Dialysis industry news

Stories from the dialysis comunity across the globe.



Home Dialysis Program celebrates 100th patient at home - HealthCanal.com PDF Print

By Leslie Shepherd - The Home Dialysis Program always said that when it had 100 patients who were receiving dialysis at home, it would have a big celebration. But before the party could be held in April, the number had risen to 115 patients and is still climbing.

Mina Kashani, a dialysis co-ordinator/nurse navigator for the Home Dialysis Program, meets with patient Bryan Cleveland. (Photo by Yuri Markarov)

Mina Kashani meets with Bryan Cleveland

“It’s more than just a number, since of course there is a patient and a personal story behind each one,” said Liz Anderson, the clinical leader manager for the Kidney Care Centre, Home and Satellite Dialysis Units. “But it is an important milestone for us 25 years after the home dialysis program began at St. Michael’s.”

Anderson attributed the accelerated growth in the Home Dialysis Program over the last two or three years to four things:

  • A urologist dedicated to the program, Dr. Jason Y. Lee, for peritoneal dialysis catheter insertions. Dr. Lee surgically implants the catheter in advance, and when the patient is ready to begin dialysis, Dr. Jeffrey Perl, a nephrologist performs a minor surgery to bring the buried portion to the surface. By burying catheters in advance, the patient has their access already in place when it’s time to begin dialysis and dialysis can be started in a more timely fashion.
  • A dialysis co-ordinator/nurse navigator, Mina Kashani, dedicated to the program, guiding patients through dialysis options and their journey if they choose home dialysis
  • The program now treats patients from Toronto East General Hospital, which does not have its own home dialysis program
  • A case manager in charge of daily clinical operations, Fatima Benjamin-Wong

The program currently has 20 patients on home hemodialysis, where their blood is filtered through a machine that eliminates impurities and fluids. Eighteen of them do “conventional” dialysis three times a week, while two do nocturnal home dialysis, which is performed for six or eight hours while the patient sleeps at night.

Ninety-five patients have chosen peritoneal dialysis, in which their abdominal lining, or peritoneum, acts as a membrane across which fluids and impurities pass. Wastes are taken out by means of a cleansing fluid called dialysate, which is washed in and out through a catheter inserted in the abdomen. This can be done manually, during the day, while patients go about their normal activities. But most use a machine to fill and empty their abdomen three to five times during the night while they sleep.

The Home Dialysis Program is also celebrating a physical expansion. It recently received approval to hire two additional nurses and it’s acquiring additional space on 2 Shuter for a satellite clinic to conduct peritoneal dialysis training. It has also started seeing some patients in Huntsville and Parry Sound via telemedicine, reducing their travel and financial costs. Nurses in the program made home visits totaling 700 hours last year.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

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Giving back: Expat doctors build dialysis centre in Abbottabad - The Express Tribune PDF Print
Giving back: Expat doctors build dialysis centre in Abbottabad - The Express Tribune

A doctor goes through the medical history sheet of a patient at the hospital. PHOTO: EXPRESS

ISLAMABAD: Expatriate nephrologists have set up a state-of-the-art dialysis centre in Abbottabad, Khyber-Pakhtunkhwa, with a promise to treat poor patients for free.

Pakistan Kidney Centre (PKC), which opened last April, has provided much-needed relief to kidney patients living in the Hazara belt, Fata and Gilgit-Baltistan, as previously, their only option was Ayub Medical Complex.

The centre is equipped with the latest dialysis equipment, while the facility is accessible to around 10 million people in the region.

The centre was built by the Pakistan Welfare Society (PWS), a Jeddah-based non-profit organization, with the support of Pakistani expatriates and philanthropists working in Saudi Arabia and other countries. At present, 14 patients are being provided with daily dialysis, which will later be increased to 50 patients-a-day.

Anyone who cannot afford treatment is eligible for free care through a Zakat fund, eligibility for which will be checked using the patient’s residence and an assessment of monthly income. Besides this, the centre also plans to provide free mobile screening facilities in the region.

The 1,039-square-metre centre is along the Karakoram Highway, some five kilometres south of Abbottabad. The land for the Rs100 million project was donated by one of the trustees of the society.

“As Pakistani nephrologists working abroad, we felt it was our responsibility to build a hospital for kidney patients in the area, where people are poor and cannot afford expensive treatment,” PKC founder Khalilur Rehman told The Express Tribune.

