By Peter Laird, MD
Malnutrition remains a significant risk factor for sudden cardiac death in American dialysis patients with as many as 90% of patients on chronic hemodialysis reporting elements of partial or severe malnutrition. Food insecurity is especially prevalent in dialysis patients due to the greater than 85% unemployment rate for patients after one year on dialysis.
Despite the proven danger of malnutrition and food insecurity in patients on renal replacement therapy, Medicare does not cover costs for nutritional supplements. Interestingly, correcting malnutrition and improving albumin levels has a much greater positive impact on mortality reduction than does improving hemoglobin levels with costly ESA therapy. In addition, cost savings from reduced hospitalizations would render payment for nutritional supplements for dialysis patients a cost neutral intervention with much greater cost savings gleaned in the long term from a relatively modest upfront investment.
Studies show that the most effective manner of administering nutritional supplements is during each dialysis session:
Nutritional supplements are a proven medical intervention at a cost of only pennies to the dollar when compared to ESA therapy which is widely prescribed and covered by Medicare. It is time for America to step up and implement this cost effective intervention as a primary method of reducing morbidity, mortality and suffering among dialysis patients.
In the vacuum left by Medicare, some nephrologists have taken matters into their own hands. One exceptional example is Dr. Phillip Tuso, a nephrologist with Kaiser Permanente who created FIRN in response to the high number of his own patients with food insecurity that were dying at an alarming rate from malnutrition. Dr. Tuso started this non profit organization dedicated to relieving food insecurity within his dialysis population which has succeeded greatly in reducing mortality among his dialysis patients. Hospitalizations are likewise over 50% lower than before he began this intervention in 2004 saving Kaiser Permanente millions of dollars from one dialysis unit alone.
One nephrologist who was motivated by the knowledge of a simple and cost effective intervention with nutritional supplements serves as a outstanding model for how America could once again regain the threshold of humane care of those at risk of food insecurity in our dialysis population. It is time for America to save both lives and money with a simple intervention with oral nutritional supplements. The best medicine is once again the cheapest medicine.