Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Renal Dialysis


Related Terms

  • Artificial Kidney Machine
  • CAPD
  • Continuous Ambulatory Peritoneal Dialysis
  • Dialysis
  • Hemodialysis
  • Kidney Dialysis
  • Peritoneal Dialysis

Specialists

  • Nephrologist

Comorbid Conditions

  • Bleeding or coagulation disorders
  • Chronic diseases (e.g., diabetes, heart, lung, or liver disease)
  • Immunosuppression as in AIDS or chemotherapy

Factors Influencing Duration

Length of disability may be influenced by the underlying cause of the kidney failure, effectiveness of dialysis, or any complications. If restrictions are not accommodated due to the lack of clean protected environment, the duration may differ greatly.

Medical Codes

ICD-9-CM:
39.95 - Hemodialysis; Artificial Kidney; Hemodiafiltration; Hemofiltration; Renal Dialysis

Overview

Renal dialysis is a mechanical method of removing waste products and excess fluid from the blood when the kidneys are unable to do so (renal failure). The two forms of dialysis are hemodialysis and peritoneal dialysis. Hemodialysis cycles blood through a machine that filters the blood and returns it to the body cleaned of waste. Peritoneal dialysis cycles fluid into and out of the abdomen using the individual's own abdominal membrane (peritoneum) as a filter.

In acute renal failure, which is a sudden, severe decrease in the blood filtering function of the kidneys, dialysis is carried out intensively over a period of days or weeks until the kidneys work normally again. Chronic renal failure usually involves progressive and irreversible kidney dysfunction and may require hemodialysis several times a week for the rest of the individual's life or until a kidney becomes available for transplant.

Acute renal failure may be caused by a sudden worsening of pre-existing renal disease (acute-on-chronic kidney disease) or liver disease (cirrhosis), toxic reactions to allergens or drugs, surgery, trauma, reduction of blood flow to the kidneys, acute fluid loss and dehydration, or obstruction of urine flow. It results in pH and electrolytes imbalance, as well as harmful accumulation of protein wastes (urea and creatinine) that are normally filtered out of the blood by the kidneys and excreted in urine. Acute renal failure occurs in approximately 4.9% to 7.2% of all hospitalized individuals, while an incidence of up to 18% has been reported. About 5% to 20% of critically ill patients experience an episode of acute renal failure during their illness.

Chronic renal failure stems from conditions or diseases causing progressive damage to the internal structures of the kidneys. It may be caused by factors present at birth (congenital), a defect of the immune system (immunological cause), inflammatory diseases, infectious diseases, anti-inflammatory medications, diabetes, multiple myeloma, high blood pressure (hypertension), obstruction in the urinary tract, or trauma to the kidneys.

Source: Medical Disability Advisor



Reason for Procedure

Renal dialysis is a method of mechanically removing protein waste products (urea and creatinine), balancing pH, stabilizing electrolytes, and removing excess fluid from the blood when damaged or dysfunctional kidneys are unable to perform these essential functions (renal failure).

Healthy kidneys filter approximately 150 liters of blood daily. From this blood, the kidneys reabsorb important elements such as sodium, potassium, calcium, amino acids, glucose, and water. In turn, the kidneys excrete in the urine waste products such as excess minerals, toxins, and drugs. In damaged kidneys, this process may fail, either suddenly (acute renal failure) or gradually (chronic renal failure). Wastes begin to accumulate in the blood (uremia) causing harmful or even life-threatening effects. Dialysis removes wastes and excess fluid from the body when damaged kidneys cannot perform this function.

Source: Medical Disability Advisor



How Procedure is Performed

Hemodialysis may be done in the hospital or a dialysis clinic. Approximately 5% of individuals undergoing dialysis in the US perform the procedure themselves with a home kidney dialysis machine. Some individuals have technicians come to their homes to perform hemodialysis using a portable dialysis machine.

Prior to the first course of hemodialysis, a surgical procedure is performed to join an artery to a vein forming an external shunt or arteriovenous fistula. The shunt or fistula provides an accessible site through which the individual's blood can be drawn into the dialysis machine and then returned when it has been filtered. The shunt or fistula is left in place for each subsequent dialysis procedure. A small dose of anticoagulant (heparin) may be instilled into the shunt between dialysis procedures to prevent blood clots from forming and obstructing the shunt.

