Bill Perckham
Joined: 04 Mar 2003
Posts: 1
Posted: Tue Mar 04, 2003 3:59 pm Post subject: SDD and SDHD
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ridgerunner that is exactly what I hope the providers would offer. Short Daily incenter Dialysis and Short Daily Home Dialysis are excellent treatment choices and HR 1004 would expand their availability. If you currently dialyze three times a week for four hours you will feel heaps better dialyzing for six days a week for 2 hours. I mean that you will feel better in every way and by every measure The shorter run time is why many patients choose this modality.
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victim
Joined: 04 Mar 2003
Posts: 1
Posted: Tue Mar 04, 2003 8:27 pm Post subject: of the Industry
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ridgerunner,<
>I'm with you. I want it in writing before I'd trust the crooks. The bill is too vague. What was that you were saying about how they would shorten the txs and then give the patients the same total hours? Is that what you meant?
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Where
Joined: 04 Mar 2003
Posts: 2
Posted: Tue Mar 04, 2003 8:34 pm Post subject: is the $$
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coming from for the extra reimbursements? Why did it take this long for the govt. to provide for better dialysis when its been available for years?
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Marty
Joined: 28 Oct 2002
Posts: 160
Posted: Wed Mar 05, 2003 5:35 am Post subject: More Treatments
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Ridgerunner and All, I think Bill's post should be given quite a bit of merit. After all he is the only one here who has posted about running more times per week at shorter run time. I don't think any other patient here has had this experience and can tell us. I wonder what the mission is try to hurt the dialysis industry through money or help patients. You obviously are never going to be able to get your cake and eat it too because without reimbursement centers will not offer more treatments period..... However we are all entitled to our opinion so if trying to control the money means more to you than more treatments go for it. I'm just glad I'm not sitting in a center waiting for a program to start up.
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plugger
Joined: 11 Jan 2003
Posts: 258
Posted: Wed Mar 05, 2003 6:36 am Post subject: HR1004
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I think this is a good bill, and I support it. I think it could be a great bill if it had more incentive for giving more hours of dialysis on top of frequency. Is that possible or not? I don't know. But I can't see the harm in mentioning it when writing in.<
><
>At least this bill is addressing one major problem (as has been said). And if this bill dies, who knows when we will see anything again?<
><
>As for the money part, I remember someone who works for the feds calling it "budget dust". I take that to mean it isn't much in the great scheme of things. And I believe there will be savings from better health of the patients (and less meds). The short, frequent dialysis will be another choice for a patient, I'm all for choice. As Marty stated before, problems in other areas of dialysis might best be addressed separately. But whatever you decide, I think this a great time for giving your input.<
><
>sky.prohosting.com/cschwab/ <
><
>www.congress.org/congressorg/home/ <
><
>
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Bill Peckham
Joined: 06 Jan 2003
Posts: 65
Posted: Wed Mar 05, 2003 1:01 pm Post subject: Re: HR1004
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?victim? you asked where would the money come from?<
>Tax dollars is the short answer. The best outcome would be that by dialyzing more frequently patients would be healthier and the total cost of treating those ESRD patients would decline, thereby saving tax dollars. These savings would be due to fewer hospitalizations and less money spent on medications principally EPO. I believe these savings would happen but even if they do not I think more frequent dialysis gives people a better quality of life, so I would support HR 1004 on that bases alone.<
><
>You also asked why has it taken so long for the government (i.e. Medicare) to even look at funding more frequent treatments?<
>That is a long story but the short of it is - institutional inertia based on an historical accident. When dialysis was first invented no one knew how long someone should dialyze. They tried once a week for 24 hours, twice a week for 8 hours, six day a week treatments and as it happened, in 1972 when Medicare began covering ESRD patients, they were trying three times a week four-hour treatments. This was handy because there were many more patients then machines. By dialyzing patients every other day you could double the number of patients each machine could support and by dialyzing patients for four hours you could see more patients each day. So three day a week four-hour treatments became the standard. There were NO studies to support this as the best treatment for ESRD, there were NO randomized comparisons of frequency or time, it was just done because at the time it was the best that they could do. <
><
>Now move to the 1990s. More frequent dialysis looks very promising, eight hour dialysis every other day, or every day, is reported to be like having a working kidney but now there has to be studies, and randomized patient populations etc., etc. This day in age you cannot just do something in the medical field because one person says it made them feel better except if you are the United States Congress. The US Congress can just decide to make this change, which is what HR 1004 is all about.<
><
>There is another path. The NIH study that was announced a short time ago that would pay for an ?official? randomized study that would compare Short Daily Hemo, with Slow Nocturnal Daily Hemo, with standard three day four hour treatments. The results could be acted on in about 2007. If you want to wait don?t support HR 1004; if you think more frequent dialysis would be a good thing for today?s patients then support HR 1004.<
> Edited by: Bill Peckham at: 3/5/03 4:03:58 pm<
>
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ridgerunner
Joined: 11 Jan 2003
Posts: 101
Posted: Wed Mar 05, 2003 1:54 pm Post subject: more dialysis
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there have been several studies on time. there is over 30 year study in cannes france. one that does 3 times a week for 6 to 8 hours. in canada there is over 7 year study on slow noctornal. ask martha, i have been doing noctornal about 5 years. there has been proven the less dialysis in time per week the more problems.and death rates. i have seen no studies on short daily dialysis only opinions. if you check any one on ultra short daily you will find their creatinine is as high as the 3 day jiffy lube. my creatinine was 1.8 last month. this a true measure of clearance not urea. it is good to increase the times per week but more important to increase the time. if a clinic gets more money for increased time but can cut the time per treatment they will be double dipping and the value of a dialysis patient will increase about 50000 dollars.
