dialysis In Children

HYPOTHESIS: Acute kidney injury (AKI) is a common cause of morbidity and mortality worldwide, with a pediatric incidence ranging from 19.3% to 24.1%. Treatment of pediatric AKI is a source of debate in varying geographical regions. Currently CRRT is the treatment for pediatric AKI, but limitations due to cost and accessibility force use of adult equipment and other therapeutic options such as peritoneal dialysis (PD) and hemodialysis (HD). It was hypothesized that more cost-effective measures would likely be used in developing countries due to lesser resource availability.

METHODS: A 26-question internet-based survey was distributed to 650 pediatric Nephrologists. There was a response rate of 34.3% (223 responses). The survey was distributed via pedneph and pcrrt email servers, inquiring about demographics, technology, resources, pediatric-specific supplies, and preference in renal replacement therapy (RRT) in pediatric AKI. The main method of analysis was to compare responses about treatments between nephrologists in developed countries and nephrologists in developing countries using difference-of-proportions tests.

RESULTS: PD was available in all centers surveyed, while HD was available in 85.1% and 54.1% (p = 0.00), CRRT was available in 60% and 33.3% (p = 0.001), and SLED was available in 20% and 25% (p = 0.45) centers of developed and developing world respectively. In developing countries, 68.5% (p = 0.000) of physicians preferred PD to costlier therapies, while in developed countries it was found that physicians favored HD (72%, p = 0.00) or CRRT (24%, p = 0.041) in infants.

CONCLUSIONS: Lack of availability of resources, trained physicians and funds often preclude standards of care in developing countries, and there is much development needed in terms of meeting higher global standards for treating pediatric AKI patients. PD remains the main modality of choice for treatment of AKI in infants in developing world.

About Dr.

Dr. Sidharth Kumar SethiKidney & Urology Institute

He was trained as a Fellow (International Pediatric Nephrology Association Fellowship) and Senior Resident in Pediatric Nephrology at All India Institute of Medical Sciences and Division of Pediatric Nephrology and Transplant Immunology, Cedars Sinai Medical Centre, Los Angeles, California. He has been actively involved in the care of children with all kinds of complex renal disorders, including nephrotic syndrome, tubular disorders, urinary tract infections, hypertension, chronic kidney disease, and renal transplantation. He has been a part of 8-member writing committee for the guidelines of Steroid Sensitive Nephrotic Syndrome and Expert committee involved in the formulation of guidelines of Pediatric Renal Disorders including Steroid Resistant Nephrotic Syndrome and urinary tract infections. He has more than 30 indexed publications in Pediatric Nephrology and chapters in reputed textbooks including Essential Pediatrics (Editors O.P. Ghai) and “Pediatric Nephrology” (Editors A Bagga, RN Srivastava). He is a part of Editorial Board of “World Journal of Nephrology” and “eAJKD- Web version of American Journal of Kidney Diseases”. He is a reviewer for Pediatric Nephrology related content for various Pediatric and Nephrology journals

Tags = Pediatric Dialysis Specialist in India, Pediatric Dialysis Specialist in delhi, Pediatric Nephrology India, Best Pediatric Nephrologist in Delhi

For more information = http://www.pediatricnephrologyindia.com/

See more blogs = https://child-kidney-specialist-in-delhi.blogspot.com/2022/06/what-is-nephrotic-syndrome-and-what.html

[kidneyfoundationohio]

2022 Person of the Year

Established in 1992, each year, this award is given to an individual or partner organization for their outstanding leadership and contributions in the field of nephrology, and their dedication and service to the mission of the Kidney Foundation of Ohio.

The 2022 Person of the Year is Hernan Rincon-Choles, MD, MS, MBA, FASN, Staff Nephrologist at the Cleveland Clinic Glickman Urological & Kidney Institute Department of Kidney Medicine and Assistant Professor of Medicine at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. 

Hernan Rincon-Choles was born in Cartagena, Colombia, South America. He is the eldest of 9 children. He obtained his medical degree from the Universidad de Cartagena, in Cartagena, Colombia, South America, in 1989 and practiced as a General Practitioner until 1992. He came to the United States and trained in Internal Medicine at New York Medical College, Our Lady of Mercy Medical Campus in the Bronx, New York, from 1993 to 1996. He practiced as a general internist in Corpus Christi, Texas until 1999 and then joined the nephrology fellowship program at the University of Texas Health Science Center in San Antonio and the South Texas Veterans Health Care System in San Antonio, Texas in 1999 where he did a basic science post-doctoral research fellowship investigating the pathobiology of diabetic nephropathy and mechanisms of proteinuria, participated in the development of animal models of diabetic nephropathy, joined as a Clinical Instructor of Medicine in 2002 and was then promoted to Assistant Professor of Medicine in 2003. He obtained a Master’s degree in Clinical Science in 2005, was the Medical Director for University Dialysis Southeast Dialysis Center from 2003 to 2004, and was co-Director of the Nephrology Fellowship Program from 2004 to 2006.

He then moved to Syracuse, New York, where he worked as a hospitalist at Saint Joseph’s Hospital in 2006, joined a private practice nephrology group from 2007 to 2010, participated in an academic hospitalist-nocturnist program at the Syracuse Veterans Administration Hospital from 2010 to 2013, joined the State University of New York Upstate Medical University as Assistant Professor of Medicine from 2010 to 2013, obtained the Satki Mookherjee Faculty Teaching Award 2011-2012 from the Department of Medicine, and participated as nocturnist for Crouse Hospital from 2011 to 2013.

Dr. Rincon-Choles receiving the 2022 Person of the Year Award at the 30th Annual Gala from Dr. Crystal Gadegbeku, Chair of the Glickman Urological and Kidney Institute Department of Kidney Medicine

He joined the Glickman Urological and Kidney Institute Department of Nephrology in 2013, pursuing his interest in critical care nephrology, health disparities, chronic kidney disease, and end-stage kidney disease. He is assistant Professor of Medicine at the Cleveland Clinic Lerner College of Medicine of the Case Western Reserve University. He has research interest into the pathogenesis, epidemiology and treatment of chronic kidney disease and participates as a Co-Principal Investigator, event adjudicator, and writing committee member for the Chronic Renal Insufficiency Cohort (CRIC) Study, Cleveland Clinic Site.

Dr. Hernan Rincon-Choles and Linda, a patient of his who he tirelessly worked to get on the kidney transplant list.

