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Welcome to the November edition of the Quality Insights Renal Network 4 (QIRN4) Network Notes patient e-newsletter. In this issue, we bring you information about potential benefits of longer hemodialysis, pneumonia vaccinations and changes to the Dialysis Facility Compare website. We encourage you to contact us ( with any questions, concerns or suggestions. 
LongerHemoLonger Hemodialysis may offer survival benefit
In a recent study featured in Renal & Urology News, extended-hours versus conventional hemodialysis (HD) was associated with a 33% decreased mortality risk. The study also had limitations. For example, patients on extended-hours HD are likely to differ in important ways from patients on conventional HD. This includes factors like motivation, cardiovascular function, exercise capacity, cognitive function, and social support structures that are not captured in available data. Learn more. (   
PneumoniaVaccineESRD patients encouraged to get pneumonia vaccine   
Pneumonia is a lung infection often caused by a bacteria called Streptococcus pneumoniae. Your body responds to this infection with lung inflammation and a buildup of fluid in your lungs. As the fluid builds inside your lungs, it gets harder for you to breathe. You develop a cough and a fever. This infection can even be fatal.

Network 4 encourages all patients to get vaccinated against Pneumonia because thousands of people die every year from Pneumonia. The infection is spread  by "respiratory droplets" when an infected person coughs, sneezes, blows their nose  or has unwashed hands.

You can prevent getting Pneumonia and stop the spread of this germ by practicing  good handwashing and getting vaccinated.

Luckily, there is a vaccine against this infection and all ESRD patients are encouraged to get it. There are two types  of vaccines to help protect against this infection.  They are PCV13 "Prevnar 13" and PPSV23 "Pneumovax 23.  Both are needed for the body to build  immunity without getting the infection.

If your facility does not stock both types of immunizations, it's important for you to go to your health care provider to get  vaccinated. Learn more. (   
FMCWynnewoodFMC Wynnewood Dialysis to Host Patient Support Group meeting   
FMC Wynnewood Dialysis is hosting a patient support group meeting on Wednesday, December 7 at 11:30 a.m. at the Lankenau hospital in the Medical Office Building, Suite 165. The topic will include Peritoneal Dialysis and a patient's experience of traveling while on dialysis. A light lunch will be provided. Please contact  Anita Abelson, MLSP, MSS at (610) 896-8539 ext. 222 for more information.    
FacebookHave you found us on facebook? 
QIRN4 posts the latest happenings and interesting insights for the dialysis community on our Facebook page. If you haven't already, please check us out and "like" our page to make sure our posts find their way to your news feed.  
DFCUpdatesCMS Announces updates to dialysis facility compare: Patient experience ratings now available
Today, the Centers for Medicare & Medicaid Services (CMS) announced changes to the Dialysis Facility Compare (DFC) ( website on, which provides information about thousands of Medicare-certified dialysis facilities across the country, including how well those centers deliver care to patients.

These changes are in direct response to the important feedback CMS has received from dialysis patients and their caregivers about what is most important to them in selecting their dialysis facility. CMS remains committed to seeking and incorporating input from all stakeholders, but especially patients, on an ongoing basis so that it can continually improve its Compare sites and make health care quality information more transparent and understandable for patients and their caregivers.

Since the initial release of the Dialysis Facility Compare website, patients have emphasized in their feedback to CMS that understanding how others like them view a dialysis center- in particular the cleanliness of the facility and how well the staff cares for them- is valuable information when choosing a facility. As a result, visitors to the updated Dialysis Facility Compare website will now be able to see how patients rate their experiences with dialysis facilities.

Changes to the website reflect CMS' ongoing commitment to making sure that Dialysis Facility Compare meets the needs of individuals with kidney disease and their caregivers. CMS also has other Compare websites to help in selecting providers across the continuum of care, including Home Health Compare (, Hospital Compare (, Nursing Home Compare ( and Physician Compare (
For more information, see the fact sheet (
FeaturedRecipeFeatured Recipe:
Orange-Pineapple Sherbet Punch
Recipe submitted by DaVita renal dietitian Bonnie from Texas.

Portions: 22
Serving size: 6 ounces

 - 1 cup orange pineapple juice

 - 1/2 gallon sherbet, flavor of your choice

 - 2 liter bottle carbonated diet lemon-lime soda, chilled



1 - Combine juice and sherbet in a punch bowl.

2 - Fill the rest of the punch bowl with the lemon-lime soda. 

Renal and renal diabetic food choices:

 - 1/2 fruit, low potassium

 - 1 high calorie


Carbohydrate choices:

 - 1-1/2

Helpful hints:

 - Use sweetened soda if preferred for extra calories.

 - Stir punch to keep it from becoming foamy as the sherbet melts.

 - Add an ice ring to keep punch chilled.

HolidayArticleenjoy Your Holiday season while Watching Your Fluid Gain
Holidays are a time to enjoy family and friends. It is important to join in the activities. Being on a hemodialysis diet should not prevent you from enjoying family gatherings.

Limit your fluids to 32 ounces. Using small cups (4 ounces) can help you portion out your fluid throughout the day. Try gum, hard candy, even frozen grapes that can stimulate your salivary glands to moisten your mouth. Sour candy like lemon drops will help quench your thirst. Take your medications with applesauce.  Keep in mind foods that melt count toward your fluid allowance such as soup, gelatin, ice cream and ice. One medium ice cube has approximately one ounce of water.

Some fluids are allowed in small amounts such as eggnog as this is high in phosphorus.  Mulled apple cider, juices such as cranberry, grape, pineapple, and the nectars-peach, pear and apricot.  Sodas that are allowed if it does not contain phosphate additives: (avoid any drink that has "phos" in the ingredient list).
As far as alcoholic drinks, it is best to check with your doctor or dietitian.  Drinking alcohol may be allowable, but it must be counted in your fluid allowance. Medications must be taken in consideration.  Some medicines may interact with alcohol and cause medicines not to work properly, check the drug labels and ask your pharmacist to make sure alcohol will not be harmful.

Beer is high in phosphorus (remember to take your binder), and wine is high in potassium. A small mixed drink may be your best choice, but avoid high potassium and high phosphorus mixers such as orange juice, tomato juice and colas.

Having a good plan in place for the Holidays and keeping a positive outlook about your nutritional intake, will allow you the freedom to enjoy any kind of social gathering.

 - Jean E Burns, RD, LDN

Do find this newsletter helpful? Are there things you'd like to see changed? Please take this short survey to provide your feedback. Please submit any items of interest for this newsletter to Deborah Knight ( 
610 Freedom Business Center,  
Suite 102 
King of Prussia, PA 19406 
(610) 265-2418 
(800) 548-9205 (patients only) 
(610) 783-0374 (fax) 
This material was prepared by Quality Insights Renal Network 4 under contract with the Centers for Medicare & Medicaid Services (CMS). The contents do not necessarily reflect CMS policy. 

Publication No. ESRD4-102616