This legislation was originally introduced in the last congressional session as HR1759 and S1303. Both versions died in committee.

This bill will move beyond the "one size fits all" current Medicare End Stage Renal Disease (ESRD) reimbursement method and allow the Medicare program to pay for more frequent hemodialysis treatments, as defined by at least five times a week provided in the home or in a dialysis facility.

Here is the text of bill HR 1004.

Here is the Summary and Status Record of Bill HR 1004 from thomas.loc.gov.

Here is a RenalWEB Topic Page on daily, home, and nocturnal hemodialysis.

March 13, 2002 - The current issue of Contemporary Dialysis and Nephrology (CDN) has an article on home hemodialysis by Dr. Christopher Blagg, who has been actively involved in the home hemodialysis program at the Northwest Kidney Centers (web site) for more than three decades. Article from CDN/iKidney. (link is no longer available)

January 31, 2002 - The New England Journal of Medicine (NEJM) published a study this week that shows daily dialysis treatments for acute renal failure patients can dramatically improve the chances of survival, compared to the standard practice of giving dialysis every other day.

Here is the abstract of "Daily Hemodialysis and the Outcome of Acute Renal Failure" from the NEJM, January 31, 2002.

Another study on treatment adequacy for acute renal failure appears in the new issue of Blood Purification. This study finds that suboptimal Kt/V values are often delivered during treatments for acute renal failure.

Here is the abstract of "Correlates of Urea Kinetic Modeling during Hemodialysis in Patients with Acute Renal Failure" - from Blood Purification

The study description on the ClinicalTrials.gov web site states, "The primary outcome of this study is to determine the effectiveness of nocturnal dialysis in hemodialysis patients in St. Louis".

RenalWEB has a full information page on the Daily, Home, and Nocturnal Hemodialysis.

October 15, 2001 - A study, presentated by Researchers from the University of Toronto, at the World Congress of Nephrology(WCN), indicates that dialysis patients who receive their treatment at night may have less cardiac enlargement and high blood pressure. Here is a news article from Doctor's Guide covering this presentation.

October 11, 2001 - The October issue of Advances in Renal Replacement Therapy (ARRT) has the abstracts of eight papers on Daily Hemodialysis. Here is the Table of Contents of this issue of ARRT.

Some of the abstracts available are:

"Hemeral (daily) hemodialysis"

"Nocturnal home hemodialysis in North America". This paper reports that as of January 2001, there were 13 centers in North America performing daily nocturnal home hemodialysis caring for 115 patients.

"Daily hemodialysis efficiency: An analysis of solute kinetics"

Here is the Northwest Kidney Centers daily hemodialysis program. Here is their Frequently Asked Questions Page about daily hemodialysis.

Federal legislation has been introduced to provide funding for daily hemodialysis. RenalWEB has a Full Coverage Page on the "Kidney Patient Daily Dialysis Quality Act of 2001".

August 10, 2001 - Last week, Senator John Kerry (D-MA) introduced a bill that would allow Medicare ESRD patients to receive daily hemodialysis treatments. (web link is no longer available)

S 1303 is the Senate version of House bill HR 1759, the Kidney Patient Daily Dialysis Quality Act of 2001.

August 9, 2001 - The American Association of Kidney Patients (AAKP) has released a "Statement Concerning Daily Hemodialysis Options":

"The American Association of Kidney Patients (AAKP), in keeping with its mission to help all kidney patients, continues to encourage the improvement of existing treatment options and the development of new treatment methods, which will result in improved quality of care and clinical outcomes for kidney patients.

Currently, some new treatment options are being investigated, such as altering frequency and duration of hemodialysis treatments. AAKP strongly encourages that all new options be verified as medically effective, safe and yield better health outcome results, as recognized by the U.S. Food and Drug Administration, National Institutes of Health and/or other required institutions and that such options be appropriate for the particular patient as determined by the physician and patient.

AAKP urges the payors and providers to develop mutually agreeable economic arrangements for all FDA approved therapies.

AAKP strongly believes that the physician and patient should work together to select the best treatment for that individual patient, and that this decision should be supported by policies and practices which ensure equal access to the most effective therapy.

American Association of Kidney Patients, August 3, 2001."

(Reproduced on RenalWEB with the permission of the AAKP.)

July 31, 2001 - The August issue of the American Journal of Kidney Diseases (AJKD) has two articles on daily or nocturnal hemodialysis:

"Daily and Nocturnal Hemodialysis: How Do They Stack Up?" - abstract of an editorial by two Fresenius Medical Care physicians, Eduardo Lacson Jr, and Jose A. Diaz-Buxo. They urge that the renal community should partner with such government institutions as the NIH and the CMS/HCFA to study systematically the outcomes and costs associated with daily or nocturnal hemodialysis. (web link is no longer available) See the item from July 4 listed below for information on an upcoming study on daily dialysis.

