Green I
U.S. Department of Health and Human Services, Agecy for Health Care and Research, Rockville, MD, USA.
Health Technol Assess (Rockv). 1994 May(2):1-12.
Patients with advanced chronic renal failure develop uremia, which is uniformly fatal if not treated by either RT or RD. At this time in the United States, there are about 200,000 individuals receiving dialysis at a cost of $7 billion a year. The precise biochemical reasons why uremia develops and why dialysis is partially successful are not fully understood. Many tests are performed on uremic patients to monitor their clinical course and the success of dialysis. The tests to judge the adequacy of dialysis and the amount and type of dialysis for individual patients (the DP) may not be optimal and are the subject of further study and modification. Some of these tests are classified in HCFA's Medicare Coverage Issues Manual as "other than routinely performed." Among these are NCTs, ECGs, chest x-rays, and tests for the presence of hepatitis B antigens and antibodies. At this time, HCFA allows reimbursement for the routine performance of these tests at specified frequencies. There is no reliable evidence to support the usefulness of such tests performed routinely in patients with ESRD. Only in the case of NCT is there a substantial literature that addresses the usefulness of this type of test in a manner specific for ESRD.
晚期慢性肾衰竭患者会发展为尿毒症，如果不进行肾移植（RT）或肾透析（RD）治疗，通常会致命。目前在美国，约有20万名患者接受透析治疗，每年花费70亿美元。尿毒症发病以及透析部分成功的确切生化原因尚未完全明确。对尿毒症患者进行了许多检查，以监测其临床病程和透析效果。判断透析充分性以及针对个体患者的透析量和类型（透析方案）的检查可能并非最佳，仍是进一步研究和改进的对象。其中一些检查在医疗保险和医疗补助服务中心（HCFA）的《医疗保险覆盖问题手册》中被归类为“非常规执行”。这些检查包括中性粒细胞趋化试验（NCT）、心电图（ECG）、胸部X光检查以及乙肝抗原和抗体检测。目前，HCFA允许按指定频率对这些检查的常规执行进行报销。没有可靠证据支持在终末期肾病（ESRD）患者中常规进行此类检查的有用性。只有中性粒细胞趋化试验有大量文献以针对ESRD的特定方式论述了这类检查的有用性。
