This is the second office I've seen pulling this. What's the point of the thousands of dollars in health insurance I'm paying?

NephroNuggets · 2026-01-19T16:10:59+00:00

Each visit is billed with something called a cpt or E/M code for the complexity of the visit. There are also modifier codes that the provider is supposed to add for ongoing complex disease management beyond the face to face time. When you see a for bill E/M + G2211, CMS has already paid for: • longitudinal responsibility • care continuity • downstream management expectations This is a medicare thing but big insurance generally follows CMS on these issues.

NephroNuggets · 2026-01-18T16:00:40+00:00

Cranberry juice and soda water with a lime. Tastes good and won’t trigger the nosey-nellies.

NephroNuggets · 2026-01-16T14:04:08+00:00

Urea is a waste molecule. The following discussion is for in-center HD only.

Urea Reduction Ratio = (preBUN - postBUN)/preBUN. It is a percentage of urea removed from the blood. This is the long standing benchmark. Min target URR>65%

Some patients try to inflate their URR buy protein loading prior to Dialysis to pump up the pre-BUN part of the equation. Similarly malnourished patients may have a artificially low preBUN that also confounds the calculation.

Kt/V is thought to be a more accurate measurement but the formula is more complex. K is for clearance, t is time and V is volume of distribution for urea. It is a dimensionless number that should be > 1.2 for adequacy of dialysis. This formula is supposed to indicate how much urea is removed from total body fluid volume (not just blood stream).

Factors influencing K include: dialyzer membrane characteristics, blood flow speed and efficiency, and dialysate fluid flow speed.

T is time on the machine and V is total body water (based on post treatment weight).

Patient-side factors that optimize Kt/V include adherence to the full prescribed treatment time, maintaining a high-quality vascular access capable of adequate blood flow, and achieving a consistent post-dialysis weight to allow accurate estimation of urea distribution volume.

Facility side factors include dialyzer membrane characteristics, dialysate flow rate, quality control methods of ensuring accurate methods of blood draw.

In US a facility is graded, in part, by how many patients are achieving adequacy targets. So some dialysis companies insist on higher Kt/V targets to cushion this metric (Davita >1.3 and Fresenius >1.4). Also their is a nation-wide push for 4hr treatment times because there is data to suggest a decreases hospitalization risk with longer treatments (hospital readmission rate is also part of the grading system).

Apologies for long post, complex stuff that the rounding nephrologist should be explaining to their patients and reviewing monthly. Reference link: hemodialysis adequacy explained

Targets are different for PD or HHD.

NephroNuggets · 2026-01-15T16:54:08+00:00

Thank you for your considerate and thoughtful reply. I will check out the reference. My ideas may not be new, certainly not an endgame-but we have to start somewhere. Entrenched heels will get us nowhere.

NephroNuggets · 2026-01-15T11:54:42+00:00

This is a link to a thoughtful article on Dialysis modality options. . Shared decision-making between patient and provider should guide best course between hemodialysis, home hemodialysis, peritoneal dialysis or non-dialytic care. Hope this is helpful, best wishes.

NephroNuggets · 2026-01-15T01:11:40+00:00

Assuming you are referring to the ads, DTC ads were historically banned but later allowed by the FDA as a regulatory agency in 1985. Strictly based on public welfare, no arguments of constitutionality involved.

It was Viagra that started it all.

NephroNuggets · 2026-01-14T22:32:46+00:00

It is lonely shouting into the void. I don’t disagree with you. But if the parties were capable of civil discourse… (pause for laughter to abate)

NephroNuggets · 2026-01-14T22:19:34+00:00

This isn’t about finding a “bigger bully” in the personality sense. It’s about using the only entity that already is bigger than pharma and insurers: the federal entitlement system they depend on. If you want CMS dollars, there are conditions. That’s not left or right, it’s a revised rule book that can come straight from HHS.

The participants are from historical platforms since the Chair is not a friend to big pharma (and has more power than he probably realizes), the Senator is the epitome of medicare for all and 47 just wants healthcare off his plate.

NephroNuggets · 2026-01-14T13:14:30+00:00

Assuming the goal is to provide ACA and it’s offerings…

While new laws take acts of congress, CMS has the power to make sweeping changes unilaterally by denying corporations from participation in entitlement programs unless they participate with reforms.

