Three barriers prevent better dialysis - Kidneys - hemodialysis treatment research - Brief Article - Statistical Data Included

USA Today (Society for the Advancement of Education), Oct, 2002

A clinical trial at Case Western Reserve University School of Medicine, Cleveland, Ohio, demonstrates that identifying and overcoming three barriers--underprescription of dialysis by physicians, use of intravenous catheters to provide treatment, and shortening of treatment time by patients--greatly improves the quality of hemodialysis treatment, a finding that may help the 33,000 Americans receiving suboptimal doses. Hemodialysis is used to treat people with kidney failure. In the process, blood is removed from the body and pumped into a machine that filters out toxic substances from the blood and then returns the purified blood to the person. The randomized, controlled study showed that educating physicians and patients about these barriers resulted in a twofold increase in dialysis dose compared to conventional care.

Virtually all dialysis treatment is paid for by Medicare, even for patients younger than 65. Despite Federal expenditures of $18,000,000,000 annually, the mortality rate among American hemodialysis patients is the highest in the industrialized world at 23% per year. (European and Japanese hemodialysis patient mortality rates run 10-15% annually.) One-sixth of the 200,000 Americans undergoing hemodialysis treatment do not receive an adequate dialysis dose, it was bund.

The study, involving 169 patients from 29 hemodialysis facilities, identified and addressed each barrier separately. If dialysis prescriptions turned out to be too low, a study coordinator helped physicians improve them. If patients received treatment through a catheter, the coordinator assisted them in getting grafts or fistulas (surgically created connections between an artery and a vein that provide a better blood flow for dialysis) instead. If patients shortened treatment time by coming late or leaving early, the coordinator educated them about the importance of staying for the full amount of time.

"Dialysis is similar to drugs in that both must be given at an appropriate dose to be effective," Aswini Sehgal, associate professor of medicine, biomedical ethics, and epidemiology and biostatistics, points out. "Patients getting an inadequate dialysis dose die sooner and are hospitalized more often." Moreover, the Federal reimbursement system, which provides a fixed payment per treatment, may act as a financial disincentive to the providing of high-quality treatment. "Using higher-efficiency machines or increasing treatment time costs money, but facilities don't get paid more for these higher costs. I urge patients to stay for their full treatment time. I urge physicians and dialysis facilities to address the three barriers we identified. I urge policymakers to reexamine how we pay for dialysis treatment."