McCann Linda, Hoefs Meghan
Nephrol News Issues. 2014 Apr;28(4):24-6, 28, 30-2 passim.
The increasing prevalence of end-stage renal disease and planned expansion of the Medicare bundled payment system will place a greater financial burden on dialysis providers. Management of chronic kidney disease mineral and bone disorder (CKD-MBD) is dependent on interdisciplinary team (IDT) interventions such as dietary modification, medication, and adequate dialysis therapy. Optimizing adherence to diet and medications requires an educated and motivated IDT, patient, and patient support system. The financial constraints of bundling will increase the roles of social workers and dietitians in promoting therapy adherence. Innovative and relevant tactics provide opportunity to overcome monotonous routines, encourage adherence to diet and complex polypharmacy regimens, and achieve recommended biochemical targets as outlined in Kidney Disease Improving Global Outcomes Guideline for Chronic Kidney Disease (KDIGO) - CKD-MBD.
终末期肾病患病率的不断上升以及医疗保险捆绑支付系统的计划扩张，将给透析服务提供商带来更大的经济负担。慢性肾脏病矿物质和骨异常（CKD-MBD）的管理依赖于跨学科团队（IDT）的干预措施，如饮食调整、药物治疗和充分的透析治疗。优化对饮食和药物的依从性需要一支受过教育且积极性高的IDT、患者及患者支持系统。捆绑支付带来的经济限制将增加社会工作者和营养师在促进治疗依从性方面的作用。创新且相关的策略提供了机会，以克服单调的常规做法，鼓励坚持饮食和复杂的多药治疗方案，并实现《改善全球肾脏病预后组织（KDIGO）慢性肾脏病临床实践指南 - CKD-MBD》中概述的推荐生化指标。