 Hernan is interested in improving medical care for minority populations. He served as the Medical Director for the Ohio Renal Care Group Huron Dialysis Center and ran a renal clinic from 2014 to 2021 at Stephanie Tubbs Jones Family Health Center in East Cleveland, Ohio. He is currently running a renal clinic for the Hispanic community at Lutheran Hospital in Cleveland, Ohio. He helped run the annual Minority Men’s Health Fair at the Glickman Urological and Kidney Institute Department of Nephrology and Hypertension at the Cleveland Clinic Foundation in Cleveland, OH, from 2014 to 2020.

He participates as an advisor on the Medical Advisory Board for the Kidney Foundation of Ohio, and the Patient Symposium Committee and Advocacy Committee of the National Kidney Foundation. He also served as the Medical Chairman of the Northeast Ohio National Kidney Foundation Kidney Walk from 2018 to 2022, and participated as an Advisor to the National Committee for Quality Assurance’s Chronic Kidney Disease Disparities: Guide for Primary Care, prepared for the Centers for Medicaid and Medicare Services in August 2019.

He is a reviewer for the Annals of Thoracic Surgery and for the Cleveland Clinic Journal of Medicine, ASN NEPHSAP and KSAP panel reviewer group, and completed a Healthcare MBA at Baldwin Wallace University in 2020.

He is married to Barbara (Rachel) Pollack-Rincon, and has a son, Hernan Benjamin Rincon, and a daughter, Jennifer Gloria Rincon.

Dr. Hernan Rincon-Choles and his wife, Rachel

[bestofferes]

What’s behind racial disparities in kidney disease? - . Health Blog

What’s behind racial disparities in kidney disease? – . Health Blog

My first exposure to kidney disease and its effects on color communities was in high school. An elderly neighbor who was like a grandfather to me was diagnosed with kidney failure. Around the same time, my older first cousin, who had children my age, started dialysis for kidney failure caused by high blood pressure. She was going to have a kidney transplant. If you ask an African American, he or…

[1truhealth]

What’s behind racial disparities in kidney disease?

What’s behind racial disparities in kidney disease?

My first exposure to kidney disease and its impact on communities of color occurred when I was in high school. An elderly neighbor, who was like a grandfather to me, had been diagnosed with kidney failure. At about the same time, my older first cousin, who had children about my age, was starting dialysis due to kidney failure attributed to hypertension. She would go on to get a kidney transplant.…

[gordonwilliamsweb]

Why Black Aging Matters, Too

Old. Chronically ill. Black.

People who fit this description are more likely to die from COVID-19 than any other group in the country.

They are perishing quietly, out of sight, in homes and apartment buildings, senior housing complexes, nursing homes and hospitals, disproportionately poor, frail and ill, after enduring a lifetime of racism and its attendant adverse health effects.

Yet, older Black Americans have received little attention as protesters proclaim that Black Lives Matter and experts churn out studies about the coronavirus.

“People are talking about the race disparity in COVID deaths, they’re talking about the age disparity, but they’re not talking about how race and age disparities interact: They’re not talking about older Black adults,” said Robert Joseph Taylor, director of the Program for Research on Black Americans at the University of Michigan’s Institute for Social Research.

A KHN analysis of data from the Centers for Disease Control and Prevention underscores the extent of their vulnerability. It found that African Americans ages 65 to 74 died of COVID-19 five times as often as whites. In the 75-to-84 group, the death rate for Blacks was 3½ times greater. Among those 85 and older, Blacks died twice as often. In all three age groups, death rates for Hispanics were higher than for whites but lower than for Blacks.

(The gap between Blacks and whites narrows over time because advanced age, itself, becomes an increasingly important, shared risk. Altogether, 80% of COVID-19 deaths are among people 65 and older.)

The data comes from the week that ended Feb. 1 through Aug. 8. Although breakdowns by race and age were not consistently reported, it is the best information available.

Mistrustful of Outsiders

Social and economic disadvantage, reinforced by racism, plays a significant part in unequal outcomes. Throughout their lives, Blacks have poorer access to health care and receive services of lower quality than does the general population. Starting in middle age, the toll becomes evident: more chronic medical conditions, which worsen over time, and earlier deaths.

Several conditions — diabetes, chronic kidney disease, obesity, heart failure and pulmonary hypertension, among others — put older Blacks at heightened risk of becoming seriously ill and dying from COVID-19.

Yet many vulnerable Black seniors are deeply distrustful of government and health care institutions, complicating efforts to mitigate the pandemic’s impact.

The infamous Tuskegee syphilis study — in which African American participants in Alabama were not treated for their disease — remains a shocking, indelible example of racist medical experimentation. Just as important, the lifelong experience of racism in health care settings — symptoms discounted, needed treatments not given — leaves psychic scars.

In Seattle, Catholic Community Services sponsors the African American Elders Program, which serves nearly 400 frail homebound seniors each year.

“A lot of Black elders in this area migrated from the South a long time ago and were victims of a lot of racist practices growing up,” said Margaret Boddie, 77, who directs the program. “With the pandemic, they’re fearful of outsiders coming in and trying to tell them how to think and how to be. They think they’re being targeted. There’s a lot of paranoia.”

“They won’t open the door to people they don’t know, even to talk,” complicating efforts to send in social workers or nurses to provide assistance, Boddie said.

In Los Angeles, Karen Lincoln directs Advocates for African American Elders and is an associate professor of social work at the University of Southern California.

“Health literacy is a big issue in the older African American population because of how people were educated when they were young,” she said. “My maternal grandmother, she had a third-grade education. My grandfather, he made it to the fifth grade. For many people, understanding the information that’s put out, especially when it changes so often and people don’t really understand why, is a challenge.”

What this population needs, Lincoln suggested, is “help from people who they can relate to” — ideally, a cadre of African American community health workers.

With suspicion running high, older Blacks are keeping to themselves and avoiding health care providers.

“Testing? I know only of maybe two people who’ve been tested,” said Mardell Reed, 80, who lives in Pasadena, California, and volunteers with Lincoln’s program. “Taking a vaccine [for the coronavirus]? That is just not going to happen with most of the people I know. They don’t trust it and I don’t trust it.”

Reed has high blood pressure, anemia, arthritis and thyroid and kidney disease, all fairly well controlled. She rarely goes outside because of COVID-19. “I’m just afraid of being around people,” she admitted.

Other factors contribute to the heightened risk for older Blacks during the pandemic. They have fewer financial resources to draw upon and fewer community assets (such as grocery stores, pharmacies, transportation, community organizations that provide aging services) to rely on in times of adversity. And housing circumstances can contribute to the risk of infection.

In Chicago, Gilbert James, 78, lives in a 27-floor senior housing building, with 10 apartments on each floor. But only two of the building’s three elevators are operational at any time. Despite a “two-person-per-elevator policy,” people crowd onto the elevators, making it difficult to maintain social distance.