"Short Daily Hemodialysis: Blood Pressure Control and Left Ventricular Mass Reduction in Hypertensive Hemodialysis Patients" - abstract from AJKD. (web link is no longer available) This prospective crossover study included 12 patients and confirmed that daily hemodialysis allows optimal control of blood pressure, reduction in left ventricular mass index, and withdrawal of antihypertensive treatment. The effects seem to be related to reduction in extracellular water content.

July 4, 2001 - The National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) is expected to announce soon that they are accepting Requests for Applications (RFAs) for a Clinical Trial of Daily Dialysis.

The proposed RFA will solicit applications to support the implementation of a carefully designed randomized trial of frequent dialysis. The overall goal is to assess the impact of more frequent dialysis on patient morbidity and mortality. It is envisioned that a planning group will be established in 2002, with the expectation that the trial will move into full implementation by 2003.

The listing is meant to provide the earliest possible alert to potential applicants in order to maximize application preparation time. While the NIDDK plans to proceed with this initiative, the publication and timing is not certain and depends on sufficient funds being available. Click here for more information on RPAs from the NIDDK web site. (link is no longer available)

June 13, 2001 - In 1998, the Rubin Dialysis Center in Albany, NY, began a new program, the Daily Nocturnal Hemo-Dialysis program (DNHD). An article about the DNHD program, written by one of the members of Rubin's Board of Directors, appears in this week's edition of the Albany business news service. It is entitled, "Dialysis center is the way to look at health care's future".

The author, John W. Rodat, uses the DNHD program as an example of how to use information technology creatively to make quantum leaps in how the care system operates. He also points out that the large dialysis providers "may be nervous about this mode of care. It challenges their ability to pay off the debts or recover the equity they invested in the physical plant."

Here is the Rubin Dialysis Center web site.

There is also a nightly home hemodialysis program run by Lynchburg Nephrology in Virginia. Here is their nightly home hemodialysis information page (web link is no longer available) and the home page of their web site.

Also, scroll down this page to see a posting by a nocturnal hemodialysis patient in the Seattle area who is also a physician. He participates in the Northwest Kidney Centers' daily hemodialysis program.

The following Frequently Asked Questions (link is no longer available) (FAQs) were prepared by the staff of the Nocturnal Home Hemodialysis (NHHD) program at the Humber River Regional Hospital in Toronto.

June 8, 2001 - The National Renal Administrators Association (NRAA) has There are now nine co-sponsors in the House of Representatives for the "Kidney Patient Daily Dialysis Quality Act of 2001."

May 30, 2001 - Two biostatisticians have published a paper in the June issue of the American Journal of Kidney Diseases (AJKD) that shows improving dialysis adequacy may both improve patient morbidity and lessen health care costs. This paper is likely to play a role in the justification for funding daily hemodialysis.

Here is the abstract of "Morbidity and Cost Implications of Inadequate Hemodialysis" from the AJKD. (web link is no longer available)

May 27, 2001 - There are now six co-sponsors in the House of Representatives for the "Kidney Patient Daily Dialysis Quality Act of 2001."

Here is an article from the Lynchburg, Virginia edition of newsadvance.com that provides background information on this legislation. (link no longer available)

May 13, 2001 - On May 8, US Representatives Jim McDermott (D-WA) and Jennifer Dunn (R-WA) introduced the "Kidney Patient Daily Dialysis Quality Act of 2001."

This bill will move beyond the one size fits all current Medicare End Stage Renal Disease (ESRD) reimbursement method and allow the Medicare program to pay for more frequent hemodialysis treatments, as defined by at least five times a week provided in the home or in a dialysis facility.

Here is the press release from Rep. McDermott's office. (link is no longer available)

Here is the text of bill HR 1759.

Here is the Summary and Status Record of Bill HR 1759 from thomas.loc.gov.

Here is a RenalWEB information page on daily hemodialysis.

Dear patients, providers, family and friends,

I am a family physician and dialysis patient in Seattle. I have dialyzed from 3-6 days a week, and have found 5-6 day/week dialysis to be much more effective in reducing my fatigue, anemia, and other problems. Patients in the US, Canada and Europe are doing more frequent daily and nocturnal hemodialysis with remarkable results - fewer uermic symptoms, better quality of life, and less need for drugs to treat anemia and high blood pressure.

In the US, this treatment is not available to patients because Medicare only pays for dialysis 3 times a week. The government are interested in more frequent dialysis and is planning a study for several years. Patients, physicians and staff who have experienced or seen the benefits of more frequent treatment feel they cannot wait for availability through the Medicare program.

