By Peter Laird, MD
RenalWeb posted a link to an article titled Practicable Frequent Hemodialysis: A Proposal to Meet the Needs of Patients and the Requirements of Medicare that offers a proposal for Medicare funding of a payed incentive for each incenter patient that is converted to a home hemodialysis program. They further recommend that we should not wait for the current ongoing NIH trials to be completed before implementing this incentive since these studies are too small to show the expected survival benefit:
They conceded that the NIH trials, each with only 250 subjects, lacked sufficient power to establish a survival advantage. Kliger2 acknowledged that more than 3,500 subjects in the daily study and 5,000 in the nocturnal study would be required to have even 90% confidence in measuring a 30% decrease in mortality, likely placing that goal out of reach. Agar5 noted that conventional HD itself has never been subjected to a randomized trial.
Although further discussion is needed on how to implement such a program and some may not agree with this proposal as the correct manner in which to implement a home hemodialysis Medicare program, I would hope that no one would disagree with the author’s concluding statement:
With a practicable alternative for home dialysis–qualified patients, we can no longer justify delaying their chance for longer and better lives.
I applaud Melville H. Hodge for his forthright proposal and I further applaud the AJKD for publishing this article written by a home dialysis helper who has seen firsthand the benefits of daily dialysis with his 79 year old wife. May the long awaiting daily dialysis dialogue begin in earnest. More especially, will the well documented home daily hemodialysis benefits noted for decades in other nations be a reality here in America as well.
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