Chronic kidney disease, or CKD, is known as the gradual loss of kidney use. The kidneys filter waste and liquids from your blood, which is then discharged into your urine. When CKD becomes more advanced, a dangerous amount of fluids can build up in the body. About 200,000 people a year are diagnosed in the U.S. with this disease. It can be detected through two simple tests, administered by your primary care physician (PCP), which benefits you. What many don’t realize is that your PCP can be a great help in detecting CKD and what the next steps may be for you!

Benefits Of Visiting A Primary Care Physician:

Early detection of CKD by your primary care physician calls for immediate action. He will lower your cardiovascular risk and will make an effort to slow the progression of CKD. There are 5 stages of chronic kidney disease. Any condition beyond Stage 3 should be monitored by a nephrologist as well. Some of the benefits of a primary care physician are listed below:

• Open communication – Patients should be encouraged to discuss any changes in medication, comfort, urine
• Effective treatment – Although there is no treatment for CKD, your primary care physician can specify the direct cause of your individualized CKD condition and provide treatment.

• Stabilization of metabolism – Unfortunately, CKD affects more than just the kidneys and renal function. Your primary care physician can address and regulate any abnormalities in your metabolism.
• Holistic approach – Your primary care physician will already be familiar with any other factors that could be affecting CKD. With a holistic approach, the medical group in Manhasset will form the best plan for you.

How Can A Primary Care Physician Help CKD?

During the early stages of CKD, it is crucial to work with your primary care physician to manage the disease. It has been found that co-management of this particular disease can help provide the highest-quality and safest treatment. With initial interference and a complete, integrative physician team approach, your primary care physician can help stay on top of the following:

•  The stabilization of renal functions (this includes blood pressure and diabetes control as well)
• Reducing risk factors like hypertension and hyperlipidemia
• Preventing Vitamin D levels from dropping
• Lowering Lipids
• Smoking Cessation

Your PCP can also guide you through the testing procedure once you have been diagnosed. These tests can help determine how well your kidneys are actually functioning as well as which treatment will be best for you. These tests may include:

• Calculating your Glomerular Filtration Rate (GFR) – This test is specifically used to show how much kidney function you have.
• Perform an Ultrasound or CT Scan – Both tests are used to show the size of your kidneys, whether they are too small or too large, as well as a full picture of your kidneys and urinary tract.
• Perform a Kidney Biopsy – This can show any type of kidney disease and any damage that has occurred.

Why You Should Visit Our Offices On Long Island:

Although there is no cure for chronic kidney disease, visiting a primary care physician early enough will help treat and lessen your symptoms, as well as slow the progression of this disease. At PRINE Health, we understand that chronic kidney disease is largely overlooked. This is why we have created a medical group consisting of both nephrologists and primary care physicians, to help treat the millions of Americans affected. Contact us today to receive the treatment plan perfect for you!

If you have diabetes, taking care of your kidneys should be a top priority. Your kidney’s main function is to filter out and remove any waste and extra water from your blood. Diabetes is the most common cause of both kidney disease and kidney failure, due to the fact diabetes can lead to your kidneys no longer functioning. Speak with a professional at a medical group in Nassau County if you are concerned with how your diabetes could affect your kidneys. At PRINE Health we can provide you with the proper care and information to help you take care of as well as protect your kidneys.

How Diabetes Damages Your Kidneys:

Diabetes is characterized by high blood sugar, which means the kidneys have to work even harder to filter out the waste in your blood.  Your kidneys are overworked and damaged protein starts to leak into your urine. Soon after your blood pressure rises, waste builds up in the blood, and kidney function will continue to decrease until you reach kidney failure.  If there is no treatment before the kidneys reach kidney failure, a kidney transplant or regular dialysis will be needed to filter out your blood.

