Advances in chronic kidney disease
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Adv Chronic Kidney Dis · Jan 2008
The Physician Quality Reporting Initiative: a practical approach to implementing quality reporting.
The Physician Quality Reporting Initiative (PQRI) is a voluntary program in which Medicare encourages eligible physicians in the United States to report on specific quality measures. This article is a case study of the implementation of PQRI reporting by Kidney Associates, a nephrology practice in Houston, TX. After reviewing and discussing 74 potential measures, the group narrowed the selection to 5 and chose 1 office measure and 2 dialysis measures. ⋯ The system was cost-effective to implement, required minimal education, and achieved 100% cooperation through feedback education and rapid correction of systems issues. Kidney Associates was able to show that PQRI reporting is easy to implement with minimal expense and staff labor. Sharing these methods with other practices should facilitate the implementation of efficient reporting systems.
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Adv Chronic Kidney Dis · Jan 2008
Review Comparative StudyA comparison of aerobic exercise and resistance training in patients with and without chronic kidney disease.
The morbidity and mortality associated with chronic kidney disease (CKD) are primarily caused by atherosclerosis and cardiovascular disease, which may be in part caused by inflammation and oxidative stress. Aerobic exercise and resistance training have been proposed as measures to combat obesity, inflammation, endothelial dysfunction, oxidative stress, insulin resistance, and progression of CKD. In non-CKD patients, aerobic exercise reduces inflammation, increases insulin sensitivity, decreases microalbuminuria, facilitates weight loss, decreases leptins, and protects against oxidative injury. ⋯ Combined aerobic exercise and resistance training during dialysis improves muscle strength, work output, cardiac fitness, and possibly dialysis adequacy. There is a need for more investigation on the role of exercise in CKD. If the benefits of aerobic exercise and strength training in non-CKD populations can be shown to apply to CKD patients as well, renal rehabilitation will begin to play an important role in the approach to the treatment, prevention, and slowed progression of CKD.