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Last Updated 11/22/15

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The benefits of daily hemodialysis treatments seem obvious. Daily treatments more closely resemble normal kidney function than three-times-a-week treatments. It also means fewer dietary and fluid restrictions as well as fewer medications. Patient testimonials about the benefits of daily treatments are abundant.

Medicare payment policy, also known as the composite rate, is based on three-times-a-week dialysis. This is, at first glance, less expensive for the government than daily treatments. Evidence is building, however, that daily treatments may result in overall lower healthcare costs for end-stage renal disease patients by reducing hospitalizations and lowering overall drug costs.

The most expensive cost component of a hemodialysis treatment is the patient-care (nursing) labor. This can be greatly reduced by performing hemodialysis treatments in the home. A new generation of home hemodialysis machines is currently under development that greatly simplifies their operation and reduces the burden on a home partner. The Internet also makes remote monitoring of the dialysis machines by trained professional staff affordable and convenient.

Warning:  Changes should never be made in a patient's treatment or care based solely on the information found here.  Every patient has unique healthcare concerns and considerations and all these factors must all be taken into account before any changes can be safely made.  All medical and therapeutic decisions must come from a qualified health care provider.  Read RenalWEB's Legal Disclaimer before proceeding.

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Benefits and Implementation of Home Hemodialysis: a Narrative Review - Free, Full-Text Article from Saudi Journal of Kidney Diseases and Transplantation - November/December 2015

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NKF Comments on Government Accountability Office's Home Hemodialysis Report - Article from the National Kidney Foundation. - November 18, 2015

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GAO Notes that Care Partner Requirement Remains a Significant Barrier to Home Hemodialysis Use, But Report Neglects to Recommend Policy Options, says Dialysis Patient Citizens - Press release. - November 17, 2015

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GAO Report — End-Stage Renal Disease: Medicare Payment Refinements Could Promote Increased Use of Home Dialysis - Report announcement and recommendations from the U.S. Government Accountability Office. Report is a 48-page pdf. - November 16, 2015
Editor's note: Payment -- and profit -- drives practice. Isn't it time to admit that for-profit dialysis has failed patients?

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Kidney Transplantation Prolongs Survival Compared with Home Hemodialysis - Press Release from the American Society of Nephrology - November 7, 2015

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Home Dialysis Use Declines in Wake of Payment Reform - Article from Renal & Urology News. - November 6, 2015
Editor's note: More evidence of how financial incentives are the source of dialysis patient-advocacy failures in the U.S.

This change was implemented by the 'renal czar' that was appointed during the Bush 43 administration. He was a biostatistician who was also instrumental in creating the CROWNWeb Project, which has been rife with fraud.

If he had instead chosen to simply report dialysis patient employment rates, so much more could have been accomplished... for a fraction of taxpayer money.

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NxStage Medical Makes More Progress Toward Profitability - Article from The Motley Fool. - November 6, 2015

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Debiotech and Fresenius Medical Care Announce Exclusive Partnership for New Home Dialysis Product - Press release.  - November 3, 2015

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Predictors of Transfer to Home Hemodialysis after Peritoneal Dialysis Completion - PDI in Press Abstract - November 2, 2015

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A Virtual Ward for Home Hemodialysis Patients — a Pilot Trial - Free, full-text, Open Access article from Canadian Journal of Kidney Health and Disease. - November 1, 2015

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Transition between Home Dialysis Modalities: Another Piece in the Jigsaw of the Integrated Care Pathway - Free, Full-Text Article from NDT - November 2015

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CMS Updates to Policies and Payment Rates for End-Stage Renal Disease Facilities for CY 2016 and Changes to the ESRD Quality Incentive Program - Fact Sheet from the Centers for Medicare & Medicaid Services (CMS). 403-page pdf Final Rule. News brief from AHANewsNow. - October 29, 2015
From the Fact Sheet:

"The CY 2016 ESRD PPS base rate is a reduction of $9.04 from the CY 2015 base rate of $239.43"

"CMS projects that the updates for CY 2016 will increase the total payments to all ESRD facilities by 0.2 percent compared with CY 2015.  For both hospital-based and freestanding ESRD facilities, CMS projects an increase in total payments of 0.2 percent."

From the Final Rule:

"While we have heard different things from stakeholders about whether or not the home dialysis training add-on payment adjustment is adequate, we are not in a position this year to address the commenters' concerns. We are, however, committed to conducting further analysis of the home dialysis training add-on payment adjustment and will consider making appropriate changes to the adjustment in future rulemaking."

"While we have heard from the commenters that we should increase the add-on so that more ESRD patients can receive the benefit of HHD (home hemodialysis), we have also heard from LDOs (large dialysis organizations) that the current training add-on is sufficient."

Editor's comment: The LDOs win by maintaining their business model and keeping their brick-and-mortar facilities filled rather than having more patients lead as normal lives as possible at home. The LDOs and other for-profit entities once again use their legal and financial might to control CMS policies.

Even though nearly all U.S. nephrologists would choose home dialysis for themselves, why don't they advocate this therapy for their patients? Where is their outrage?