Symptoms of Kidney Disease:

Various signs point to kidney disease.  Here are some things to look for if you think you could have kidney damage:

• High blood pressure
• Blood test shows a poor estimated glomerular filtration rate (eGFR)
• Urine tests show high protein levels
• Urinating more often than normal
• Swollen ankles
• Weight gain
• Decrease in appetite
• Feeling weak

Ways to Treat Kidney Disease:

If you have diabetes and kidney damage, there are a few ways a medical group in Nassau County may suggest to help you treat your kidney damage or slow down its progression.  Here are some of those ways:

• Lifestyle changes – Regular exercise and healthy eating habits can help manage your cholesterol, blood glucose, and blood pressure and help your kidneys not have to work too hard.  Lifestyle changes including eating less protein, salt, or fat, limiting alcohol consumption, and quitting smoking are also recommended.
• Medication – Limiting the consumption of painkillers can help slow down kidney damage.  If you have diabetes your doctor might prescribe ACE Inhibitors or angiotensin receptor blockers to also help slow kidney damage and manage blood pressure.
• Regular monitoring – Check your blood glucose often to keep your diabetes in check and also check your blood pressure often to make sure it isn’t too high.

How a medical group in Nassau County Can Help You:

If you are diabetic and need guidance on taking care of your kidneys, consider visiting a medical group in Nassau County.  At PRINE Health, there are plenty of experienced doctors who can answer questions, keep you informed, and help you take care of your kidneys to ensure that you are in the best health possible. Contact us for more information on how we can help you.

Peripheral vascular disease (PVD) also known as peripheral arterial disease (PAD) is a slow and progressive disorder characterized by a narrowing, blockage, or spasms in blood vessels in the body. While PVD may affect any blood vessel outside of the heart, the distal extremities (legs and feet) are most commonly affected.

Population data from the National Health and Nutrition Examination Survey (NHANES 1999-2000) reported that 24% of persons with CKD stage 3 or greater (creatinine clearance of <60 mL/min) had peripheral arterial disease as objectively defined by an ankle-brachial index (ABI) <0.9. The use of the ABI as the key diagnostic criteria significantly increased prevalence rates to nearly 35%, especially in more advanced chronic kidney disease.

HOW IS PERIPHERAL VASCULAR DISEASE DIAGNOSED?

• Ankle-brachial index (ABI). An ABI is a comparison of the blood pressure in the ankle with the blood pressure in the arm. To calculate the ABI, the systolic blood pressure (the top number of the blood pressure measurement) of the ankle is divided by the systolic blood pressure of the arm.
• Doppler ultrasound. This uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Your doctor may use the Doppler technique to measure and assess the flow of blood. Faintness or absence of sound may mean blood flow is blocked.
• Angiogram. This is an X-ray of the arteries and veins to detect blockage or narrowing. This procedure involves inserting a thin, flexible tube into an artery in the leg and injecting a contrast dye. The contrast dye makes the arteries and veins visible on the X-ray.

WHAT ARE THE COMPLICATIONS OF PERIPHERAL ARTERIAL DISEASE?

• Amputation (loss of a limb)
• Poor wound healing
• Restricted mobility due to pain or discomfort
• Severe pain in the affected extremity
• Stroke (3 times more likely in people with PVD)

HOW TO PREVENT PERIPHERAL VASCULAR DISEASE

• Quit smoking, including avoidance of second-hand smoke and use of any tobacco products
• Weight loss
• Limiting or quitting alcohol intake
• Medicine to reduce your risk for blood clots, as determined by your healthcare provider
• Exercise 30 minutes or more daily
• Control of diabetes, cholesterol, and high blood pressure

Once PVD is symptomatic there are more invasive treatments that may be indicated such as angioplasty or vascular surgery.

Due to the high prevalence of PVD in the CKD patient population, PRINE Health is launching PRINE Vascular. We have brought in a skilled interventional radiologist and seasoned Podiatrist. We are starting a sonogram program and will be screening patients in our offices with ABI measurements proactively. A new Vascular lab will be opening in September at Parker Jewish Institute.

Vitamins are important for everyone. The human body functions best when in balance. The best way to achieve optimum health is through a balanced diet, but with our busy lives and often unhealthy eating habits, diet alone may not work for many people. This is especially true for people with chronic kidney disease (CKD), which is why good vitamins are important.

Our bodies need vitamins and minerals to help them with our most basic and critical bodily functions. It would be great if we could simply get everything we need from the foods we eat, but when that is not possible, vitamins will work to help your body repair tissue and get as much energy as possible from the foods you eat, so you maintain a healthier life. Vitamins and minerals are essential for the overall health of your body.

People suffering from kidney disease, especially those on dialysis, may not be getting enough of the daily vitamins needed to increase their health and assist with keeping CKD under as much control as possible. This can lead to issues such as skin lesions, fatigue, muscle weakness, and nerve pain.

