chapter 5

Question 1

dialysis

Answer 1

“the process of artificially removing metabolic end products and water across a semipermeable membrane by diffusion” (McAfee, 1987). The two most common types of dialysis are hemodialysis and peritoneal dialysis.

Question 2

Chronic kidney disease (CKD)

Answer 2

a gradual loss of kidney function classified into five stages, ranging from mild loss of kidney function in the early stages to severe or total loss in the later stages; in the final Stage 5, the individual’s kidneys are no longer able to perform the task of excreting the body’s wastes or promoting homeostasis, and the patient requires dialysis or kidney transplant to survive.

Question 3

renal replacement therapy (RRT)

Answer 3

a treatment that replaces kidney function. For chronic renal failure, the treatment typically is some type of dialysis, or it may be kidney transplantation.

Question 4

end-stage renal disease (ESRD)

Answer 4

stage 5 of chronic kidney disease, the extreme at which the patient has irreversible renal failure with little or no kidney function. When a patient is in end-stage renal disease, he or she requires either dialysis or a kidney transplant to maintain life.

Question 5

ESRD networks

Answer 5

organizations that have contracted with the Centers for Medicare & Medicaid Services (CMS) to assess the quality of care rendered to ESRD patients and to collect and analyze ESRD data.

Question 6

dialysis facility

Answer 6

“an entity that provides (1) outpatient maintenance dialysis services; or (2) home dialysis training and support services; or (3) both. A dialysis facility may be an independent or hospitalbased unit…or a self-care dialysis unit that furnishes only self-dialysis services” (Conditions for Coverage, 2008, p. 20476).

Question 7

hemodialysis (HD)

Answer 7

cleansing of the blood as it circulates through an artificial kidney machine outside of the patient’s body.

Question 8

Peritoneal dialysis (PD)

Answer 8

filling the patient’s abdominal cavity with a solution (dialysate). The semipermeable membrane across which the products diffuse is the patient’s own peritoneal membrane. The fluid containing the wastes is withdrawn later from the peritoneal cavity.

Question 9

dialysate

Answer 9

a solution used to filter products across a semipermeable membrane by the process of diffusion. Waste products filter into the dialysate from the blood, whereas certain other products, such as bicarbonates, filter into the blood from the dialysate.

Question 10

continuous ambulatory peritoneal dialysis (CAPD)

Answer 10

a form of peritoneal dialysis in which the patient is able to dialyze himself or herself three or four times a day without special assistance and with a minimum amount of equipment.

Question 11

Continuous cycling peritoneal dialysis (CCPD)

Answer 11

a form of peritoneal dialysis in which the patient uses a cycler machine to dialyze once a day for 9 or 10 hours, usually while sleeping.

Question 12

validation survey

Answer 12

a survey conducted by a regional office of the CMS to determine whether the surveys being conducted by state agencies (or other groups) are assessing the facility’s operations appropriately.

Question 13

renal bone disease

Answer 13

also known as renal osteodystrophy, a disorder that results from an imbalance in calcium, parathyroid hormone (PTH), phosphorus, and activated vitamin D, which can occur in chronic kidney disease. It can result in weakened bones that break easily, and also hardening of soft tissues of the body including the heart. Disorders of mineral metabolism are associated with a higher death rate in people with end-stage renal disease (ESRD).

Question 14

adequacy of dialysis

Answer 14

a determination of whether the patient’s dialysis treatment is removing sufficient waste and excess fluid from the body. To be adequate, the patient must dialyze long enough and often enough to achieve the goals of treatment. Adequate dialysis is essential to patient survival.

Question 15

Kt/V

Answer 15

a means of measuring the adequacy of dialysis (i.e., a way to determine whether the patient is dialyzing long enough or often enough to remove sufficient waste and excess fluid from the body). Target Kt/V values in the Conditions for Coverage are 1.2 for hemodialysis and a weekly Kt/V of at least 1.7 for peritoneal dialysis

Question 16

vascular access monitoring

Answer 16

physical examination of the dialysis access site to detect possible access complications. Types of monitoring include visual examination of the access site to detect changes, palpation (examination by touching), and auscultation (listening with a stethoscope).

Question 17

erythropoieis stimulating agents (ESAs)

Answer 17

agents that stimulate the bone marrow to make red blood cells and are used to treat and prevent anemia, a common complication of chronic kidney disease in patients on dialysis.

Question 18

Consolidated Renal Operations in a Web-enabled Network (CROWNWeb)

Answer 18

CMS internet-based software application, the required method by which dialysis facilities submit data about patients and facility operations.

Question 19

Renal Management Information System (REMIS)

Answer 19

a protocol that determines Medicare coverage periods for ESRD patients and serves as the primary mechanism to store and access information in the ESRD Program Management and Medical Information System (PMMIS) Database. REMIS tracks the ESRD patient population for both Medicare and non-Medicare patients.

Question 20

quality assessment and performance improvement (QAPI)

Answer 20

the Conditions for Coverage require each dialysis facility to adopt a data-driven performance improvement program that utilizes indicators or performance measures associated with improved health outcomes and with the identification and reduction of medical errors.

Question 21

Clinical Performance Measures (CPM) Project

Answer 21

an ongoing project of CMS, implemented through the ESRD networks, to measure and report the quality of renal dialysis services provided under the Medicare program.