And there is still no mention of targeting or increasing dialysis patient employment, although it was specifically stated as a goal in the original 1972 legislation. This omission virtually guarantees, in terms of improving patients' lives, that U.S. dialysis care will remain stagnant. Until patient advocacy groups embrace the necessity of increasing patient employment, patients' voices will remain unheard. In the meantime, for-profit dialysis corporations, pharmaceutical companies, and some influential U.S. nephrologists will continue to benefit immensely from stagnant dialysis care.

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In UK, Dialysis at Home Possible for Kidney Patients with New Machine - Video from the BBC. Quanta web site. - October 25, 2015

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The Use of Vascular Access Audit and Infections in Home Hemodialysis - Early View Abstract from Hemodialysis International - October 14, 2015

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Long-Term Effects of Frequent In–Center Hemodialysis - JASN Express abstract. - October 14, 2015
"In conclusion, a 12-month frequent in–center hemodialysis intervention significantly reduced long-term mortality, suggesting that frequent hemodialysis may benefit selected patients with ESRD."

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blue ball Latest Scientific Journal Articles on Home and Daily Dialysis Continually Updated!
Home Dialysis Central web site
Nocturnal Home Haemodialysis web site
Home Dialyzors United web site
Current Issues of Home Dialysis Central Newsletter
Current Issue of At Home with AAKP an electronic newsletter produced and distributed by the American Association of Kidney Patients (AAKP)
Alliance for Home Dialysis web site
Home Hemodialysis Fact Sheet (pdf format requires Adobe Acrobat reader.) from the American Nephrology Nurses’ Association
PD and Home Hemo Coverage Maps from the Home Dialysis Central web site
Home Hemodialysis (pdf format requires Adobe Acrobat reader) from the National Kidney Foundation (NKF) web site
Home Hemodialysis: Helping Patients Lead a Healthier Life online seminar from the American Association of Kidney Patients (AAKP)
Home Hemodialysis from the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)
Home Dialysis DVD from Home Dialysis Central web site
Home Dialysis Assessment Tool (pdf) from the Home Dialysis Central web site

Live healthier, better, longer with more frequent home hemodialysis an educational booklet that outlines the documented benefits and risks of home and more frequent home hemodialysis therapy from the NxStage web site

Book: Daily and Nocturnal Hemodialysis by Lindsay, Buoncristiani, Lockridge, Pierratos, and Ting © 2004

Book: Help, I Need Dialysis! How to have a good future with kidney disease by Dori Schatell, MS and Dr. John Agar © 2012

Nocturnal Home Hemodialysis - A First Person Account, Part I and Part II by Michael Williams
American Nephrology Nurses Association (ANNA web site) position on daily home hemodialysis

Self-Cannulation - Video via Renal Fellow Network web site

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A Home Dialysis Slide Show—And Sign Up For A Meeting! from the NxStage web site

blue ball Search result for Nocturnal dialysis by Google Continually Updated!
Home Dialysis web sites by Yahoo! Continually Updated!
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Find a home dialysis center in your area from the Home Dialysis Central web site
The following Frequently Asked Questions (FAQs) were prepared by the staff of the Nocturnal Home Hemodialysis (NHHD) program at the Humber River Regional Hospital in Toronto.
Lynchburg Nephrology (Virginia) has their Nightly Home Hemodialysis (NHHD) Program.
Rogosin Kidney Center of The Rogosin Institute is the first center in the New York City metropolitan area to offer patients nocturnal hemodialysis. This type of self care home dialysis offers patients independence and freedom for day time activities.

Four, well known, not-for-profit dialysis providers:

Northwest Kidney Centers
Rubin Diaylsis Center
Satellite Healthcare

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  PUBMED SEARCHES (National Library of Medicine's MEDLINE Database)
daily dialysis AND hemodialysis Continually Updated!
home hemodialysis Continually Updated!
nocturnal AND dialysis Continually Updated!
MEDLINE / Pubmed Information from the National Library of Medicine
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  K/DOQI™ -  Kidney Disease Outcomes Quality Initiative
NKF-K/DOQI Clinical Practice Guidelines

Clinical Practice Guidelines and Clinical Practice Recommendations 2006 Updates
K/DOQI Home Page from the National Kidney Foundation web site
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Care-Partners for Home Dialysis discussion page
Daily, Home, Nocturnal Hemodialysis Discussion Forum - RenalWEB Discussion Forum
Home Dialysis Central Face Book discussion page
Home Dialyzors United Face Book discussion page
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Adequate Hemodialysis Therapy - topic page from RenalWEB
Hemodialysis Dose and Adequacy from NIDDK
Clinical Practice Guideline on Adequacy of Hemodialysis - a book available from the Renal Physicians Association web site
Consensus Statement: Mortality and Morbidity of Dialysis from the NIH Consensus Development Program (written in 1993 with 1998 update)
United States Renal Data System (USRDS) 
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E-mail to RenalWEB on the Hemodialysis Adequacy Topic
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