“The building doesn’t keep us updated on how they’re keeping things clean or whether people have gotten sick or died” of COVID-19, James said. Nationally, there are no efforts to track COVID-19 in low-income senior housing and little guidance about necessary infection control.

Large numbers of older Blacks also live in intergenerational households, where other adults, many of them essential workers, come and go for work, risking exposure to the coronavirus. As children return to school, they, too, are potential vectors of infection.

‘Striving Yet Never Arriving’

In recent years, the American Psychological Association has called attention to the impact of racism-related stress in older African Americans — yet another source of vulnerability.

This toxic stress, revived each time racism becomes manifest, has deleterious consequences to physical and mental health. Even racist acts committed against others can be a significant stressor.

“This older generation went through the civil rights movement. Desegregation. Their kids went through busing. They grew up with a knee on their neck, as it were,” said Keith Whitfield, provost at Wayne State University and an expert on aging in African Americans. “For them, it was an ongoing battle, striving yet never arriving. But there’s also a lot of resilience that we shouldn’t underestimate.”

This year, for some elders, violence against Blacks and COVID-19’s heavy toll on African American communities have been painful triggers. “The level of stress has definitely increased,” Lincoln said.

During ordinary times, families and churches are essential supports, providing practical assistance and emotional nurturing. But during the pandemic, many older Blacks have been isolated.

In her capacity as a volunteer, Reed has been phoning Los Angeles seniors. “For some of them, I’m the first person they’ve talked to in two to three days. They talk about how they don’t have anyone. I never knew there were so many African American elders who never married and don’t have children,” she said.

Meanwhile, social networks that keep elders feeling connected to other people are weakening.

“What is especially difficult for elders is the disruption of extended support networks, such as neighbors or the people they see at church,” said Taylor, of the University of Michigan. “Those are the ‘Hey, how are you doing? How are your kids? Anything you need?’ interactions. That type of caring is very comforting and it’s now missing.”

In Brooklyn, New York, Barbara Apparicio, 77, has been having Bible discussions with a group of church friends on the phone each weekend. Apparicio is a breast cancer survivor who had a stroke in 2012 and walks with a cane. Her son and his family live in an upstairs apartment, but she does not see him much.

“The hardest part for me [during this pandemic] has been not being able to go out to do the things I like to do and see people I normally see,” she said.

In Atlanta, Celestine Bray Bottoms, 83, who lives on her own in an affordable senior housing community, is relying on her faith to pull her through what has been a very difficult time. Bottoms was hospitalized with chest pains this month — a problem that persists. She receives dialysis three times a week and has survived leukemia.

“I don’t like the way the world is going. Right now, it’s awful,” she said. “But every morning when I wake up, the first thing I do is thank the Lord for another day. I have a strong faith and I feel blessed because I’m still alive. And I’m doing everything I can not to get this virus because I want to be here a while longer.”

KHN data editor Elizabeth Lucas contributed to this story.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Why Black Aging Matters, Too published first on https://nootropicspowdersupplier.tumblr.com/

[pediatricnephrologyindia]

Pediatric Continuous Renal Replacement Therapy (PCRRT)

Pediatric Continuous Renal Replacement Therapy  (PCRRT) Expert Committee Recommendation On Prescribing Prolonged Intermittent Renal Replacement Therapy (PIRRT) In Critically Ill Children

Introduction

Recently, prolonged intermittent renal replacement therapies (PIRRT) have emerged as cost‐effective alternatives to conventional CRRT and their use in the pediatric population has started to become more prominent. However, there is a lack of consensus guidelines on the use of PIRRT in pediatric patients in an intensive care setting.

Methods

A literature search was performed on PubMed/Medline, Embase, and Google Scholar in conjunction with medical librarians from both India and the Cleveland Clinic hospital system to find relevant articles. The Pediatric Continuous Renal Replacement Therapy workgroup analyzed all articles for relevancy, proposed recommendations, and graded each recommendation for their strength of evidence.

Results

Of the 60 studies eligible for review, the workgroup considered data from 37 studies to formulate guidelines for the use of PIRRT in children. The guidelines focused on the definition, indications, machines, and prescription of PIRRT.

Conclusion

Although the literature on the use of PIRRT in children is limited, the current studies give credence to their benefits and these expert recommendations are a valuable first step in the continued study of PIRRT in the pediatric population.

Tag: Best Pediatric Nephrologist in Delhi, Disparities In Dialysis In Children,

Nephrotic syndrome Specialist in India

[dinafbrownil]

Why Black Aging Matters, Too

Old. Chronically ill. Black.

People who fit this description are more likely to die from COVID-19 than any other group in the country.

They are perishing quietly, out of sight, in homes and apartment buildings, senior housing complexes, nursing homes and hospitals, disproportionately poor, frail and ill, after enduring a lifetime of racism and its attendant adverse health effects.

Yet, older Black Americans have received little attention as protesters proclaim that Black Lives Matter and experts churn out studies about the coronavirus.

“People are talking about the race disparity in COVID deaths, they’re talking about the age disparity, but they’re not talking about how race and age disparities interact: They’re not talking about older Black adults,” said Robert Joseph Taylor, director of the Program for Research on Black Americans at the University of Michigan’s Institute for Social Research.

A KHN analysis of data from the Centers for Disease Control and Prevention underscores the extent of their vulnerability. It found that African Americans ages 65 to 74 died of COVID-19 five times as often as whites. In the 75-to-84 group, the death rate for Blacks was 3½ times greater. Among those 85 and older, Blacks died twice as often. In all three age groups, death rates for Hispanics were higher than for whites but lower than for Blacks.

(The gap between Blacks and whites narrows over time because advanced age, itself, becomes an increasingly important, shared risk. Altogether, 80% of COVID-19 deaths are among people 65 and older.)

The data comes from the week that ended Feb. 1 through Aug. 8. Although breakdowns by race and age were not consistently reported, it is the best information available.

Mistrustful of Outsiders

Social and economic disadvantage, reinforced by racism, plays a significant part in unequal outcomes. Throughout their lives, Blacks have poorer access to health care and receive services of lower quality than does the general population. Starting in middle age, the toll becomes evident: more chronic medical conditions, which worsen over time, and earlier deaths.

Several conditions — diabetes, chronic kidney disease, obesity, heart failure and pulmonary hypertension, among others — put older Blacks at heightened risk of becoming seriously ill and dying from COVID-19.

Yet many vulnerable Black seniors are deeply distrustful of government and health care institutions, complicating efforts to mitigate the pandemic’s impact.

