It’s the beginning of a new year, and that means medical professionals are setting goals to further improve health outcomes for their patients. This is particularly important for patients who suffer from complex, chronic illnesses.

I’ve compiled a list of trends that I predict will play a large part in shaping kidney care during 2014, with a focus on patients with end stage renal disease (ESRD).

Working patients. This was a hot topic closing out 2013 and will continue to gain attention throughout 2014. Admittedly, for some patients there are medical reasons that prevent them from  working when on dialysis; however, I foresee the kidney care community turning its focus toward the education of patients, employers and the public about the benefits of continuing to work despite being on dialysis. A key part of this educational effort will be an emphasis on treatment options for patients who can continue working. For such patients, the use of home dialysis modalities is particularly helpful. Read more…

I was speaking to a group of end stage renal disease (ESRD) patients at a symposium recently and met a 50-year-old man with polycystic kidney disease who had just started on in-center hemodialysis. He had been followed by a nephrologist for a number of years prior to progressing to ESRD, and had been well prepared by conventional standards to start dialysis while being placed on the cadaver transplant list. He had an arteriovenous fistula, and began dialysis uneventfully as an outpatient. He said that physically he was adapting well to dialysis, but was concerned and depressed because he quit his job when he knew dialysis was imminent. His doctor had not had a conversation about this issue with him and he didn’t know what to do or how he was going to continue to take care of his family. He asked me why dialysis patients had to stop working and he was surprised to hear me say that he could continue working, and that his doctor and dialysis facility should be helping him work through this issue and get back to work. This story is only too common. Read more…

As many of you may know, on Nov. 22, the Centers for Medicare & Medicaid Services (CMS) issued its final rule on 2014 payment rates for dialysis facilities paid under the End Stage Renal Disease Prospective Payment System (ESRD PPS) as well as updates to the Quality Incentive Program (QIP). CMS first announced a proposed cut of 12 percent(1) from Medicare’s ESRD program in July, potentially threatening access to dialysis care for thousands of patients with kidney disease across the country.

Thanks to the support from our physician partners, patients, teammates and other members of the kidney care community over the last few months, we were able to generate more than 124,000 contacts to Congress asking them to help stop the cuts. Our combined efforts were a success, resulting in flat rates over the next two years and continued access to dialysis care for our patients. But we still have some work to do to help mitigate future cuts. Read more…

The American Society of Nephrology’s (ASN’s) Kidney Week, the world’s premier nephrology conference, is upon us again. This year more than 13,000 kidney professionals from across the globe will descend on Atlanta, Ga., for a week of sharing knowledge, learning the latest scientific and medical advances and engaging in provocative discussions that will help usher in a better tomorrow in kidney care.

ASN is changing the focus of Kidney Week in 2013 to innovation and individualization. In a preview video, ASN executive director Tod Ibrahim spoke with ASN president Bruce Molitoris, MD, FASN, about what’s new. After watching it, I am excited to know that attendees will be gaining more real-world information to carry home and use directly for patient care. Additionally, attendees will enjoy expanded early programs, more basic science sessions and a new and enhanced Kidney Week 2013 app. Read more…

While looking at my calendar recently, I noticed World Mental Health Day was near. I began to think about the many dialysis patients we, as renal caregivers, see and how depression is such a prevalent issue among them. The lifestyle changes to be made during dialysis often bring up feelings of despair and loneliness for patients. They need a support team to help them get over this hurdle.

For today’s post, I asked Duane Dunn, MSW, national director of social work for DaVita, to give us a little insight into the issue of depression in dialysis patients, depression-treatment options and the teams that support this fragile population. Read more…

Twitter has become one of my favorite ways to consume news about the kidney care community. Tweets abound daily with proclamations advocating for patient rights, kidney-friendly diet tips, kidney disease education resources and more. In an ever-increasing world of digital media, social networks and the like, Twitter serves as a tool for me to tune into conversations that are relevant to the topics important to me. If you’re not on Twitter and would like to become part of the larger digital kidney care community that lives there, here are a few must-follow accounts to get you started. Read more…

On Aug. 13, I joined other members of the kidney care community for Voices of Dialysis: Protecting Access to Care—a Google+ Hangout discussing the government’s proposed funding cut for dialysis care. In this interactive video chat, the other speakers and I shared our concerns about the Centers for Medicare & Medicaid Services (CMS) plans to cut dialysis funding by 9.4 percent and elaborated on the potential impact for hundreds of thousands of Americans who rely on dialysis for life-saving treatments.

In case you missed the live Google+ Hangout, watch the complete 45-minute recap of Voices of Dialysis: Protecting Access to Care.

Speakers:
Eric Edwards, Dialysis Patient,
Dialysis Patient Citizens Board President

Allen R. Nissenson, MD, Chief Medical Officer,
DaVita

Robert J. Kossmann, MD, President,
Renal Physicians Association (RPA)

Diane Wish, President and CEO,
Centers for Dialysis Care

Join representatives from the kidney care community myself on Tuesday, Aug. 13, at 4 p.m. PT/ 7 p.m. ET for Voices of Dialysis: Protecting Access to Care—an important Google+ Hangout discussing the government’s proposed funding cut for dialysis care.

What’s a Google+ Hangout?
It’s a 45-minute interactive video chat that’s free to join and open to anyone. Participants will watch as a panel of speakers discuss a particular topic. All you need to participate is internet access.

Speakers to include:

Eric Edwards, Dialysis Patient,
Dialysis Patient Citizens Board President

Allen R. Nissenson, MD, Chief Medical Officer,
DaVita

Robert J. Kossmann, MD, President,
Renal Physicians Association (RPA)

Diane Wish, President and CEO,
Centers for Dialysis Care

“July and August will be critical months to take our message to Washington: no more cuts for dialysis patients and their providers.”

The recent proposal from the Centers for Medicare & Medicaid Services (CMS) to cut reimbursement for dialysis treatments by 9.4 percent has made me think hard about where dialysis has been, where it is now and where it might be headed. When I began my internship and residency at Michael Reese Hospital in Chicago (now gone, unfortunately), the Medicare entitlement for dialysis had not yet been enacted. Michael Reese had a long connection with pioneers in dialysis dating back to the 1920s. During my internship I rotated on the nephrology service. We had converted a hospital room to a dialysis ward and built Kiil dialyzers each time we wanted to do hemodialysis. We created Scribner shunts for blood access, and each treatment was an exciting challenge to get through without hypotension, clotting or other misadventures. We also had more than 40 patients on intermittent peritoneal dialysis (IPD). They would be admitted to the hospital each week, have a peritoneal catheter inserted and receive 48 hours of IPD. As the intern on the service, I admitted each patient, drew blood and then ran a set of electrolytes in a dedicated lab on the ward. I prescribed the peritoneal dialysis regimen for the 48 hours based on the physical examination and laboratory values. The Medicare entitlement for dialysis was enacted in the first year of my residency, 1972, and implemented in 1973. It changed everything.

Read more…

Centers for Medicare & Medicaid Services (CMS) recently took another step in a series of funding cuts for some of the most vulnerable patients in the U.S. healthcare system. These cuts threaten a system of care that has provided significant, systematic improvements in clinical outcomes and survival rates for patients with kidney failure.

Read more…