When dealing with CKD, there may be a variety of reasons why a patient may not be able to get all the recommended vitamins needed. Some water-soluble vitamins will have more stringent requirements to work well with issues CKD may cause. Some kidney medicines may not play well with specific vitamins. If you have CKD, your waste products will likely build up and affect how vitamins react to your body. Your physician will likely make changes in your diet so you may not get some of the vitamins from certain foods no longer part of your day-to-day foods and eating habits will change based on how well you feel day-to-day. Some days your appetite may not be robust.

Vitamins that are typically recommended for CKD patients:

B1, B2, B6, B12, folic acid, niacin, pantothenic acid, and biotin, as well as some vitamin C, are essential vitamins for people with CKD. Vitamin C may be suggested in low doses as large doses can cause a buildup of oxalate. Oxalate can cause build-up in bones and soft tissue and can be painful over time.

You will often see B complex vitamins grouped together, but each of the B vitamins plays a different role. Pantothenic acid and niacin are part of the B complex group and are taken so that the food you eat can more easily be turned into the energy your body will need. B1, B2, B6, B12, and folic acid work in conjunction with iron, preventing you from becoming anemic. Your doctor will decide if you need to take iron and, if so, what dosage.

Vitamin C can help bruises heal faster, and your doctor will probably recommend adding this to your vitamin regimen. Vitamin D is also significant, especially in maintaining healthy bones. If you’re dealing with CKD, your doctor will recommend what type of vitamin D and dosage is needed.

You will likely need to avoid some vitamins if you have kidney disease. A, E, and K can cause nausea and dizziness at the very least if too much of these build up in your system over time.

What about herbal remedies and supplements?

It is best to avoid herbal remedies and supplements sold over the counter if you suffer from chronic kidney disease and are on dialysis. These remedies may cause issues when interacting you’re your doctor-prescribed medicines and may cause serious side effects. Always ask your doctor before taking any vitamin or supplement.

What is the best way to get the vitamins I need if I am dealing with CKD?

No one wants to take several pills every day. Filling pillboxes and remembering to take every vitamin needed to stay as healthy as possible can be cumbersome. Dealing with CKD is a challenge. If it is at all possible, you will be better off taking one vitamin formula that includes everything your body needs.

PRINE Health has created a formula called PRINE VITE, which includes vitamins B1, B2, B6, B 12, folic acid, niacin, pantothenic acid, and biotin, as well as a small dose of vitamin C. PRINE VITE also includes Vitamin D 1000 IU and a higher dosage of B1 which has been shown to decrease and potentially reserve early diabetic kidney disease. This formula also contains two herbs, Dandelion Extract, known for its anti-inflammatory, diuretic, and cholesterol-lowering effects, and Uva Ursi, which has a history of aiding the urinary tract and UTIs. This formula is also gluten-free and non-GMO.

For more information on PRIVE VITE, or if you seek the advice of a Nephrologist, visit us at https://prinehealth.com/

Facts About Salt And Hypertension In The United States

High blood pressure (also known as hypertension) is associated with three leading causes of death, cardiovascular disease, stroke, and kidney disease. Hypertension is extremely prevalent around the world. About half of adults (45%) with uncontrolled hypertension have a blood pressure of 140/90 mm Hg or higher. This includes 37 million U.S. adults. In 2017, the American College of Cardiology and the American Heart Association published new guidelines for hypertension management and defined high hypertension as blood pressure at or above 130/80 mm Hg. Stage 2 hypertension is defined as blood pressure at or above 140/90 mm Hg.  One notorious contributor to hypertension is excessive dietary salt intake.

Salt and Hypertension

Salt is perhaps the most popular flavoring added to food. Unfortunately, there is a downside. Too much salt can lead to fluid retention and worsen hypertension. How much is too much? Well, we need salt. We need about 500 mg per day. Americans consume much, much more than that. We take in on average closer to 3,500 mg, more than 7 times what is necessary. The Dietary Guidelines for Americans by the FDA advise we stick to a diet of fewer than 2,300 mg per day (about one teaspoon).