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Bill Peckham
Joined: 06 Jan 2003
Posts: 65
Posted: Wed Mar 05, 2003 4:16 pm Post subject: SDHD
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First HR 1004 would increase the availability on Daily Home Nocturnal Dialysis, this should not be turned into which is better, short daily or long overnight but ridgerunner I feel I must respond to your rant against Short Daily.<
><
>Here are three studies on Short Daily Dialysis. There are many more:<
>www.uninet.edu/cin2000/co...aeger.html<
>this reports the results of a Dutch study.<
>www.multi-med.com/homehem.../main.html <
>this study was published by Association utilisation rein artificiel Lyon, France which is the location of the three day a week eight hour study you refer. That unit is in Tassin outside Lyon not Cannes.<
>www.coloradohealthsite.or..._ESRD.html<
>this study is by Dr. George Ting, El Camino Hospital, Mountain View, California, U.S.A he has six years of experience with SDHD<
><
>Third since I substantiated my figure of less then $10,000 per patient per year you should tell us where you got your $50,000 figure and address why you think that there would not be savings on the $10,000 figure because of fewer hospitalizations and the need for less EPO.<
><
>Forth, ridgerunner you?re a smart enough guy to know why the studies you referred to are not enough to make statements of fact basaed on their results. When patients select themselves for nocturnal dialysis a resulting study can not be extrapolated to the entire patient population. I?m glad you report you are doing so well but that is not the end of the discussion.<
>
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plugger
Joined: 11 Jan 2003
Posts: 258
Posted: Tue Mar 11, 2003 3:54 am Post subject: HR1004
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I'm trying to see how much noise one guy can make. So far, some of the members of my church have been nice enough to put a paragraph about my website in the church bulletin. I've put a flyer on the church bulletin board and I've sent off an editorial to the local paper. And finally it looks like my chance to speak in front of the church is coming. A guy has to keep busy.
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Any studies
Joined: 11 Mar 2003
Posts: 1
Posted: Tue Mar 11, 2003 7:19 am Post subject: on how daily/nocturnal
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affects the access? Seems like it would shorten the life by half which would not be good. I did read a study on the buttonhole technique of sticking where they showed it would not hinder the life of the access.
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Here
Joined: 23 Feb 2003
Posts: 3
Posted: Tue Mar 11, 2003 7:37 am Post subject: SDHS access study
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In October 1996, El Camino Dialysis Services started a sDHD program. El Camino Hospital, a nonprofit community hospital in Mountain View, California, was willing to underwrite the additional unreimbursed treatments in order to make this therapy available to those patients failing on conventional HD. Short DHD was, in effect, offered as a form of "rescue therapy."<
><
>This report describes the effect of sDHD on the different types of blood accesses in our study over a 39-month period:<
><
>www.multi-med.com/homehem.../main.html<
><
>"Conclusions :<
>We conclude that sDHD does not appear to have an adverse effect on blood accesses, including artificial grafts and catheters, and that blood access problems should not be the major stumbling block to the widespread adoption of more frequent hemodialysis."
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39 months
Joined: 11 Mar 2003
Posts: 1
Posted: Tue Mar 11, 2003 11:38 pm Post subject: is 39 months
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I want my access to last 39 years not 39 months! Not sure this study proves anything.
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Bill Peckham
Joined: 06 Jan 2003
Posts: 65
Posted: Wed Mar 12, 2003 12:16 pm Post subject: 154 months and counting
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There is no reason to think that the trends noted in the study would change over time. One reason for fistula durability is that SDHD patients are much more likely to stick themselves or have a single person stick them because they are often home patients. <
><
>If you are trying for thirtynine years on dialysis you would be well advised to dialyze more frequently, at home and stick yourself, preferably using the buttonhole method.