The procedure requires no anesthesia. A needle connected to the shunt passes blood from the individual through plastic tubes into the machine. The machine consists of many layers of special membrane. This membrane separates the blood from the dialysing solution (dialysate). Urea and creatinine, the nitrogen end-products of protein metabolism (amino acid metabolism), along with excess fluid from the blood pass through the membrane and into the dialysate, which is then discarded. The purified blood is then returned to the individual. Each hemodialysis session lasts 2 to 6 hours. The individual's heart rate, blood pressure, and respiration are monitored throughout the procedure. Blood chemistries may be drawn before, during, and after the procedure to monitor changes in circulating levels of blood constituents that occur in response to treatment.

Although peritoneal dialysis is usually performed in the hospital, an increasing number of individuals now dialyse themselves at home through continuous ambulatory peritoneal dialysis. This portable self-dialysis technique allows an individual to have control over his or her own care. It requires a simple surgical procedure, but no medical equipment and usually little assistance.

Prior to the first ambulatory dialysis, a flexible synthetic catheter is inserted through a small incision into the abdominal cavity (insertion of a peritoneal catheter). The catheter is left in place indefinitely. The peritoneum is a smooth piece of tissue covering the abdominal contents like an apron, which serves as a filter in the dialysis procedure. The dialysing solution (dialysate) is instilled via the peritoneal catheter into the abdominal cavity. The dialysate remains in the abdominal cavity for a prescribed period of time (approximately 30 to 60 minutes). The dialysate attracts excess fluid, electrolytes, and some toxins from the blood vessels in the peritoneum. The dialysate and the excess fluid, electrolytes, and toxins are then allowed to flow out of the peritoneal catheter into a collection bag. The individual is usually weighed prior to and following the procedure. A record is kept of the amount of fluid instilled and the amount withdrawn.

Source: Medical Disability Advisor



Prognosis

Outcome with dialysis procedures is dependent on the underlying disease process and physical condition of the individual. Acute renal failure is often reversible while chronic renal failure is not. In general, those undergoing dialysis therapy have an average life expectancy of 4 years although many survive as long as 25 years on dialysis therapy.

Source: Medical Disability Advisor



Complications

Complications of the hemodialysis procedure include dehydration, bleeding, and electrolyte imbalance, which can affect the heart rate. Complications associated with the hemodialysis shunt are infection, blood clot (thrombosis), and weakening of the shunt arterial wall (aneurysm). Common complications of peritoneal dialysis are infection and inflammation of the abdominal covering (peritonitis).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals on either form of renal dialysis should be restricted from any work such as lifting heavy objects or wearing restrictive belts or harnesses that could dislodge or contaminate an indwelling shunt or catheter.

Individuals on continuous ambulatory dialysis may require an additional break for approximately 1 hour to perform a dialysis exchange during the day. Special accommodations may be needed to perform the dialysis procedure at work. Hemodialysis treatments are most often carried out 3 times weekly with treatments lasting 3 to 5 hours each time. The procedure should be performed in a clean environment. Accommodations should be made to allow the individual to be seated and hang the sealed dialysis bag during the procedure.

Risk: No job should impact dialysis return to work.

Capacity: With typical successful dialysis, individuals can return the same or next day.

Tolerance: The common symptom from dialysis is fatigue that may not correlate with any objective measures and would limit tolerance for work.

Source: Medical Disability Advisor



Maximum Medical Improvement

60 days.

Source: Medical Disability Advisor



References

Cited

Clochesy, John M., et al., eds. Critical Care Nursing. 2nd ed. Philadelphia: W.B. Saunders, 1996.

Liano, F., et al. "Epidemiology of Acute Renal Failure: A Prospective, Multicenter, Community-Based Study." Kidney International 50 3 (1996): 811-818.

Mangram, A. J., et al. "Outbreak of Sterile Peritonitis Among Continuous Cycling Peritoneal Dialysis Patients." Kidney International 54 4 (1998): 1367-1371.

Source: Medical Disability Advisor






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