Dr Rehman said Rs100 million has already been spent on the project, and another Rs100 million was required to add an operation theatre, intensive care unit (ICU) and a 50-bed inpatient facility under the expansion plan.

PWS further plans to establish clinics in various towns in the region and will soon start working on this, he added.

The non-profit organisation has also signed an agreement with the Pakistan Red Crescent Society to run eye clinics and blood donation campaigns in the region.

Besides the dialysis centre, the society has been providing medical diagnosis, laboratory tests and medicines to needy patients through over 200 free medical camps in Jeddah and other Saudi cities for the last few years.

Till now, the society claims to have provided health services to around 31,000 kidney patients in the expat community in Saudi Arabia.

Published in The Express Tribune, June 3rd, 2015.

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State Efforts to Promote Organ Donation Mostly Fizzle - MedPage Today PDF Print

Action Points

Most state programs to boost organ donation haven't worked, and it's time to try new strategies, including cutting back on heart transplantation wait listing, experts said.

Every state in the U.S. has passed at least one policy to attempt to increase organ donation over the past 2 decades, Erika G. Martin, PhD, MPH, of the University at Albany-State University of New York, and colleagues reported online in JAMA Internal Medicine.

But analysis against time trends in actual donation in United Network for Organ Sharing (UNOS) and related national databases showed no significant or robust associations with either donation rates or number of transplants for first-person consent laws, donor registries, public education, paid leave, or tax incentives created by those new policies.

That was the case "even after allowing for prolonged delays for policies to take effect" in sensitivity analyses.

The only thing that did have some modest impact was revenue policies for individuals to contribute to a protected state fund to promote organ donation, which was associated with a 5.3% increase in the absolute number of transplants, equivalent to an extra 15 transplants per state per year (P=0.03).

Notably, that effect was driven by deceased donor rather than living donor transplants, "which may indicate that such funds are being targeted toward the improvement of clinical practices to optimize the organ procurement process at the time of deceased donation."

Most policies implemented by states appear not to have gone far enough to have a real effect, Martin's group suggested.

"For instance, the maximum cash value of tax deduction policies under existing policies is approximately $600, which is markedly less than the suggested $10,000 threshold to motivate donation of a solid organ, as described in prior studies," they pointed out.

Radical Incentives

The study is a "yet another reason to get serious about meaningful reform," Sally Satel, MD, a psychiatrist at Yale University, and David C. Cronin, II, MD, PhD, a transplant surgeon at the Medical College of Wisconsin in Milwaukee, wrote in an invited commentary.

"Altruism is not enough," they wrote.

Paired kidney exchanges and domino chains for living donation will help, "but they are not intended to recruit new donors in large numbers," the group added.

Even switching to presumed consent to take organs after death unless specifically forbidden "will not yield enough new kidneys for transplant because less than 1% of deceased individuals are medically eligible to donate," they added.

Satel's group called for disruptive innovation -- "compensating donors, not simply seeking to soften the financial ramification of donation. It is time to test incentives, to reward people who are willing to save the life of a stranger through donation."

The National Organ Transplant Act makes brokered or direct cash sales between buyer and seller a felony, but doesn't actually prohibit the proposed system of in-kind, third-party compensation, they noted.

"Donors would not get a lump sum of cash; instead, a governmental entity or a designated charity would underwrite and offer them in-kind rewards, such as a contribution to the donor's retirement fund, an income tax credit, or a tuition voucher worth roughly $50,000," they wrote. "To enhance deceased donation, a funeral benefit could be offered."

"Finally, as part of their compensation package from federal or state government or charity, all rewarded live donors would be guaranteed follow-up medical care for any complications, which is not ensured now," Satel and colleagues suggested.

Balancing Heart Supply and Demand

Whatever the pilot incentives to boost donation, clinicians need to stop "overselling" the heart transplantation list, Lynne Warner Stevenson, MD, of Brigham and Women's Hospital in Boston, wrote in a special communication in the same issue.

"The ethics of allocating hearts for transplant have always recalled the classic lifeboat dilemma of how many people can be allowed to board an already overcrowded lifeboat without sinking the ship and everyone on board," she wrote.

"In recognizing our responsibilities as stewards of scarce donor hearts, we should reduce new listings for heart transplants, thus restoring balance to the waiting list and keeping the lifeboat afloat," she argued.

Heart transplant numbers have seen no increase over the past 2 decades whereas the waiting list has expanded, she noted.

