Further approaches to reduce the cost of renal replacement therapy

Vanholder, Raymond; Annemans, Lieven; Brown, Edwina A.; Gansevoort, Ron T.; Gout-Zwart, Judith J; Lameire, Norbert; Morton, Rachael L.; Oberbauer, Rainer; Postma, Maarten J.; Biesen, Wim Van; Zoccali, Carmine

doi:10.1038/nrneph.2017.136

Cited by 6 publications

(7 citation statements)

References 7 publications

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“…idney transplantation is the preferred treatment for most of the 700 000 adults with end-stage kidney disease (ESKD) in the United States as of 2016. [1][2][3] However, only 14% of patients with incident ESKD are placed on the deceased donor kidney transplantation waiting list or receive transplants within 1 year of ESKD diagnosis. 2 The Centers for Medicare & Medicaid Services (CMS) requires dialysis facilities to provide transplant education and help interested patients pursue kidney transplantation.…”

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confidence: 99%

Association Between Dialysis Facility Ownership and Access to Kidney Transplantation

Gander

Zhang

Ross

et al. 2019

JAMA

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IMPORTANCE For-profit (vs nonprofit) dialysis facilities have historically had lower kidney transplantation rates, but it is unknown if the pattern holds for living donor and deceased donor kidney transplantation, varies by facility ownership, or has persisted over time in a nationally representative population. OBJECTIVE To determine the association between dialysis facility ownership and placement on the deceased donor kidney transplantation waiting list, receipt of a living donor kidney transplant, or receipt of a deceased donor kidney transplant. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study that included 1 585 947 patients treated at 6512 US dialysis facilities. Adult patients with incident end-stage kidney disease from the US Renal Data System (2000-2016) were linked with facility ownership (Dialysis Facility Compare) and characteristics (Dialysis Facility Report). EXPOSURES The primary exposure was dialysis facility ownership, which was categorized as nonprofit small chains, nonprofit independent facilities, for-profit large chains (>1000 facilities), for-profit small chains (<1000 facilities), and for-profit independent facilities. MAIN OUTCOMES AND MEASURES Access to kidney transplantation was defined as time from initiation of dialysis to placement on the deceased donor kidney transplantation waiting list, receipt of a living donor kidney transplant, or receipt of a deceased donor kidney transplant. Cumulative incidence differences and multivariable Cox models assessed the association between dialysis facility ownership and each outcome. RESULTS Among 1 585 947 patients, the median age was 65 years (interquartile range, 54-75 years), with 55.8% male, and 28.4% non-Hispanic black patients. Eighty-eight percent of patients received care at a for-profit dialysis facility. A total of 115 650 patients (7.3%) received care at 435 nonprofit small chain facilities; 66 539 (4.2%) at 325 nonprofit independent facilities; 527 458 (33.3%) at 2239 facilities of large for-profit chain 1; 525 997 (33.2%) at 2082 facilities of large for-profit chain 2; 245 633 (15.5%) at 997 for-profit small chain facilities; and 104 670 (6.6%) at 434 for-profit independent facilities. During the study period, 230 202 patients (14.5%) were placed on the deceased donor waiting list, 39 767 (2.5%) received a living donor kidney transplant, and 88 431 (5.6%) received a deceased donor kidney transplant. For-profit facilities had lower 5-year cumulative incidence differences for each outcome vs nonprofit facilities (deceased donor waiting list: −2.6% [95% CI, −2.8% to −2.4%]; receipt of a living donor kidney transplant: −0.9% [95% CI, −1.0% to −0.8%]; and receipt of a deceased donor kidney transplant: −1.4% [95% CI, −1.5% to −1.3%]). Adjusted Cox analyses showed lower relative rates for each outcome among patients treated at all for-profit vs all nonprofit dialysis facilities: deceased donor waiting list (hazard ratio [HR], 0.87 [95% CI, 0.86 to 0.88]); receipt of a living donor kidney transplant (HR, 0.82 [95% CI, 0.80 to 0....