Salt is ubiquitous and added to all sorts of foods you consume on a daily basis. Moreover, the is often a salt shaker around to add even more. If you already have hypertension you are at risk for extra salt worsening your hypertension. So, when you can help it, skip the salt!  Learn more about High blood pressure.

Kidney Care First Initiative – CMS

PRINE Health is happy to announce our preliminary acceptance by CMS to participate in the upcoming Kidney Care First program, a new offering from CMS – CMMI under the Kidney Care Choices initiative. This is a program that stems from the Executive Order, Advancing American Kidney Health, and championed by HHS. We will make a final decision in Fall 2020 as to whether we will participate in the first performance year which is set to kick off, on April 1, 2021. The start was initially set for January 1, 2021, but was delayed due to COVID-19.

PRINE is excited to partner with CMS and other managed care payors on value-based kidney care initiatives. We feel this important, high-cost, complex patient population has been overlooked for too long. There is a great deal we can do together to raise the level of care and improve alignment between payors, patients, providers, and other caregivers.

In the meantime, PRINE is investing in technology and care management resources to further prepare for value-based contracting with various strategic partners.

Empire Blue Cross Blue Shield has entered into an agreement with the PRINE Health Medical Group and PRINE Health IPA. The contracts are based on our commitment to Value-Based Kidney Care with our shared mission to:

• Increase Home Dialysis
• Facilitate more Kidney Transplantations
• Improve Quality ESRD Starts outside the hospital setting with AV Fistuals
• Lower overall cost
• Improving the quality of care and Quality of Life for the advanced chronic kidney disease patient.

We look forward to developing this relationship further as we continue to build our infrastructure and capabilities toward providing an even better level of care for this important patient population.

For Nephrologists and complimentary physicians who take part in the care of Chronic Kidney Disease patients, please contact us to learn more about joining the IPA.

Over the last 12-24 months, we’ve seen legislatures and stakeholders in the Renal/Medical community place an increased emphasis on both telemedicine and home dialysis. As a result of the global pandemic, change and progress have been thrust upon patients and providers alike.

While the term ‘telemedicine’ sounds like an intimidating buzzword, all it means is an increased sense of safety and flexibility for patients, allowing them to be seen from the comfort of their own homes on a schedule that suits them best. No longer do patients have to worry about transportation to and from the doctor’s office, nor do they have to worry about additional safety measures from the virus. This is imperative for kidney failure patients who see a physician more often than other seniors. But we didn’t get here overnight. Below we will touch on milestones that laid the foundation for the rise of telemedicine for kidney disease patients.

Recent Events

One of the few objective successes of the President Trump era came in 2019 when he signed the Advancing American Kidney Health executive order, paving the way for an overhaul in the treatment process for end-stage renal disease patients. Not only did the President’s order shift resources towards Americans who have CKD and ESRD and how they’ll receive coverage from Medicare or Medicaid, but it also paved the way to make access easier for patients to receive organ transplants, telemedicine visits, and home dialysis.

In the United States, most patients receive dialysis for end-stage renal disease at a treatment facility, however, across the globe most patients receive their dialysis at home. However, there was a tangible shift in the last 12 months as a result of the pandemic

Home dialysis allowed patients to maintain safe social distancing protocols, while also allowing them to work from home and receive treatment on a schedule that best fits their needs. One of the top dialysis providers in the country reported a 25 percent increase in home dialysis training sessions in 2020 compared to the previous year, signaling that it could be the treatment option of the future.

Telemedicine also improves access to an accurate diagnosis and treatment plan for kidney disease patients in rural areas. Instead of requiring patients to drive multiple trips to a nearby hub where a provider and an accompanying dialysis treatment facility are located, now patients can schedule an appointment online, travel to a hub once to receive their access, and receive their treatment at home, allowing them to save time and money.

What the Future Holds

Home dialysis was undoubtedly a positive result for kidney disease patients, it wouldn’t be possible without telemedicine becoming more mainstream. By overcoming hurdles like ensuring that patients had access to the right technology, while also ensuring that HIPAA regulations were still being adhered to, there is an entirely new evolution in the way that physicians conduct instructional visits, and how patients receive care and treatment.

However, there are still obstacles to be overcome if telemedicine is going to be further streamlined into the mainstream of healthcare. For starters, high-speed internet access needs to be consistent across the board, otherwise, everything else is moot. Additionally, there needs to be somewhat of a regulatory overhaul in the way providers can practice across state lines. With the rise of telemedicine, we’re going to see a correlated rise in patients moving from their homes but still seeking treatment or diagnosis from a provider they are familiar with.

