Medicare s Preventive Care Services. Manage Your Chronic Kidney Disease (CKD stages 3-4) with Diet

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1 s Preventive Care Services Manage Your Chronic Kidney Disease (CKD stages 3-4) with Diet

2 What do the kidneys do? Your kidneys have important jobs to do in your body. Two of the kidneys most important jobs are: out of the body As part of filtering wastes and forming urine, the kidneys maintain the blood levels of the following: What is chronic kidney disease (CKD)? What do I need to know about chronic kidney disease (CKD)? Being diagnosed with chronic kidney disease (CKD) can be a very difficult time, but information can go a long way towards helping gain control of the situation. At first, talk with your doctor about pinpointing your diagnosis to assess your kidney function to help plan your treatment. Tests are conducted to determine the stage and type of kidney disease, the size of the kidneys and the damage already done. After receiving these results, your doctor and you will meet and create a plan of action. You may hear your doctor refer to your glomerular filtration rate, or GFR. This rate is the best test to measure your level of kidney function and determine your stage of kidney disease. Your doctor can calculate it from the results of your blood creatinine test, your age, race, gender and other factors. Chronic kidney disease (CKD) includes conditions that damage your kidneys and lower their ability to work properly. For people with CKD, the kidneys don't work as well as they should and they can't filter enough wastes from the body. As a result, wastes can build up in your blood. People with kidney failure may feel sick, but people with early stage kidney disease may feel fine. If you know your kidneys are not working as well as they should, there are actions you can take to prevent or slow further decline in kidney function. That is why screening is so important. As CKD progresses it can lead to kidney failure, stage 5, when a kidney transplant or dialysis would be needed to stay alive. 2 s Preventive Care Services s Preventive Care Services 3

3 5 Stages of Chronic Kidney Disease What causes chronic kidney disease (CKD)? Stage Description Glomerular Filtration Rate (GFR) Anyone can get CKD at any age. However, some people are more likely than others to develop it. The two main causes of CKD are diabetes and high blood pressure. At increased risk Risk factors for kidney disease (e.g., diabetes, high blood pressure, family history, older age, ethnic group) 60 or More Diabetes: For people with diabetes, the body doesn't use glucose (sugar) very well and as a result, blood levels of glucose are too high. This can cause damage to many organs, including the kidneys Kidney damage (protein in the urine) and normal GFR Kidney damage and mild decrease in GFR Moderate decrease in GFR Severe decrease in GFR 90 or More 60 to to to 29 High Blood Pressure: High blood pressure, or hypertension, occurs when the pressure of your blood against the walls of your blood vessels increases. This can cause damage to the small blood vessels in your kidneys. You can also develop CKD if you have other conditions, such as a family history of CKD. You should ask your doctor about annual screening for kidney disease if you have diabetes, high blood pressure or other risk factors. To find out more about CKD and other risk factors, visit or call toll free Kidney failure (dialysis or kidney transplant needed) Less than 15 Reprinted with permission from the National Kidney Foundation. * Stages 3, 4 and 5 include a GFR that meets the Part B regulations for medical nutrition therapy services. Some, but not all, patients with stage 5 CKD may qualify for MNT. 4 s Preventive Care Services s Preventive Care Services 5

4 Why is diet important with chronic kidney disease (CKD)? Covers When you have CKD, eating the right foods is important. The work of the kidneys can be made easier by limiting the intake of certain foods. Your recommended diet depends on your stage of CKD and can change over time, however there are certain nutrients to watch in your diet, including: Calories: Be sure to get the right amount of calories every day to help give your body energy. Protein: People with CKD need to make sure to get the right amount of protein. Too much protein creates extra waste products that can stress the kidneys. Too little protein can put you at risk for malnutrition. A registered dietitian can tell you how much protein is needed for your specific diet plan. Vitamins and Minerals: Get the right amounts of vitamins and minerals, such as potassium, phosphorus and calcium, and limit sodium intake. Your doctor may refer you to a registered dietitian (RD) for help with your diet. An RD can create a meal pattern just for you based on the stage of your kidney disease, other medical conditions and your specific needs. To find an RD in your area, visit the Find a Nutrition Professional section on or call 800/ , ext Nutrition and diet play an important role in helping people with certain diseases manage their health. For people with kidney disease, proper diet and nutrition can help prevent and reduce complications from their conditions. Did you know that covers three hours of one-on-one or group nutrition counseling services the first year, and two hours each year after that for patients who have been diagnosed with kidney disease (except for those receiving dialysis), diabetes, or have had a kidney transplant? If your condition, treatment, or diagnosis changes, you may be able to get additional hours of nutrition treatment with an additional doctor s referral. These services can be given by a registered dietitian or -approved nutrition professional. A nutrition assessment and counseling can help you manage your disease, improve your overall health and even delay the progression of your kidney disease. If you qualify for Medical Nutrition Therapy, you will only be responsible to pay 20% of the approved amount after meeting the annual deductible. Talk to your doctor or dietitian to determine if you qualify for Medical Nutrition Therapy. 6 s Preventive Care Services s Preventive Care Services 7