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confidence: 99%

Association Between Dialysis Facility Ownership and Access to Kidney Transplantation

Gander

Zhang

Ross

et al. 2019

JAMA

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“…Most of these practices are economically viable and even profitable for dialysis facilities, which makes convincing the board of directors and investors to support a sustainable approach much easier. In a scenario in which the costs of renal replacement therapy around the world are an increasing concern and our capability as a healthcare system to universally provide this therapy is at risk 25,26 , this are indeed excellent news. After all, green dialysis is a win-win initiative; advantageous for the environment, society, and dialysis facilities.…”

Section: Introductionmentioning

confidence: 99%

A call-to-action for sustainability in dialysis in Brazil

Moura-Neto¹,

Barraclough

Agar

2019

Braz. J. Nephrol.

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Human-induced climate change has been an increasing concern in recent years. Nephrology, especially in the dialysis setting, has significant negative environmental impact worldwide, as it uses large amounts of water and energy and generates thousands of tons of waste. While our activities make us responsible agents, there are also several opportunities to change the game, both individually and as a society. This call-to-action intends to raise awareness about environmentally sustainable practices in dialysis and encourages this important discussion in Brazil.

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“…The high prevalence of kidney diseases, affecting around 10% of the population worldwide, and the high cost of renal replacement therapy (RRT), consuming up to 2% of the health care expenditure for 1:1000 individuals (rounded prevalence of patients on RRT) are good reasons to explore the field of prevention and health care management [ 6 , 7 , 8 , 9 , 10 , 11 ]. Paediatric and geriatric nephrology have become self-standing subspecialties, while the field of obstetric nephrology is attracting increasing interest [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…Dialysis is an expensive treatment; in most European countries the key determinant of cost of treatment is nurses’ and doctors’ salaries [ 9 , 10 , 11 , 24 ]. The more years of work experience a staff member has, the higher their salary will be, which means that “old” experts cost more than young beginners.…”

Section: Introductionmentioning

confidence: 99%

Where Are You Going, Nephrology? Considerations on Models of Care in an Evolving Discipline

Piccoli

Breuer

Cabiddu

et al. 2018

JCM

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Nephrology is a complex discipline, including care of kidney disease, dialysis, and transplantation. While in Europe, about 1:10 individuals is affected by chronic kidney disease (CKD), 1:1000 lives thanks to dialysis or transplantation, whose costs are as high as 2% of all the health care budget. Nephrology has important links with surgery, bioethics, cardiovascular and internal medicine, and is, not surprisingly, in a delicate balance between specialization and comprehensiveness, development and consolidation, cost constraints, and competition with internal medicine and other specialties. This paper proposes an interpretation of the different systems of nephrology care summarising the present choices into three not mutually exclusive main models (“scientific”, “pragmatic”, “holistic”, or “comprehensive”), and hypothesizing an “ideal-utopic” prevention-based fourth one. The so-called scientific model is built around kidney transplantation and care of glomerulonephritis and immunologic diseases, which probably pose the most important challenges in our discipline, but do not mirror the most common clinical problems. Conversely, the pragmatic one is built around dialysis (the most expensive and frequent mode of renal replacement therapy) and pre-dialysis treatment, focusing attention on the most common diseases, the holistic, or comprehensive, model comprehends both, and is integrated by several subspecialties, such as interventional nephrology, obstetric nephrology, and the ideal-utopic one is based upon prevention, and early care of common diseases. Each model has strength and weakness, which are commented to enhance discussion on the crucial issue of the philosophy of care behind its practical organization. Increased reflection and research on models of nephrology care is urgently needed if we wish to rise to the challenge of providing earlier and better care for older and more complex kidney patients with acute and chronic kidney diseases, with reduced budgets.

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Further approaches to reduce the cost of renal replacement therapy

Cited by 6 publications

References 7 publications

Association Between Dialysis Facility Ownership and Access to Kidney Transplantation

Association Between Dialysis Facility Ownership and Access to Kidney Transplantation

A call-to-action for sustainability in dialysis in Brazil

Where Are You Going, Nephrology? Considerations on Models of Care in an Evolving Discipline

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