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Institutional Barriers Seen in VA MOVE Program Rollout
- Categorized in: Department of Veterans Affairs (VA), Diabetes, March 2012
Researchers Look at GFR Patterns In Kidney Failure
While the course of patients on dialysis have been extensively documented, little is known about patterns of kidney function decline leading to the initiation of long-term dialysis. A recent study at the VA Pugent Sound Healthcare System has sought to fill in that knowledge gap.1
Researchers looked at 5,606 VA patients who initiated long-term dialysis between 2001 and 2003. The patients looked at the trajectory of estimated glomerular filtration rate (eGFR) during the two years prior to dialysis. Testing eGFR is currently the measure of kidney function and a patient’s stage of kidney disease.
The study identified four distinct trajectories of eGFR during that two-year period: 62.8% of patients had persistently low level, 24.6% had progressive loss of eGFR, 9.5% had accelerated loss of eGFR, and 3.1% experienced catastrophic loss of eGFR within six months or less.
Patients with steeper eGFR trajectories were more likely to have been hospitalized and have an inpatient diagnosis of acute kidney injury but less likely to have received recommended predialysis care and had a higher risk of death in the first year after dialysis initiation.
According to the researchers, these findings suggest a substantial heterogeneity in patterns of kidney-function loss, which might call for a more flexible approach when preparing patients for end-stage renal disease.
1.O'Hare AM, Batten A, Burrows NR, Pavlov ME, Taylor L, Gupta I, Todd-Stenberg J, Maynard C, Rodriguez RA, Murtagh FE, Larson EB, Williams DE. Trajectories of Kidney Function Decline in the 2 Years Before Initiation of Long-term Dialysis. Am J Kidney Dis. 2012 Feb 3. [Epub ahead of print] PubMed PMID: 22305760.
Age Not a Factor in Relationship Between GFR and Metabolic Problems
Are elderly adults with a low glomerular filtration rate (GFR) at an increased risk for anemia, hyperkalemia, acidosis and hyperphosphatemia? According to research conducted by VA, they are, although age does not modify the relationship between GFR and development of metabolic complications. 1
A study conducted by researchers at the Louis Stokes Cleveland VA Medical Center looked at 13,874 veterans age 65 and older with chronic kidney disease and a GFR between 15 and 60 mL/min per 1.73 m(2).
Researchers looked at levels of anemia, hyperkalemia, acidosis and hyperphosphatemia, examining the effect low GFR had on metabolic complications.
The study showed that 3.1% of patients had anemia, 2.5% had hyperkalemia, 2.3% had acidosis and 4.4% had hyperphosphatemia. Lower GFR was associated with higher levels of metabolic complications across all age groups, and there was no significant interaction between age and GFR.
According to the study, all elderly adults with chronic kidney disease are at a risk for these metabolic complications, regardless of their age. Elderly adults with low GFR also should be monitored for these complications, the authors said.
1.Drawz PE, Babineau DC, Rahman M. Metabolic Complications in Elderly Adults with Chronic Kidney Disease. J Am Geriatr Soc. 2012 Jan 27. doi: 10.1111/j.1532-5415.2011.03818.x. [Epub ahead of print] PubMed PMID: 22283563.
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Stress is a major factor in weight gain. The mismanagement of VA billing and the Treasury Department was cold and careless.
Many Veterans walked away from the program.
MOVE is a potentially highly effective program, however, in the context of system that has disregard for the Veteran MOVE's effectiveness is mitigated.
to progress.
I have lost 100+ pounds in the MOVE Program at the VA West Los Angeles. I attribute this to an excellent highly qualified and focused Physician and good staff follow through. The MOVE Program at this facility is well organized.
The MOVE Program is so well run at this facility that it gives Veterans, such as myself, false confidence when dealing with other
departments, such as general surgery, with extremely poor results.
A sound concept is only going to be be effective if the quality and work ethic of the staff are on the same level. This compatibility of concept and staff is something the Veteran is entitled to and has been prepaid by military service particularly during time of war.
But you've got bigger problems than just offering surgery at the VA---you've got to change a entire culture that believes just "putting down the fork" will result in weight loss. Good luck with that.