5 Preventive Services and Screening Below is a chart that shows what Preventive Services and Screening may cover (continued through page 11): Service Who is Covered? Frequency Diabetes Self-Management Training (DSMT) People with at risk for complications from diabetes, recently or previously diagnosed with diabetes Physician must certify that DSMT is needed Up to 10 hours of initial training within a continuous 12-month period Subsequent years: Up to 2 hours of follow-up training each year Pays Service Who is Covered? Frequency Initial Preventive Physical Examination (IPPE) Also known as the Welcome to Physical Exam Ultrasound Screening for Abdominal Aortic Aneurysm (AAA) Cardiovascular Disease Screenings Diabetes Screening Tests whose first Part B coverage began on or after January 1, 2005 with certain risk factors for abdominal aortic aneurysm Important This screening is only covered if a referral is given during a Welcome to physical exam 12-hour fast is required prior to testing with certain risk factors for diabetes or diagnosed with pre-diabetes People previously diagnosed with diabetes are not eligible for this benefit Once Must be furnished no later than 12 months after the effective date when the first Part B coverage begins Once Every 5 years 2 screening tests per year if diagnosed with pre-diabetes 1 screening per year if previously tested but not diagnosed with pre-diabetes, or if never tested Pays applies for certain services still applies for some other services No No Medical Nutrition Therapy (MNT) Screening Pap Tests Screening Pelvic Exam Screening Mammography Bone Mass Measurements diagnosed with diabetes, kidney disease or postkidney transplant A physician referral is needed All women with All women with All women with age 40 or older Women with ages People with at risk for developing osteoporosis 1st year: 3 hours of one-on-one or group counseling Subsequent years: 2 hours Additional hours if condition, diagnosis or treatment changes Annually if high-risk, or childbearing age with abnormal Pap test within past 3 years Every 24 months for all other women Annually if high-risk, or childbearing age with abnormal Pap test within past 3 years Every 24 months for all other women Annually One baseline Every 24 months More frequently if medically necessary for Pap test collection (No copayment/ for Pap lab test) For more information about s Preventive Services, visit or call TTY users should call s Preventive Care Services s Preventive Care Services 9

6 Service Who is Covered? Frequency Pays Service Who is Covered? Frequency Pays Colorectal Cancer Screening Prostate Cancer Screening 1. Digital Rectal Exam (DRE) 2. Prostate Specific Antigen Test (PSA) age 50 and older Screening colonoscopy: individuals at high risk; no minimum age requirement No minimum age for having a barium enema as an alterative to high-risk screening colonoscopy if the beneficiary is at high risk 1. All men with age 50 or older (coverage begins the day after 50th birthday) 2. All men with age 50 or older (coverage begins the day after 50th birthday Fecal occult: Annually Flexible Sigmoidoscopy: Every 4 years or once every 10 years after having a screening colonoscopy Screening Colonoscopy: Every 24 months at high risk; every 10 years not at high risk Barium enema: Every 24 months at high risk; every 4 years not at high risk 1. Annually 2. Annually No copayment/ or deductible for Fecal Occult Blood Tests For all other tests, copayment/ apply No copayment/ Hepatitis B (HBV) Smoking and Tobacco-Use Cessation Counseling People with at medium to high risk who are diagnosed with a smoking-related illness or are taking medicine that may be affected by tobacco Scheduled dosages required 2 cessation attempts per year; each attempt includes maximum of 4 intermediate or intensive sessions, up to 8 sessions in a 12-month period For more information about s Preventive Services, visit or call TTY users should call Glaucoma Screening with diabetes mellitus, family history of glaucoma, African Americans age 50 and over or Hispanic Americans age 65 and over Annually for people in one of the high-risk groups Flu Shot Once per flu season in the fall or winter may provide additional flu shot if medically necessary No copayment/ Pneumococcal Shot Once in a lifetime may provide additional vaccinations based on risk No copayment/ 10 s Preventive Care Services s Preventive Care Services 11

7 This information is brought to you as a public service by Abbott Nutrition. This brochure is intended to help people better understand Preventive Benefits; it is not a substitute for detailed materials from the Centers for & Medicaid Services (CMS). You should consult with your representative, health insurance advisor, or other counselor for more information to evaluate which program best fits your needs. These organizations recognize the importance of nutrition and preventative healthcare in achieving and maintaining good health Abbott Laboratories Inc /AUGUST 2009 LITHO IN USA Abbott Nutrition Abbott Laboratories Columbus, Ohio USA

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