The recently announced partnership of DaVita and the Kingdom of Saudi Arabia is a great opportunity to work together with an outstanding healthcare-delivery system to improve the health of its citizens. Kidney disease is an emerging public health concern in Saudi Arabia, as it is in the United States. DaVita is honored to be able to bring our knowledge and experience to enhance what is already excellent care, as well as to continue learning how best to improve care for kidney patients. This is truly a winning situation for DaVita, for Saudi Arabia and for kidney patients.

Read on below for more details on this partnership.

Left to right: Vice Minister of Health and Health Affairs, Dr. Mansour Naser Al-Howasi, Charge d’Affaires, U.S. Embassy in Riyadh, Tim Lenderking, Minister of Health, Dr. Abdullah bin Abdul Aziz Al Rabeeah, Chief Operating Officer of DaVita HealthCare Partners, Dennis Kogod.

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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…

“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.

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Patients with ESRD are the most medication-burdened of all the chronically ill. They take an average of 8 to 10 different medications, consuming more than 20 pills per day. It is not surprising, therefore, that the ability of nephrologists, dialysis facilities and patients to manage these medications is a challenge. Patients often do not know what medications they are on, and the monthly “pill check”—usually a shoebox filled with medication bottles—is notoriously inaccurate (1). More importantly, it has been estimated that up to a third of hospitalizations among the frail elderly (which includes a significant number of ESRD patients), and nearly half of re-hospitalizations in this population, are related to medication errors or adverse reactions. Finally, because of the large pill burden, the high costs of some medications and the significant occurrence of adverse events, adherence to prescribed medications is suboptimal (2).

Integrated pharmacy services can help resolve many of these issues for ESRD patients, as recently demonstrated by Weinhandl et al (3). This study compared nearly 9,000 patients enrolled in the DaVita Rx full-service pharmacy program to more than 40,000 control patients not in the program. Read more…