The infamous Tuskegee syphilis study — in which African American participants in Alabama were not treated for their disease — remains a shocking, indelible example of racist medical experimentation. Just as important, the lifelong experience of racism in health care settings — symptoms discounted, needed treatments not given — leaves psychic scars.

In Seattle, Catholic Community Services sponsors the African American Elders Program, which serves nearly 400 frail homebound seniors each year.

“A lot of Black elders in this area migrated from the South a long time ago and were victims of a lot of racist practices growing up,” said Margaret Boddie, 77, who directs the program. “With the pandemic, they’re fearful of outsiders coming in and trying to tell them how to think and how to be. They think they’re being targeted. There’s a lot of paranoia.”

“They won’t open the door to people they don’t know, even to talk,” complicating efforts to send in social workers or nurses to provide assistance, Boddie said.

In Los Angeles, Karen Lincoln directs Advocates for African American Elders and is an associate professor of social work at the University of Southern California.

“Health literacy is a big issue in the older African American population because of how people were educated when they were young,” she said. “My maternal grandmother, she had a third-grade education. My grandfather, he made it to the fifth grade. For many people, understanding the information that’s put out, especially when it changes so often and people don’t really understand why, is a challenge.”

What this population needs, Lincoln suggested, is “help from people who they can relate to” — ideally, a cadre of African American community health workers.

With suspicion running high, older Blacks are keeping to themselves and avoiding health care providers.

“Testing? I know only of maybe two people who’ve been tested,” said Mardell Reed, 80, who lives in Pasadena, California, and volunteers with Lincoln’s program. “Taking a vaccine [for the coronavirus]? That is just not going to happen with most of the people I know. They don’t trust it and I don’t trust it.”

Reed has high blood pressure, anemia, arthritis and thyroid and kidney disease, all fairly well controlled. She rarely goes outside because of COVID-19. “I’m just afraid of being around people,” she admitted.

Other factors contribute to the heightened risk for older Blacks during the pandemic. They have fewer financial resources to draw upon and fewer community assets (such as grocery stores, pharmacies, transportation, community organizations that provide aging services) to rely on in times of adversity. And housing circumstances can contribute to the risk of infection.

In Chicago, Gilbert James, 78, lives in a 27-floor senior housing building, with 10 apartments on each floor. But only two of the building’s three elevators are operational at any time. Despite a “two-person-per-elevator policy,” people crowd onto the elevators, making it difficult to maintain social distance.

“The building doesn’t keep us updated on how they’re keeping things clean or whether people have gotten sick or died” of COVID-19, James said. Nationally, there are no efforts to track COVID-19 in low-income senior housing and little guidance about necessary infection control.

Large numbers of older Blacks also live in intergenerational households, where other adults, many of them essential workers, come and go for work, risking exposure to the coronavirus. As children return to school, they, too, are potential vectors of infection.

‘Striving Yet Never Arriving’

In recent years, the American Psychological Association has called attention to the impact of racism-related stress in older African Americans — yet another source of vulnerability.

This toxic stress, revived each time racism becomes manifest, has deleterious consequences to physical and mental health. Even racist acts committed against others can be a significant stressor.

“This older generation went through the civil rights movement. Desegregation. Their kids went through busing. They grew up with a knee on their neck, as it were,” said Keith Whitfield, provost at Wayne State University and an expert on aging in African Americans. “For them, it was an ongoing battle, striving yet never arriving. But there’s also a lot of resilience that we shouldn’t underestimate.”

This year, for some elders, violence against Blacks and COVID-19’s heavy toll on African American communities have been painful triggers. “The level of stress has definitely increased,” Lincoln said.

During ordinary times, families and churches are essential supports, providing practical assistance and emotional nurturing. But during the pandemic, many older Blacks have been isolated.

In her capacity as a volunteer, Reed has been phoning Los Angeles seniors. “For some of them, I’m the first person they’ve talked to in two to three days. They talk about how they don’t have anyone. I never knew there were so many African American elders who never married and don’t have children,” she said.

Meanwhile, social networks that keep elders feeling connected to other people are weakening.

“What is especially difficult for elders is the disruption of extended support networks, such as neighbors or the people they see at church,” said Taylor, of the University of Michigan. “Those are the ‘Hey, how are you doing? How are your kids? Anything you need?’ interactions. That type of caring is very comforting and it’s now missing.”

In Brooklyn, New York, Barbara Apparicio, 77, has been having Bible discussions with a group of church friends on the phone each weekend. Apparicio is a breast cancer survivor who had a stroke in 2012 and walks with a cane. Her son and his family live in an upstairs apartment, but she does not see him much.

“The hardest part for me [during this pandemic] has been not being able to go out to do the things I like to do and see people I normally see,” she said.

In Atlanta, Celestine Bray Bottoms, 83, who lives on her own in an affordable senior housing community, is relying on her faith to pull her through what has been a very difficult time. Bottoms was hospitalized with chest pains this month — a problem that persists. She receives dialysis three times a week and has survived leukemia.

“I don’t like the way the world is going. Right now, it’s awful,” she said. “But every morning when I wake up, the first thing I do is thank the Lord for another day. I have a strong faith and I feel blessed because I’m still alive. And I’m doing everything I can not to get this virus because I want to be here a while longer.”

KHN data editor Elizabeth Lucas contributed to this story.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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from Updates By Dina https://khn.org/news/why-black-aging-matters-too/

[stephenmccull]

Why Black Aging Matters, Too

Old. Chronically ill. Black.

People who fit this description are more likely to die from COVID-19 than any other group in the country.

They are perishing quietly, out of sight, in homes and apartment buildings, senior housing complexes, nursing homes and hospitals, disproportionately poor, frail and ill, after enduring a lifetime of racism and its attendant adverse health effects.

Yet, older Black Americans have received little attention as protesters proclaim that Black Lives Matter and experts churn out studies about the coronavirus.

“People are talking about the race disparity in COVID deaths, they’re talking about the age disparity, but they’re not talking about how race and age disparities interact: They’re not talking about older Black adults,” said Robert Joseph Taylor, director of the Program for Research on Black Americans at the University of Michigan’s Institute for Social Research.

A KHN analysis of data from the Centers for Disease Control and Prevention underscores the extent of their vulnerability. It found that African Americans ages 65 to 74 died of COVID-19 five times as often as whites. In the 75-to-84 group, the death rate for Blacks was 3½ times greater. Among those 85 and older, Blacks died twice as often. In all three age groups, death rates for Hispanics were higher than for whites but lower than for Blacks.

