Kidney News May 2013, 5#5 : Page 3
May 2013 | ASN Kidney News | 3 Slow Walking Speed Continued from page 1 physical performance compared to the healthy population,” Roshanravan said. “Second, objective physical perfor-mance testing is an important bedside clinical tool that adds to the value of regular laboratory assessment of kid-ney function in discriminating those at high risk of mortality even among those without a history of stroke or disability in their activities of daily living.” During an average of three years of follow-up, the investigators found that measures of lower extremity perfor-mance were at least 30 percent lower than predicted. Each 0.1-meter-per-second slower walking speed was linked with a 26 percent higher risk for death, and each one-second longer timed up and go was linked with an 8 percent higher risk for death. These associations were also seen even after excluding the subgroup with baseline self-reported mobility disability. Walking speed and timed up and go more strongly predicted three-year mortality than kidney function or com-mon blood tests. Adding walking speed to common laboratory tests of kidney function significantly improved the prediction of three-year mortality. “We discovered that even after ac-counting for renal function, diabetes, and coronary artery disease, worse lower extremity physical performance was associated with all-cause mortality, but unexpectedly, this association after adjusting for renal function and comor-bid illness was not seen with handgrip strength,” Roshanravan said. “Our find-ings suggest that lower extremity physi-cal performance testing in chronic kid-ney disease patients may help identify those individuals who are more bur-dened by their CKD.” Other experts agree that the findings may have a significant clinical impact. “This novel study demonstrates that physical performance measures can im-prove the health assessment of persons with advanced chronic kidney disease. The key advantages of these measures are that they are low cost, non-invasive, and highly informative,” said Michelle Odden, PhD, who was not involved with the study and is an assistant pro-fessor of epidemiology at Oregon State University. “Additionally, these physical performance measures may provide in-sight into the systemwide health effects of chronic kidney disease.” Odden’s research focuses mostly on kidney disease, cardiovascular out-comes, and loss of physical function in older adults. Additional studies needed As with any observational study, cau-tion must be taken in this case against ascribing a causal relationship between lower extremity physical performance. The study provides no insights on whether lower physical activity may be a consequence of or a cause of lower physical performance in individuals with CKD. Roshanravan also noted that the fol-low-up time in the study may not have been sufficiently long enough to detect significant differences in survival be-tween those with strong and weak grip strength. While more research is needed, the study’s findings suggest that measur-ing lower extremity physical perfor-mance may capture a complex set of skeletal muscle and neurologic impair-ments that develop in CKD patients and substantially affect their survival. The authors encourage additional in-vestigations that look into the biologi-cal mechanisms underlying decreased physical performance in patients with CKD and that evaluate whether inter-ventions that improve physical perfor-mance in CKD translate to improve-ments in health and longevity. Study co-authors include Cassianne Robinson-Cohen, PhD, Kushang Patel, PhD, Ernest Ayers, Alyson Littman, PhD, Ian de Boer, MD, T. Alp Ikizler, MD, Jonathan Himmelfarb, MD, Les-lie Katzel, MD, PhD, Bryan Kesten-baum, MD, and Stephen Seliger, MD. Disclosures: Dr. Baback Roshanravan was funded by a Ruth L. Kirschstein National Research Service Award (NRSA) and T32 grant from the National Institute of Dia-betes and Digestive and Kidney Diseases (NIDDK). The authors reported no other financial disclosures. HIPAA Continued from page 1 to obtain an electronic copy of their re-cords. Preparing for compliance demonstrate, through a risk assessment, that there was a low probability that PHI was disclosed. Provisions in the HITECH Act also strengthen compli-ance and enforcement of HIPAA regu-lations by instituting audits for all cov-ered entities—large and small—and by increasing civil and criminal penalties for unauthorized disclosure of PHI. Other sections of the HITECH Act directly affect patients, who now have to provide additional authorization be-fore their PHI can be disclosed for pay-ment of services. If a medical practice uses EHRs, patients now have the right Before the September 23 deadline, phy-sicians, office staff, and business asso-ciates will have to take several steps to meet the new HIPAA compliance re-quirements. One of the first actions covered en-tities will need to take is to appoint a privacy officer and security officer. The practice’s current privacy and secu-rity policies and procedures will need to be revised to align with new provi-sions, and be updated on a regular basis. These should include policies on secur-ing portable electronic devices that may store PHI, as well as protocols to destroy any information on devices that may be-come compromised. Procedures for en-crypting and securely transferring PHI electronically should also be included. Staff members who use PHI (e.g., those working in the coding or billing departments) must become familiar with new office policies and HIPAA requirements. To ensure that practices are prepared for the new enforcement mechanisms, in-house audits and risk assessments should be conducted to identify and correct any potential com-pliance issues. Patient privacy notices Patient privacy notices must be revised to reflect the requirements for addi-tional authorization before disclosure of PHI for processing payment of services. Entities must also prepare methods to provide copies of a patient’s electronic PHI when requested. Procedures for how staff should iden-tify, investigate, and report a potential breach of PHI should be drafted and re-viewed regularly. Finally, all agreements with business associates need to be up-dated to reflect the extended HIPAA definition and liability. Designed to protect and secure sensi-tive patient data, the new HITECH Act provisions will affect all health care pro-viders this year. For more information on HIPAA and the requirements imple-mented under the Omnibus Final rule, visit http://www.hhs.gov/ocr/privacy/ index.html. Your membership matters. Continue to help lead the ght against kidney disease. Renew your membership for 2013 today. ASN members enjoy: • Subscriptions to ASN’s publications: CJASN, JASN, NephSAP and Kidney News • Discounts on ASN’s live educational and distance learning programs • Eligibility to apply for research grants and travel support and much more. Visit www.asn-online.org/membership for more information.
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