"As the transplant waiting list has become longer and waiting times have increased, the major route to heart transplants has become deterioration to the most urgent priority status, which accounts for 10% of patients on the waiting list but two-thirds of transplants," she noted, pointing out that "status 1A was intended to be used only in rare urgent cases."

Meanwhile, status 2 patients have little hope of getting a transplant anytime soon but often curtail their travel and participation in family events to be ready in case a donor heart becomes available, Stevenson noted.

"More realistic triage to ventricular assist devices as lifetime (destination) therapy, rather than to a long transplant waiting list, would encourage patients and families to more fully embrace and adapt their lives to enjoy maximal benefit from mechanical circulatory support," she wrote.

Putting more and more patients onto an "oversold" list undermines the promises and outcomes of transplant listing, she argued.

It's time to start saying no to wait listing patients less likely to fare well with a transplant and only add as many patients to the waitlist as are removed, she said.

"If new listings for heart transplants were reduced by 20% to 25%, the waiting list in the United States could reach a steady state close to 1,000 within 5 years," she noted, which might be doable by dialing back the contraindications for transplant that have been stretched over the years.

Martin and co-authors disclosed no relevant relationships with industry.

Satel and Cronin disclosed no relevant relationships with industry.

Stevenson disclosed support by the William T. Young Sr and Jr Foundation and grants from the National Heart, Lung, and Blood Institute for related work with the INTERMACS registry of mechanical circulatory support and the National Heart Failure Network.

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DOH, PhilHealth to probe dialysis centers for fraud - Inquirer.net PDF Print

After discovering questionable claims for cataract surgeries filed by two eye centers last year, the Department of Health (DOH) and the state-owned Philippine Health Insurance Corp. (PhilHealth) have turned their attention on dialysis centers with bloated claims.

Health Secretary Janette Garin said the investigation by a PhilHealth task force will include dialysis centers that have registered an unusual increase in insurance claims over the last two years.

“In the coming months, other cases of possible fraud will start coming in and we are looking into the possibility of checking dialysis centers,” Garin told reporters in a recent press briefing.

She said that an audit of the P78 billion that PhilHealth paid to affiliated healthcare institutions in 2014 showed a suspicious spike in hemodialysis treatments for kidney patients.

“The audit is still ongoing and our team has seen an increasing trend in the coverage of dialysis sessions. The intention now is to bring it down,” said Garin.

She said it was important that the fraudulent claims were stemmed to allow PhilHealth to expand its dialysis coverage for kidney patients.

Instead of insurance funds going to spurious claims, PhilHealth could pay for more dialysis sessions for its beneficiaries, she said.

“If we curb that, there is a chance for us to widen the coverage of hemodialysis treatment for our patients,” she said.

Garin said that PhilHealth was set to mark down its rate for hemodialysis from P4,000 per session to P2,500 in order to allow patients to have more sessions, from 45 to 72 a year.

She said P2,500 was enough to cover treatment, the doctor’s or healthcare worker’s professional fee and payment to the healthcare institution.

Earlier, PhilHealth president Alex Padilla announced the suspension of payments to two eye centers in Makati and Quezon City pending a thorough validation of their claims, particularly for cataract surgeries.–Jocelyn R. Uy

 

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Edmonton dialysis patient treated with contaminated water dies - The Globe and Mail PDF Print

Alberta Health Services says one of four dialysis patients treated with contaminated water in an Edmonton hospital last week has died.

AHS says it is not known if the patient’s death on Sunday was connected to the water problem two days earlier at Royal Alexandra Hospital.

The health agency says another patient remains in hospital, one has been moved off the acute-care unit and another has been discharged.

AHS says a wrong valve was opened during regular system cleaning and a chemical was released into the water used for dialysis.

The error was discovered during monitoring and the dialysis water supply was immediately turned off.

AHS says portable dialysis was used while the water was flushed and cleaned.

“Our heartfelt condolences go out to the family of the patient who died,” Vickie Kaminski, president and CEO of Alberta Health Services, said in a release Tuesday.

“We apologize that this incident occurred. It should not have happened and we will do all we can to support the patients’ families and loved ones through this difficult time.”

Kaminski said AHS is installing extra lockouts on valves, improving valve indicators and using better signage to ensure the water supply is protected from contamination.

It is also conducting a review to identify ways to prevent something similar from happening again.

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