(The gap between Blacks and whites narrows over time because advanced age, itself, becomes an increasingly important, shared risk. Altogether, 80% of COVID-19 deaths are among people 65 and older.)

The data comes from the week that ended Feb. 1 through Aug. 8. Although breakdowns by race and age were not consistently reported, it is the best information available.

Mistrustful of Outsiders

Social and economic disadvantage, reinforced by racism, plays a significant part in unequal outcomes. Throughout their lives, Blacks have poorer access to health care and receive services of lower quality than does the general population. Starting in middle age, the toll becomes evident: more chronic medical conditions, which worsen over time, and earlier deaths.

Several conditions — diabetes, chronic kidney disease, obesity, heart failure and pulmonary hypertension, among others — put older Blacks at heightened risk of becoming seriously ill and dying from COVID-19.

Yet many vulnerable Black seniors are deeply distrustful of government and health care institutions, complicating efforts to mitigate the pandemic’s impact.

The infamous Tuskegee syphilis study — in which African American participants in Alabama were not treated for their disease — remains a shocking, indelible example of racist medical experimentation. Just as important, the lifelong experience of racism in health care settings — symptoms discounted, needed treatments not given — leaves psychic scars.

In Seattle, Catholic Community Services sponsors the African American Elders Program, which serves nearly 400 frail homebound seniors each year.

“A lot of Black elders in this area migrated from the South a long time ago and were victims of a lot of racist practices growing up,” said Margaret Boddie, 77, who directs the program. “With the pandemic, they’re fearful of outsiders coming in and trying to tell them how to think and how to be. They think they’re being targeted. There’s a lot of paranoia.”

“They won’t open the door to people they don’t know, even to talk,” complicating efforts to send in social workers or nurses to provide assistance, Boddie said.

In Los Angeles, Karen Lincoln directs Advocates for African American Elders and is an associate professor of social work at the University of Southern California.

“Health literacy is a big issue in the older African American population because of how people were educated when they were young,” she said. “My maternal grandmother, she had a third-grade education. My grandfather, he made it to the fifth grade. For many people, understanding the information that’s put out, especially when it changes so often and people don’t really understand why, is a challenge.”

What this population needs, Lincoln suggested, is “help from people who they can relate to” — ideally, a cadre of African American community health workers.

With suspicion running high, older Blacks are keeping to themselves and avoiding health care providers.

“Testing? I know only of maybe two people who’ve been tested,” said Mardell Reed, 80, who lives in Pasadena, California, and volunteers with Lincoln’s program. “Taking a vaccine [for the coronavirus]? That is just not going to happen with most of the people I know. They don’t trust it and I don’t trust it.”

Reed has high blood pressure, anemia, arthritis and thyroid and kidney disease, all fairly well controlled. She rarely goes outside because of COVID-19. “I’m just afraid of being around people,” she admitted.

Other factors contribute to the heightened risk for older Blacks during the pandemic. They have fewer financial resources to draw upon and fewer community assets (such as grocery stores, pharmacies, transportation, community organizations that provide aging services) to rely on in times of adversity. And housing circumstances can contribute to the risk of infection.

In Chicago, Gilbert James, 78, lives in a 27-floor senior housing building, with 10 apartments on each floor. But only two of the building’s three elevators are operational at any time. Despite a “two-person-per-elevator policy,” people crowd onto the elevators, making it difficult to maintain social distance.

“The building doesn’t keep us updated on how they’re keeping things clean or whether people have gotten sick or died” of COVID-19, James said. Nationally, there are no efforts to track COVID-19 in low-income senior housing and little guidance about necessary infection control.

Large numbers of older Blacks also live in intergenerational households, where other adults, many of them essential workers, come and go for work, risking exposure to the coronavirus. As children return to school, they, too, are potential vectors of infection.

‘Striving Yet Never Arriving’

In recent years, the American Psychological Association has called attention to the impact of racism-related stress in older African Americans — yet another source of vulnerability.

This toxic stress, revived each time racism becomes manifest, has deleterious consequences to physical and mental health. Even racist acts committed against others can be a significant stressor.

“This older generation went through the civil rights movement. Desegregation. Their kids went through busing. They grew up with a knee on their neck, as it were,” said Keith Whitfield, provost at Wayne State University and an expert on aging in African Americans. “For them, it was an ongoing battle, striving yet never arriving. But there’s also a lot of resilience that we shouldn’t underestimate.”

This year, for some elders, violence against Blacks and COVID-19’s heavy toll on African American communities have been painful triggers. “The level of stress has definitely increased,” Lincoln said.

During ordinary times, families and churches are essential supports, providing practical assistance and emotional nurturing. But during the pandemic, many older Blacks have been isolated.

In her capacity as a volunteer, Reed has been phoning Los Angeles seniors. “For some of them, I’m the first person they’ve talked to in two to three days. They talk about how they don’t have anyone. I never knew there were so many African American elders who never married and don’t have children,” she said.

Meanwhile, social networks that keep elders feeling connected to other people are weakening.

“What is especially difficult for elders is the disruption of extended support networks, such as neighbors or the people they see at church,” said Taylor, of the University of Michigan. “Those are the ‘Hey, how are you doing? How are your kids? Anything you need?’ interactions. That type of caring is very comforting and it’s now missing.”

In Brooklyn, New York, Barbara Apparicio, 77, has been having Bible discussions with a group of church friends on the phone each weekend. Apparicio is a breast cancer survivor who had a stroke in 2012 and walks with a cane. Her son and his family live in an upstairs apartment, but she does not see him much.

“The hardest part for me [during this pandemic] has been not being able to go out to do the things I like to do and see people I normally see,” she said.

In Atlanta, Celestine Bray Bottoms, 83, who lives on her own in an affordable senior housing community, is relying on her faith to pull her through what has been a very difficult time. Bottoms was hospitalized with chest pains this month — a problem that persists. She receives dialysis three times a week and has survived leukemia.

“I don’t like the way the world is going. Right now, it’s awful,” she said. “But every morning when I wake up, the first thing I do is thank the Lord for another day. I have a strong faith and I feel blessed because I’m still alive. And I’m doing everything I can not to get this virus because I want to be here a while longer.”

KHN data editor Elizabeth Lucas contributed to this story.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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This story can be republished for free (details).

Why Black Aging Matters, Too published first on https://smartdrinkingweb.weebly.com/

[dara-steine]

Lisa Cooper on Why the Racism Roiling America Is a Public Health Issue

America, reeling from twin crises brought on by police brutality and a virus that takes disproportionate aim at people of color, must now reckon with the racism that paved the path for both.

