Do We Need to Abandon High Ultrafiltration Rates in America?

By Peter Laird, MD

Dialysis practices around the world differ significantly from the practice patterns observed in America and many have long believed this is in part the explanation for our higher dialysis mortality.

I recently spoke with a manager of a dialysis unit and his experience with horrified Japanese patients who couldn't believe the blood flow rates used in America compared to Japan. Japan, Europe, Australia and New Zealand have long recognized the survival benefits of longer, slower and gentler dialysis compared to our American style violent sessions.

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Kidney patients at for-profit dialysis centers less likely to get transplants

12/13/2011

Kidney disease patients treated at for-profit dialysis centers are 20% less likely to be informed about transplant options and referred for the potentially lifesaving operation than those at nonprofit centers, new Johns Hopkins research suggests. A report on the research appears online in the American Journal of Transplantation.

Older, obese, uninsured and Medicaid patients were also less likely to be given all of their options, the research showed, and overall, the uninformed were 53% less likely to be placed on a waiting list for a new organ or to receive a kidney from a living donor.

"Transplantation is not for everyone, but it is important that every dialysis patient be assessed and informed about the risks and benefits of getting a transplant," says study leader Dorry L. Segev, MD, PhD, an associate professor of surgery at the Johns Hopkins University School of Medicine.

For their study, Segev and his colleagues examined the Centers for Medicare & Medicaid Services Form 2728, recently modified to require reporting of transplant education in the hopes of encouraging physicians to at least evaluate and consider every patient for transplantation. On the form, nephrologists are asked if they informed patients about transplant options, and, if not, to select a reason. The team examined data collected by the United States Renal Data System and found that of the 236,079 adults in the United States who developed end-stage renal disease between Jan. 1, 2005 and Sept. 24, 2007, more than 30% had not been informed about transplantation at the time the form was filled out. The primary reason, given by 42% of providers, was that they had not yet assessed whether the patient was even a candidate for transplant.

Patients at for-profit centers and those with Medicaid or no insurance were more likely to be unassessed, suggesting that financial pressures to keep patients on dialysis at the centers could be driving the disparity, Segev says. For-profit centers are also less likely to be affiliated with transplant hospitals, and many lack personnel trained specifically to conduct transplant education.

Nephrology News and Issues:

http://www.nephrologynews.com/kidney-transplant/article/kidney-patients-at-for-profit-dialysis-centers-less-likely-to-get-transplants

John Hopkins:

http://www.hopkinsmedicine.org/news/media/releases/kidney_patients_at_for_profit_dialysis_centers_less_likely_to_get_transplants