This is true with chronic illnesses such as kidney disease and diabetes, but also for mental illness and general counseling. With that reform, legislators and regulators should also consider the way that providers can prescribe medication via telemedicine and across certain state lines.

Conclusion

Regardless of whether it improves patient-to-provider dialogue and accessibility, or if it’s allowing one provider to relay previous findings to a specialist for a referral, the potential improvements that nephrology telemedicine has to the quality of life for healthcare patients are limitless. Because we’re only in the first few years of it becoming mainstream, the industry has only scratched the surface of the potential that telemedicine has.

Once insurance companies, regulators, and legislators get on board to make the process easier, experts expect to see telemedicine become the norm in both general practice and for specialists. If you have questions about how to transition to telemedicine or home dialysis, contact your nephrologist and ask them about the possibilities.

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Susan Baker is a contributing author on behalf of InsuranceFAQ.net. Susan has been a freelance writer for five years and covers a wide array of topics ranging from Medicare insurance regulations to autoimmune disease health and wellness.

FOR IMMEDIATE RELEASE: October 28, 2020

PRINE Health
370 Old Country Rd. Suite 100
Garden City, NY 11530
[email protected]

PRINE Health launches PRINE Vascular and Welcomes Dr. Dan Simon

PRINE Health is excited to announce its arrival into the Outpatient Vascular Lab space with the launch of PRINE Vascular!

Adding Dr. Dan Simon–a nationally recognized expert in the treatment of vascular disease–allows PRINE Health to venture into the outpatient surgery field of medicine with a focus on treating Peripheral Arterial Disease (PAD). This specific disease largely affects diabetic, hypertensive patients with known atherosclerosis. However, there is a strong albeit less well-known association with Chronic Kidney Disease (CKD). Studies show that up to one-third of patients with CKD may have underlying peripheral vascular disease. It is with that in mind that PRINE Health has moved forward with plans to create a unique vascular program with an emphasis on kidney patients. Thus, finding an expert on PAD treatment who has performed thousands of cases comes as a huge addition to the PRINE Health team.

Dr. Dan Simon, a board-certified interventional Radiologist, returns to New Hyde Park after having worked in various parts of the country (including Washington D.C., New Jersey, and California). Prior to getting into the outpatient field, Dr. Simon was co-chair of interventional Radiology at North Shore University Hospital (Northwell) in Manhasset, NY. As a native New Yorker, Dr. Simon is excited to return back home to Long Island with his wife and children.

“We are beyond thrilled to have Dr. Simon join us as Chief of PRINE Vascular as we kick off our first outpatient vascular lab,” said Dr. Simon Prince, CEO of PRINE Health. “We’re excited about the future. We believe our vascular ambitions complement our strategic focus on kidney care and will generate great value for our patients.”

PRINE Vascular Services:

• PAD Treatment
• Dialysis Access Management
• Uterine Fibroid Embolization (UFE)
• Kyphoplasty

All procedures are performed within the comfort of an outpatient setting, where patients can return home on the same day. Find out more at www.prinehealth.com/prine-vascular

ABOUT PRINE HEALTH

PRINE Health is a unique, multispecialty medical group focused on chronic kidney disease. PRINE launched last year with the merger of 6 independent nephrology groups to become the largest independent nephrology group in New York. In addition to the nephrologists, PRINE has added seasoned primary care physicians, podiatrists, and an interventional radiologist, and is involved in multiple ongoing conversations with other complementary specialties. There are currently 9 office locations and 18 dialysis center affiliations in Long Island and Queens.

PRINE also has a management company that is owned and governed by physicians. The MSO provides traditional practice management and population health services to the medical group. Over the last several months, PRINE has developed care management capabilities and several strategic relationships. PRINE has partnered with managed care payors and was recently selected by CMS to participate in a new value-based kidney care program, Kidney Care First in 2021.  Additionally, PRINE has partnered with data scientists to use predictive analytics and artificial intelligence on their growing patient population as efforts are being made to get ready to take risks in this complex, costly CKD/ESRD population.

To find out more about PRINE, visit www.prinehealth.com.