To understand the challenges, Global Health NOW turned to Lisa Cooper, MD, MPH, a Bloomberg Distinguished Professor and director of the Johns Hopkins Center for Health Equity at the Johns Hopkins Bloomberg School of Public Health.

Also a practicing physician and director of the Johns Hopkins Urban Health Institute, Cooper has spent decades working to make health equity a core principle of all public health work. In this exclusive Q&A, she shares her thinking on racism's role in poor health outcomes for African Americans, why they have suffered more from COVID-19, and the search for solutions.

What do most people not understand about how the persistent experience of racism impacts the health of African Americans, and why is racism is a public health issue?

We just have so much evidence that racism negatively impacts health.

There have been centuries of a system that has created inequities in opportunities for people of color—and for African Americans, in particular—in this country. Having been brought to this country as slaves and subjected to forced labor and atrocities, there is that whole backdrop. And even after emancipation, there were laws put in place that preserved that system of inferiority for an entire race of people.

One really common form of institutional racism in our country has been racial segregation. And those neighborhoods didn’t have social investment, access to healthy food and safe environments from crime, education and employment opportunities, and access to health care. All of those things that determine whether or not people can be successful in society.

There is this myth that America is the land of equal opportunity, but it’s not.

The data on racial differences in health are tragic. Life expectancy for African Americans, for example, is 3.5 years shorter than for white Americans. What other disparities should people be aware of?

It starts from infancy. African Americans also have the highest infant mortality rates. African-American babies die at twice the rate of white babies before their first birthday.

And before birth, maternal mortality rates are about 3-4 times higher for African American mothers. African American children suffer more from conditions like asthma. Death rates from heart disease, diabetes are all much higher among African Americans than whites.

As a physician, have you seen African American patients suffering more?

I see them every week. I see women who are in their 30s who have heart disease, who had a stroke, or who have diabetes and are on the verge of having an amputation, of going blind—women and men of color.

I see young African Americans with kidney failure on dialysis not even 50 years old yet, who are disabled. It’s just incredible. When I see people, I’m often really shocked when they tell me how old they are. I expect them to tell me they’re older than I am, and I find out they’re 10 or more years younger.

Is it a coincidence that we’ve seen massive protests against racism during the COVID-19 pandemic?

I think it’s happening in the backdrop of this pandemic that has already created a lot of additional stresses and hardships on people of color.

People of color are overrepresented among frontline, essential workers, so they’ve been exposed to the virus from having to go to work at a time when a lot of other people can stay home or work from home.

The relationship between law enforcement and communities of color has been problematic for centuries as well.

The data shows that when there’s violence against minority communities by law enforcement, it impacts the mental health of that entire community.

Why are more African Americans dying of COVID-19, and suffering more from hardships related to the pandemic?

Before COVID-19, minority communities were already disproportionately impacted by social inequities. People in those communities already have higher rates of obesity, diabetes, heart disease, lung disease—so these are the folks who were actually going to be at more risk of getting seriously ill with COVID-19. And all the stresses: the financial stresses of being poor, the social stresses of being from a marginalized group with a history of institutionalized, sanctioned mistreatment by law enforcement and other large societal institutions.

There’s a confluence of all these different factors—not having access to food, not having access to good quality housing, crowded in small houses where there are multiple generations, unable to engage in social distancing, stock up on groceries for several weeks at a time, or having to use public transportation.

What can the public health community do to counter stigma against people of color with COVID-19?

What we can do is make the links between social conditions and health clearer.

A lot of the pushback emphasizes individual responsibility. So, if African Americans would just stop overeating and engaging in unhealthy behavior they wouldn’t be in that situation. But it isn’t that African Americans don’t know what they should and shouldn’t be eating, but that society has thrown up obstacles to choosing healthier behaviors.

What can be done right now to ease the toll of COVID-19 on black and minority communities?

Keeping an eye on the data is an important priority: knowing who is impacted, where they’re impacted.

Communication is also really important—making sure that the public understands why we might be seeing these patterns, and that it’s more about our society and the way our resources and opportunities are allocated than it is about individual behaviors. We need to do what we can to better understand the challenges of those communities and show empathy and concern.

We also need to focus on the frontline workers, and the low-wage workers, and understand their needs—providing protective equipment, safe spaces to work, paid sick leave, hazard pay, or health insurance and access to testing and care.

Let’s talk about solutions. Racism is so deeply ingrained in American life and so are the many social and economic inequities. What should the public health community be doing about racism?

We need to bring some of the health equity and social justice aspects of public health more into the mainstream of the curriculum—not just in courses and concentrations. It needs to be brought into all of our work.

Public health can also help set the tone for others to follow—like health care, law enforcement, transportation, housing—by exemplifying those principles in all of our work.

At the Urban Health Institute, our first goal is to facilitate collaborations and offer training and capacity building for academics and for communities to work together toward these evidence-informed strategies and to build “communities of opportunity.”

We’ve developed courses and workshops, and we’re exploring how to enhance them and make them more accessible to more stakeholders.

One thing I’m particularly excited about is the focus on anti-racism training for bystanders; that’s a very promising strategy for changing social norms. If someone is perpetrating racist and biased behavior, ensuring people around them are equipped to respond in such a way that it doesn’t go unchecked.

We’re also working hard to connect the resources of academic institutions and the health care system with policymakers in Baltimore to bring that translation of evidence into policy.

What makes you hopeful about the future?

I see people coming together in a way that they haven’t in a very long time. I see a lot of empathy and connections based on our shared vulnerability at this time.

Even if it seems unprecedented, there have been times in the past that our country and the world went through similar challenges. We are strong and resilient, and we have so many tools at our fingertips now that we didn’t have then. I think that there is hope, and we need to seize on that and not despair.

This is also an opportunity to remember how interconnected we are. Our fates are intertwined. The pandemic has shown us that more than ever that what happens to one of us affects all of us. If we want to be healthier and have more opportunities, it’s not enough to just worry about ourselves. We have to think about how what we do affects other people.

Source: https://www.globalhealthnow.org/2020-06/lisa-cooper-why-racism-roiling-america-public-health-issue?utm_source=Global+Health+NOW+Main+List&utm_campaign=10cc59cabd-EMAIL_CAMPAIGN_2020_06_04_04_27&utm_medium=email&utm_term=0_8d0d062dbd-10cc59cabd-2980849

[jasonheart1]

Undocumented woman almost dies weekly for help

DENVER (CNN) — Every Monday morning, like clockwork, one of Lucia's children or her husband drives her to the emergency room at Denver Health.

Lucia's body is broken; her head throbs. She is short of breath and nauseated, and she drifts in and out of consciousness. The 51-year-old mother of five is in kidney failure, a result of her Type 2 diabetes.

