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November 10, 2017


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Istenio Pascoal, MD

Dear Bill,

I admit that I am a little disappointed with your disappointment. For so many years you had been engaged in encouraging patients, payors and providers to embrace frequent hemodialysis concept and experience. My CBN&D colleagues and some of our patients have closely followed your blog's arguments while we hardly set up an in-center short daily hemodialysis (SDHD) program in the last decade.

First, we reported data at the WCN-2009 (Milan), showing better outcomes in Incident SDHD patients as compared with Converted SDHD patients - those who had previously been on conventional thrice-weekly schedule: http://www.cbndialise.com.br/images/pdf/wcn-2009.pdf

One year later, at the ERA-EDTA (Munich), studying only Incidents SDHD patients, several clinical, biochemical and social aspects were analyzed and have confirmed a better profile: http://www.cbndialise.com.br/images/pdf/edta-2010.pdf

At the ADC-2013 (Seattle), we presented outcomes from our first 100 patients and we announced, based on those supeior results, that SDHD had become an standard of practice in our unit: http://www.cbndialise.com.br/images/pdf/Seatle-2013.pdf

Further we verified that, in contrast with data on conventional 3 tx/week HD, our SDHD transplantation rate was higher than our mortality rate. So, based on that, at the ADC-2015 (New Orleans) we proposed an novel index for better evaluating dialysis quality: http://www.cbndialise.com.br/images/pdf/NewOrleans-2015.pdf

At the Kidney Week-2016 (Chicago) we showed how we have overcome the transportation barriers to sustain our long-term in-center SDHD program: http://www.cbndialise.com.br/images/asn2016-Final.pdf

And now, at the Kidney Week-2017 (New Orleans) we have discussed the positive impacts of 7 days a week dialysis service on our daily program: http://www.cbndialise.com.br/images/2017/seven-days.pdf

It has been a long journey with no way to come back. Hopefully you can joining us... again.

Adolfo Simon

Dear Mister Peckham
Reading your post, I wondered how the relay would be done among the patients, for the dialysis scheme that you propose. A large proportion of the patients, perhaps 30% or more, would need to agree to this relay between the different days of the week, causing a significant change in the schedules of eventual extra dialytic activities of all patients, impairing one of the primary purposes of dialysis: patient’s ability for his socio-professional activities, without the benefit of the smaller post-dialytic recovery time, as with SDHD.
Thinking on the economic side, the Clinic would have to open every Sunday, with labor costs higher than in other days of the week, to increase only about 4.6% in its monthly dialysis number: (0.3 x 15) + (0.7 x 13 ) = 13.6 HD pat / m,. Would it be economically viable?
Best Regards.
Adolfo Simon

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