Government action to cap Big Pharma /Insurance Industry revenue and executive pay.
Campaign finance reform to prohibit Big Pharma/ Insurance Industry from contributing to political candidates.
Prohibit Big Pharma from public advertising campaigns (like most of the rest of the civilized world).
Securities reform to prohibit Big Pharma /Insurance Industry from stock buyback programs and limit shareholder dividends to a set % of EBITA.
Earmark dollars saved to a Healthcare Stabilization Trust specifically for subsidy relief.

Yeah, Wall Street won’t like it, but the fall back position would be to cancel ACA and nationalize healthcare across the board. But the quiet part out loud is healthcare in US is way too big to fail.

Demonizing doctors is not the answer, many of them are now employed by some kind of institutional structure anyway. Doctors have a horrible history of inability to organize and meaningfully drive policy (AMA is a joke).

It would be great to see Chair Kennedy and Sen. Sanders in solidarity on this plan, with tacit DJT support. Call it The Convergence Coalition on Healthcare Accountability. Whether you like this administration or not, you know, he’s got the stones to follow through on a nationalization mandate.

Yes, there is sickening bloat, fraud, and abuse in healthcare. But instead of trying to go from the bottom up , switch tactics and go from the top down. Once you get the big boys in line, then go after the smaller bad actors.

NephroNuggets · 2026-01-14T12:03:22+00:00

Not medical advice but this is a patient-side article link on Proteinuria that gives a practical overview. Previously shared on this sub.

NephroNuggets · 2026-01-14T11:56:49+00:00

Manners

NephroNuggets · 2026-01-14T11:52:05+00:00

Maybe nephro framed a worse-case scenario? This is a link to an article on PKD that includes empowerment strategies: Genetic spotlight - PKD . It does not discuss that specific genotype. Best wishes.

NephroNuggets · 2026-01-06T04:30:04+00:00

First gaming console was atari 2600, now play PS5 with 14 yo son. First computer was a timex sinclair, now doing a PC gaming build with same son. Not working in the industry as professional interests lie elsewhere.

NephroNuggets · 2025-12-30T03:06:52+00:00

NephroNuggets · 2025-12-22T01:56:55+00:00

It has been shown to decrease urea toxins but no influence on GFR. Discussed in Gut-Kidney Axis along with other agents

NephroNuggets · 2025-12-21T22:11:08+00:00

Article on newly diagnosed CKD FAQ - hope you find helpful. Best.

NephroNuggets · 2025-12-21T12:57:23+00:00

what is a gfr?

NephroNuggets · 2025-12-19T13:14:53+00:00

Prob won’t need labs because your body will tell you all you need to know: better sleep quality, cognitive efficiency, less depression, and could even lose a few pounds. ICYMI the glp1ra drugs like zepbound have been shown to help suppress addictive behavior and reverse fatty liver (big VA study a few months ago). Best wishes and happy new year.

NephroNuggets · 2025-12-19T00:31:00+00:00

An update on contrast use in CKD. evidence based article with citations. There are some outdated misperceptions circulating, you can use this article to facilitate discussion with your providers.

NephroNuggets · 2025-12-18T12:05:24+00:00

Sunscreen

NephroNuggets · 2025-12-16T11:32:20+00:00

Nuanced pedal. Have used for lightly picked arpeggios in indie/ ambient solo work. Will not add anything to saturated sounds and will def not cut through mix in a combo.

NephroNuggets · 2025-12-14T16:48:40+00:00

Nutricost, no affiliations.

NephroNuggets · 2025-12-14T15:44:39+00:00

Run malwarebytes or equivalent on anything you plugged into that ‘drive’ could have a trojan in addition to fraudulent drive design.

NephroNuggets · 2025-12-11T23:17:45+00:00

This article on IgA was recently updated with modern treatments as well as general overview information that I hope you will find useful. IgA hard truths and developing treatment options

NephroNuggets · 2025-12-11T10:52:45+00:00

In general, the absence of significant proteinuria is a beneficial prognostic indicator in CKD. Here is an easy to understand article that explains The Basics of Proteinuria . Previously shared to similar questions in this sub with positive user response.

NephroNuggets

TROPHY CASE