Lucia (whose last name has been withheld at her request because of her family's immigration status) is one of an estimated 6,500 undocumented immigrants in the United States who are living with end-stage renal disease, but only barely. The chronic condition requires ongoing kidney dialysis, without which a person would die in a matter of days.

For more than 650,000 American adults, end-stage renal disease is a manageable illness, treated with dialysis three times per week and covered by private health insurance, Medicare or Medicaid, no questions asked. But because Lucia is an undocumented immigrant, she is not eligible for traditional Medicare or Medicaid. And since she is unable to afford private medical insurance or pay for her expensive treatment out of pocket, she is forced to wait until her condition deteriorates to a life-threatening medical emergency.

She must wait to nearly die before she can be revived and brought back to life.

At that point, but not a moment sooner -- even though Lucia and her doctors know that her impending emergency is completely preventable -- Lucia receives care under the Emergency Medical Treatment and Labor Act. The 1986 law compels hospitals with emergency rooms to care for anyone and everyone whose life is in imminent danger, regardless of their citizenship status or ability to pay.

What's more, over the past five years of dealing with her disease, Lucia has learned that if she shows up at the hospital too early, she will be turned away because her life is not in immediate jeopardy. If she waits just a few minutes too late, she might need to be revived from cardiac arrest. Determining the precise minute to arrive at the ER is a critically important decision. Lucia's life depends on it.

Drowning in her own body

"The function of the kidneys is to filter blood of excess toxins and excess fluid," said Dr. Lilia Cervantes, a physician at Denver Health who is involved in Lucia's care. "When both kidneys stop working, people, on average, will live anywhere from 10 to 14 days. And so, to continue living, you need some process to filter blood, which is a dialysis machine.

"If you don't have dialysis, all that excess fluid and excess toxin builds up in the body," Cervantes said. "For example, if someone takes a spoonful of soup or a bite of watermelon or even a small gulp of water, your body isn't able to get rid of that through urine. Instead, it stays in their system."

For her part, Lucia knows that she cannot eat certain water-dense foods such as potatoes, tomatoes and oranges. "I even have to measure the water," she said through an interpreter. "I cannot drink a lot of water."

It's an unimaginable predicament to be in: needing water to live but knowing that consuming just a little too much of it could kill you.

"And so, for these patients, because they only come in ... once every seven days instead of the three times per week, [the excess fluid] stays in their body, and it goes into the lungs," Cervantes said. "It goes into their legs. Separate from that, the toxins build up, one of the most important toxins being potassium, which, at high levels, can make the heart stop."

The stark disparity between how American hospitals care for the insured versus the uninsured -- and undocumented -- is an issue Cervantes has dedicated her life and career to changing. She was motivated to transition from clinical work to more of a research role by another patient she treated, who ultimately died four years ago as a result of her illness.

"After Hilda passed away, I looked at the literature, and I found one article that was particularly interesting," Cervantes said. It was written by Dr. Barry M. Straube, who was then the chief medical officer for the federal government's Centers for Medicare and Medicaid Services. "And in it, he discussed this issue of emergency-only hemodialysis and said that until we have the right research, the cost-effectiveness analysis, the comparative analyses, to demonstrate that this type of care needs to change, that potentially we wouldn't change it until the right data are available. And so that's when I set off to really begin to build the body of research."

The Centers for Medicare and Medicaid Services, which is part of the US Department of Health and Human Services, is responsible for making decisions as to what is and isn't covered by Medicare, Medicaid and CHIP (the Children's Health Insurance Program). Although some of the agency's policies are black and white, others fall into a bit of a gray area, including what exactly defines a medical emergency -- namely, when someone like Lucia can be provided care.

At Denver Health, where Lucia receives treatment, the criteria for admission to emergency dialysis include toxic levels of potassium and other blood electrolytes, as well as symptoms such as severe shortness of breath, substantial nausea and vomiting, confusion and diminished mental status.

Some states, including California, New York, North Carolina and Washington, have initiated programs and set aside funds to provide standard dialysis to undocumented immigrants who need it -- before they are in critical condition. Not only is this type of treatment more manageable for patients, studies have shown that it saves the government and taxpayers a significant amount of money.

The economic and physical costs

A 2007 study conducted at the Baylor College of Medicine in Houston found that the cost of treating undocumented immigrants with emergency-only hemodialysis is 3.7 times more expensive than caring for them with standard dialysis three times per week. It's because patients like Lucia are so much sicker and require more care by the time they come in for treatment. And that money adds up -- to approximately $285,000 vs. $77,000 a year -- according to the study.

In her research at Denver Health, Cervantes found that five years after initiating dialysis, undocumented immigrants with end-stage renal disease who receive emergency-only hemodialysis have on average a 14 times greater risk of death compared with people who receive three-times-a-week dialysis.

In addition to the greater financial cost and the heavier toll this delayed treatment wreaks on the body, Cervantes found that many of her patients experience something she calls "death anxiety."

"Participants described the overwhelming distress their families experienced as they watched a loved one cope with symptom accumulation and fear of dying each week," Cervantes wrote in her research. "Parents described their children as depressed because they were afraid of losing their parent. Two participants described suicide attempts by their children. Participants preemptively said their goodbyes to their families each week because they were uncertain whether they would survive the process of waiting to be admitted or of undergoing hemodialysis under emergency conditions."

Lucia, for one, said she is at peace with her illness and doesn't worry anymore that she is not going to survive. She feels grateful for the limited care she receives here in the United States, because she is acutely aware of the reality that she would not be entitled to any care in her native Mexico and would almost certainly have died by now.

It is worth noting that Lucia and the other participants in Cervantes' study were diagnosed with kidney disease after arriving in the United States and did not enter the country to seek treatment.

"It's been really hard for my family," Lucia said. "The worst is for my son. ... He worries about me."

Every week, 18-year-old Alex watches his mother steadily decline, not able to do anything about it until she arrives at the precipice of death -- at which point, he will rush her to the hospital.

What particularly aggrieves Cervantes is that patients like Lucia are not eligible for organ transplants, even from a family member, but they are encouraged to give the gift of life and donate their organs when they die.

"I just want care to change so badly," Cervantes said, as she started to cry. "I can do all the research, but it's not until people actually listen ... [that] access can finally change."

