Editor's note: Reviewing the methodology for the 5-star system is not going to solve a bigger problem with the system: GIGO.
As Dr. Jeffrey Berns noted about Kt/V values reported to DOPPS in this February video blog posting:
"One example is the Kt/V. More than half of patients on hemodialysis in the United States have a Kt/V of 1.6 or greater, and another 43% have a Kt/V between 1.2 and 1.59, with a mean of about 1.6, which seems good, although I wonder whether the Kt/V is higher than it needs to be given data showing an absence of benefit from such high Kt/Vs. Somewhat discordant is the fact that 80% of patients in this country are still dialyzed for 4 hours or less, and 30% for 3 hours or less, with a mean treatment time still only slightly longer than 3 hours."
Dr. Joanne Bargman reported during a keynote address at a scientific meeting this year that she is aware of widespread cheating in data reported to CMS/CROWNWeb and DOPPS.
Who is going to investigate the widespread data fraud in the dialysis industry? The two medical directors from the largest for-profit corporations? The representatives from the non-profit organizations which happen to receive significant funding from the for-profit corporations? The biostatisticians from outside the industry who are unlikely to challenging U.S. nephrology's tradition of self-policing?
I would contend that there has been widespread, undetected cheating in dialysis data reporting for 15 years, that these practices has become institutionalized,
and that the conclusions drawn from this data should be considered worthless.