End Stage Renal
What are the two types of home dialysis?
Peritoneal Dialysis and home hemodialysis
When should you start the BTC assessment?
NCM first outreach to the member
What kidney stage has GFR range of 30-44?
CKD 3B
Common side effects to review if member is taking Ozempic?
- dehydration to can further progress CKD
- GI issues (N/V/D and even constipation)
- worsening renal function (kidney function needs to be monitored)
You have a CKD stage 3B member...what must be done in opps to move to low status?
Core CKD 4 opps
Med Reconciliation w/in 6 months
No hospitalizations for 30 days or greater
Common stating point for fluid restriction in ESRD to help prevent fluid overload?
32 oz (about 4 cups) if a patient is still having urine output their fluid restriction will not be as strict
How long do you have to complete the BTC assessment?
180 days from first outreach of a NCM
What are the two leading causes of CKD
Diabetes and Hypertension
What is sevelamer is for?
Hyperphosphatemia
CKD member report having difficulty sleeping and you provide educations...what opportunity would you chart this in?
Improved sleep quality
You are educating you PD patient of s/s of peritonitis. What do you tell then to monitor for and report to PD RN and/or nephrologist
- cloudy effluent
- abdominal pain that can include nausea/vomiting
- fever
- can have chills
What is site site called where you can look up your metrics and your hours worked?
My BPS
A CKD patient with low erythropoietin levels is at risk for?
Anemia
You are talking to you member and note they have a GFR of 25 and they are taking Metformin 1000 mg daily. What are your next steps?
- discuss concern with decreased GFR and still taking metformin with mbr (we can NOT tell mbr to stop taking without their provider telling them)
- call provider to have disconnected due to decreased GFR w/ or w/out member
What opportunity would you document your member education that individuals with kidney disease are at greater risk for developing vascular disease?
Vascular Screening
What steps can we do as NCM to help a member do outpatient dialysis start verses inpatient starts?
- Plan in place for RRT
- member has been educated on all modality options (to include transplant, and no dialysis)
- mbr has plan for access
- mbr has discussed plan with his healthcare team
Where can you find the KRS Job aids?
KRS SharePoint and select KRS Index
A CKD stage 5 member is complaining of pruritus and white crystallized deposits on the skin. What substance is responsible for this?
Urea. This is known as uremic frost and caused by high urea levels excreted through sweat glands
How does a SGLT2 work? (action) ex: Farxiga
It works by blocking the reabsorption of glucose and sodium from the kidneys into the bloodstream. This helps lower blood glucose levels and reduce the risk of kidney damage
What are the 5 topics that must be addressed and have supporting documentation to gap close the DC opp?
1. Individual/Caregiver provided date of scheduled follow-up appointment (enter date of appointment in add context area below)
2. Individual/Caregiver provided date of scheduled follow-up appointment (enter date of appointment in add context area below)
3. D/C INSTRUCTION: Individual/Caregiver verbalized receiving and understanding of facility discharge instructions
4. MEDICATION: Individual/Caregiver filled post discharge medications and verbalized understanding of medications
5. READMISSION PREVENTION: Individual/Caregiver verbalized why they were in the hospital, s/s to report to physician and has knowledge of how to prevent readmission.
You are talking to your member and he asks that dialysis access is associated with better outcomes for hemodialysis patients, what would your recommend?
AV fistula
(it is a natural connection that last longer, is less prone to infection and blood clots, and provides efficient, high volume blood flow)
Which Job Aid would you look up how to address consults from HA?
KRS NCM Care Delivery
What GFR should a member start being referred for transplant evaluation if mbr is interested in seeking renal transplant options?
GFR of 20
What medication is very common for PD patient but a red flag for HD patients?
potassium
What opportunity would you document educating a member regarding their dialysis access (such as s/s of how to access AVF)
Individual Understands Access Maintenance