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from Local News https://www.thedenverchannel.com/news/local-news/undocumented-immigrants-on-dialysis-forced-to-cheat-death-every-week

[csrgood]

Blue Cross And Blue Shield Of Texas To Launch $10-Million Statewide Initiative To Help Fight Chronic Diabetic Kidney Disease And Chronic Obstructive Pulmonary Disease

Blue Cross and Blue Shield of Texas (BCBSTX) announced today a new $10-million community investment Initiative to help raise awareness around the prevention and early detection of Chronic Diabetic Kidney Disease (CKD)1and Chronic Obstructive Pulmonary Disease (COPD)2– two conditions greatly impacting the life span, productivity and quality of life of Texans.

The initiative coincides with BCBSTX's new community investment strategy to focus its resources to meaningfully impact serious public health issues in Texas. The investments will be awarded through BCBSTX's Healthy Kids, Healthy Families® (HKHF) grants. BCBSTX will award up to $2 million annually to existing and new partners that are delivering improved health results in preventing CKD and COPD – or have the ability to build programs to help slow the progression of the two chronic diseases.

As the prevalence of diabetes has exploded to epidemic levels in the United States – with more than 29 million Americans living with the disease – chronic kidney disease primarily caused by diabetes and high blood pressure, has also soared and continues to grow. An estimated 11 percent of Texans live with diabetes, with many advancing to chronic complications at an alarming rate, according to the Texas Department of State Health Services.

Meanwhile, an estimated 5.5 percent of Texans suffer from COPD, many who are undiagnosed and according to BCBSTX claims data, many patients enter the healthcare system at an advanced stage. Roughly 85 to 90 percent of all COPD cases are caused by cigarette smoking, according to the American Lung Association. Environmental factors such as extended exposure to air pollution, secondhand smoke and dust, fumes and chemicals also play a role in developing COPD.

"We realize daily that as a statewide health insurance company, we are uniquely positioned to address issues affecting the health and wellness of Texans," said Dr. Dan McCoy, president of BCBSTX. "This new initiative builds on an already successful BCBSTX community investment history that has touched a myriad of public health issues and hundreds of community organizations statewide."

"Understanding that, we made the strategic decision to focus our community investment resources on a long-term effort to impact CKD and COPD because our claims data revealed these two chronic illnesses were not only driving up the cost of care, but also profoundly affecting the health and quality of life of thousands of Texans," McCoy continued.

Interestingly, CKD and COPD represent a tale of two chronic conditions affecting disparate populations of Texans in opposite ends of the state. In the southwest and southeast regions of Texas, BCBSTX claims data show higher incidents of diabetes largely affecting Latinos and African-Americans and in the North region, Caucasians are predominately affected with COPD.

Last year, BCBSTX claims data showed a 107 percent increase in diabetes with chronic conditions. If the trend continues, by 2021 the prevalence of BCBSTX members with diabetic complications will grow from 3 percent to 7 percent. Moreover, CKD is the leading cause of end stage renal disease (ESRD).

ESRD is the point where the kidneys no longer function in a manner that sustains life, requiring dialysis or transplant. In 1982, diabetes accounted for 27 percent of patients with ESRD. In 2012, that percentage had nearly doubled to 47 percent, BCBSTX data showed.

Texas has the third largest number of Chronic Kidney Disease (CKD) patients and the second highest expenditures for CKD in the United States, with an estimated 1 in 7 South Texas residents affected by this disease, and another 1 in 5 adults at high risk for developing symptoms, according to the Texas Kidney Foundation.

Conversely, cases of COPD are highest in the north region of Texas and affect more women with the highest mortality among Caucasian women. COPD patients tend to make less than $25,000 annually and are more likely to have insurance, but report that cost remains a barrier to access. The data also show that COPD patients tend to have a history of asthma and smoking (11 percent of COPD patients in Texas are still active smokers).

Nationally, about 15 million Americans have been diagnosed with COPD – the third most common cause of death in the country. However, if detected early, the chances of abating further damage to the lungs improve.

"Our new approach to community investment is a more focused strategy intended to deliver maximum results against CKD and COPD," said Dr. Esteban López, Chief Medical Officer BCBSTX. "This initiative will require stronger and more sustained collaborations with our existing partners, but also with those organizations that have been successful in developing programs to fight CKD and COPD. With this program, our goal is to demonstrate that we can make a measurable difference in improving the health of Texans. This new strategy also aligns with our Healthy Kids, Healthy Families® program."

Launched in 2011, HKHF started as a three-year initiative designed to improve the health and wellness of at least one million children through community investments. The program was extended as BCBSTX's ongoing commitment to the health and well-being of the children and families across Texas. To date, the HKHF program – which centers on nutrition, physical activity, disease prevention and management and supporting safe environments – has helped nearly three million children.

BCBSTX will begin considering proposals for our Healthy Kids, Healthy Families® grants on June 5. For more information on how to apply for a HKHF grant, please email txhkhfgrants@bcbstx.com or follow this link to begin the application process.

About Blue Cross and Blue Shield of Texas Blue Cross and Blue Shield of Texas (BCBSTX) – the only statewide, customer-owned health insurer in Texas – is the largest provider of health benefits in the state, working with nearly 80,000 physicians and healthcare practitioners, and 500 hospitals to serve more than 5 million members in all 254 counties. BCBSTX is a Division of Health Care Service Corporation (HCSC) (which operates Blue Cross and Blue Shield plans in Texas, Illinois, Montana, Oklahoma and New Mexico), the country's largest customer-owned health insurer, and fourth largest health insurer overall. Health Care Service Corporation is a Mutual Legal Reserve Company and an Independent Licensee of the Blue Cross and Blue Shield Association.

BCBSTX.com | Twitter.com/BCBSTX | Facebook.com/BlueCrossBlueShieldOfTexas |  YouTube.com/BCBSTX BCBSTX 2016 Social Responsibility Report

1National Kidney Foundation: CKD is the gradual loss of kidney function over time and inhibits the kidneys to remove waste products and fluids from the body.. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.

2American Lung Association: COPD is a chronic, progressive lung disease that can cause long-term disability and early death. The lung airways become inflamed and the tissue is destroyed where oxygen is exchanged, causing the flow of air to decrease to the lungs. When that happens, less oxygen enters body tissues and it becomes difficult to get rid of to get rid of the waste gas, carbon dioxide.

About Blue Cross Blue Sheidl Association Blue Cross Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for one in three Americans. For more information on the Blue Cross Blue Shield Association and its member companies, please visit BCBS.com. We encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out the BCBS Blog for up-to-date information about BCBSA.

source: http://www.csrwire.com/press_releases/40078-Blue-Cross-And-Blue-Shield-Of-Texas-To-Launch-10-Million-Statewide-Initiative-To-Help-Fight-Chronic-Diabetic-Kidney-Disease-And-Chronic-Obstructive-Pulmonary-Disease?tracking_source=rss