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November 28, 2008

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Tracy Lynn

As someone who has done both incenter and now home hemo, I can tell anyone who ask that yes, there IS a difference. More dialysis for me has meant that I feel better than I do while dialyzing three times a week incenter. I feel, well, almost as good as I did before my kidneys failed. It's amazing, really.

So Glenn Chertow is so full of shit, he squeaks. I'm just sayin'.

Zach

If you think frequent hemodialysis is better, wait until you try frequent hemodiafiltration!

Bill Peckham

Zach, that's what the Aksys was, to a degree ... I think of it often.

Dori

I was very disappointed by Dr. Chertow's quote, too, Bill. As you and others have pointed out, 3x/week "standard" HD is a historical accident--it was NOT determined by RCTs, and when Medicare began paying for dialysis in 1973, those 3 treatments were 6-8 hours long (a schedule that was recently demonstrated to DOUBLE survival in a cross-over study from Turkey).

As Dr. Kjellstrand noted in his "Unphysiology Hypothesis" 33 years ago, the primary purpose of kidneys in the body is to maintain homeostasis. Filtering water and wastes from the blood is done IN ORDER TO MAINTAIN HOMEOSTASIS. The community's exclusive focus on small molecule removal has framed the entire focus of dialysis in the wrong place. The right place is homeostasis, and the right way to RESTORE homeostasis is by doing longer and/or more frequent treatments. This is simple common sense.

I agree with you. No-one who doesn't feel a benefit will continue to do more frequent treatments. CMS should make more dialysis available to anyone who will do it (and tear down that wall between Medicare Parts A & B while they're at it, so they realize the hospital-side savings of more treatment).

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