RESUMEN
The Affordable Care Act is the most visible element of health care reform. However, both before the Affordable Care Act and now with the acceleration since its passage, the Centers for Medicare and Medicaid have been and are testing integrated care models in medicine in general as well as nephrology. The pressures to do so come from the well known increasing costs of health care in the face of a number of clear gaps in quality. The future will likely be more and more integrated care with less and less fee for service. More measurement of quality and the linking of quality measures to payments are also all but certain future elements of the health care economy. Nephrologists need to educate themselves on these trends and be prepared to engage them for the good of the profession and the improvement in care for patients.
Asunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Fallo Renal Crónico/terapia , Nefrología/organización & administración , Rol del Médico , Médicos/organización & administración , Organizaciones Responsables por la Atención/organización & administración , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/legislación & jurisprudencia , Costos de la Atención en Salud , Reforma de la Atención de Salud , Política de Salud , Humanos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/mortalidad , Medicare/organización & administración , Modelos Organizacionales , Nefrología/economía , Nefrología/legislación & jurisprudencia , Patient Protection and Affordable Care Act , Médicos/economía , Médicos/legislación & jurisprudencia , Formulación de Políticas , Mecanismo de Reembolso/organización & administración , Estados Unidos , Recursos HumanosRESUMEN
Metabolic acidosis was one of the earliest complications to be recognized and explained pathologically in patients with CKD. Despite the accumulated evidence of deleterious effects of acidosis, treatment of acidosis has been tested very little, especially with respect to standard clinical outcomes. On the basis of fundamental research and small alkali supplementation trials, correcting metabolic acidosis has a strikingly broad array of potential benefits. This review summarizes the published evidence on the association between serum bicarbonate and clinical outcomes. We discuss the role of alkali supplementation in CKD as it relates to retarding kidney disease progression, improving metabolic and musculoskeletal complications.