AJKD Article: A Cause with Solutions

By Peter Laird, MD

AJKD just published a testimonial essay on my own journey with kidney disease in which I also advocate for optimal home hemodialysis 0ptions, the one ignored gift of life for renal patients in America.

A Cause with Solutions: An American Hemodialysis Story

America continues to deny access to life-saving treatments proven by decades of observational studies which have been confirmed by at least 2 randomized and controlled trials. The ACTIVE trial (ClinicalTrials.gov identifier NCT00649298) testing the differences between more than 24 h/wk versus fewer than 18 h/wk of hemodialysis should be completed in the next couple of years, but in my opinion, we already have overwhelming evidence of the benefits of more frequent and longer duration hemodialysis rivaling deceased donor transplant survival.

Yet today, access to improved dialysis techniques is a little-heralded cause, especially in comparison to the frequent coverage in both the medical and popular press of transplant issues. Whereas the current standard of care requires all patients with ESRD to be evaluated for eligibility for transplant, only 1%-2% of the 400,000 hemodialysis patients in America have access to potentially life-saving home hemodialysis options. The ESRD “Conditions of Coverage” mandate a discussion regarding home dialysis options, but in reality this option is available only in limited areas. We have a long way to travel to match the nearly 25% home hemodialysis population seen in New Zealand and Australia. This is a cause with solutions, a cause that I will continue to champion. It is time for America to return to our pioneering days and reveal the true potential of this life-saving treatment.

Sadly, few American dialysis patients have access to the same hemodialysis options that I now enjoy in the comfort of my own home. It is time that the vision of home hemodialysis from Dr. Scribner and his many colleagues  come full circle and begin to save hundreds of thousands of lives every year.  The technology is now available, what is lacking is the will to purpose in our hearts to carry this vision to completion. 

Comments

[Bill Peckham]

Congratulations Peter.

One article at a time, one step at a time. It's all we can do.

[Peter Laird, MD]

Thanks Bill and thank you for giving my start as a blogger.

God bless.

Peter

[Rich Berkowitz]

Well said Peter. The LDO's have decimated the original intent of the Medicare entitlement, which was to rehabiltate dialysis patients and help restore their lives as much as possible to what it was before. But instead, we have seen the steady debilitation of the dialysis population. Home dialysis gives people the opportunity to regain their lives from the tyranny of in-center. Slowly, it's beginning to come back, but still at a excruciating slow pace.

[roberta mikles]

What is so unbelievable is the following ---
If an employee is injured at work, receive worker's compensation, they are often rehabiliatated and go through various training programs so that they can remain independent and productive individuals meetings their emotional needs as well as other needs they have. However, one who does not choose ESRD does not get the same opportunity. This is the sad part. Those with ESRD who require dialysis, and WANT to continue to work, should be afforded and have the opportunity just as those who are injured on the job. Truly discrimination in a sense, as I see it.

I recommend to those who contact me that they do home dialysis if they can. I continue to have contact with patients who are not being able to to job interviews due to their staff not re-scheduling their dialysis, or some who work who can not get their units to meet their schedules. Sad, indeed. Perhaps if one provider, at the top, experienced what a dialysis patient experience, then, maybe then, someone would listen
opinions of Roberta Mikles BA RN
Dialysis Patient Safety Advocate
www.qualitysafepatientcare.com

[MooseMom]

I would never have known about home dialysis had it not been for the internet. We are in the information age; the information is there, and more and more people are finding it. As nice as it would be to have LDOs and even just nephrologists help patients access home hemo, I see on my web journeys more and more people being pro-active and teaching themselves about this modality. I actually have great hope for the future as more patients educate themselves.

Peter, I really enjoyed reading your article for the AJKD. Would you mind posting it on IHD? It's astonishing how many new members visit that forum, and reading your article would help so many people!