Seattle Congressman Jim McDermott (D) and Congresswoman Jennifer Dunn (R) have introduced legislation (HR1759) to pay for more frequent hemodialysis. Attached is a copy of their letter asking colleagues to co-sponsor this bill and also some background information. For more frequent dialysis to be available to all patients who wish to use it, Congress must direct Medicare to provide payment so dialysis units can provide this service. At the same time, Medicare will save from fewer hospitalizations and lower drug costs, while the improved quality of life will allow more patients to return to work or school.

For HR1759 to pass Congress a grass-roots effort is needed for each of you to:
1. Write, call, email and/or fax the Representatives in your state asking them to co-sponsor HR1759.
3. Write John Davis, Chief Executive Officer, National Kidney Foundation,
asking the Foundation to support HR1759.
4. Write Kris Robinson, Executive Director, American Association of Kidney
Patients, asking the Association to support HR1759.

Sample letters are attached. Keep it brief and to the point. Phone calls, faxes and emails are also effective. A visit to the district office of your Congressperson is even better. Let meknow whom you have approached and their responses.

If you or someone you know have experience with frequent dialysis, describe these experiences. You may also write to comment on current experiences with 3 times a week dialysis and why you would like to have more frequent treatment as an option that you and other patients could select if you wished to do so.

If you have questions, contact me at bob@kickbutt.org. Thanks for your support.

Robert D Jaffe MD

Dear Congressman (woman)_________
There is increasing evidence that hemodialysis five or more times weekly rather than the usual three times a week provides great benefits for many patients with end stage renal disease. Patients feel better during and between dialyses, their quality of life is markedly improved and opportunity for rehabilitation is enhanced. These benefits have been reported in many papers from this country, Canada, and Europe. The Medicare Program currently only pays for hemodialysis three times weekly. While more frequent dialysis will increase the cost of dialysis, this will be offset by savings to both Medicare and patients from reduction or elimination of the need for erythropoetin and drugs to control high blood pressure, and reduction in frequency and days of hospitalization.

I (My family member__________ or My friend______) have/has been on more frequent dialysis in (place)_____ since (date)_________confirms these findings.

On May 8th, Congressman Jim McDermott (D) and Congresswoman Jennifer Dunn (R) introduced HR1759, the “Kidney Patient Daily Dialysis Quality Act of 2001” to amend title XVIII of the Social Security Act to provide for payment under the Medicare program for more frequent hemodialysis treatments.

On behalf of dialysis patients here and throughout the United States, I urge you to support this bipartisan legislation and to consider becoming a co-sponsor of this important bill.

If you have any questions, please feel free to contact Representatives McDermott or Dunn or their staff or to call me at ___-___-____.

Sincerely yours
_____________(Patient, Family of Patient, Friend of Patient)

John Davis
Chief Executive Officer
National Kidney Foundation
30 East 33rd Street
New York, NY 10016
Phone: 800-622-9010
Fax: 212-689-9261
Email: info@kidney.org

Dear Mr. Davis,

There is increasing evidence that hemodialysis five or more times weekly rather than the usual three times a week provides great benefits for many patients with end stage renal disease. Patients feel better during and between dialyses, their quality of life is markedly improved and opportunity for rehabilitation is enhanced. These benefits have been reported in many papers from this country, Canada, and Europe. The Medicare Program currently only pays for thrice weekly hemodialysis. While more frequent dialysis will increase the cost of dialysis, this will be offset by savings to both Medicare and patients.

I (My family member__________ or My friend______) have/has been on more frequent dialysis in (place)_____ since (date)_________confirms these findings.

On May 8th, Congressman Jim McDermott (D) and Congresswoman Jennifer Dunn (R) introduced HR1759, the “Kidney Patient Daily Dialysis Quality Act of 2001” to amend title XVIII of the Social Security Act to provide for payment under the Medicare program for more frequent hemodialysis treatments.

On behalf of dialysis patients throughout the United States, I urge the National Kidney Foundation to support this bipartisan legislation - HR1759. This is an important quality of care issue, as well as a choice issue for all ESRD patients.

Sincerely yours
_____________(Patient, Family of Patient, Friend of Patient)

Kris Robinson
Executive Director
American Association of Kidney Patients
100 S Ashley Drive, Suite 280
Tampa, FL 33602
Phone: 800-749-2257
Fax: 813-223-0001
Email: info@aakp.org

Dear Ms. Robinson,

There is increasing evidence that hemodialysis five or more times weekly rather than the usual three times a week provides great benefits for many patients with end stage renal disease. Patients feel better during and between dialyses, their quality of life is markedly improved and opportunity for rehabilitation is enhanced. These benefits have been reported in many papers from this country, Canada, and Europe, and there are now more than 150 papers in the world literature documenting them. The Medicare Program currently only pays for hemodialysis three times weekly. While more frequent dialysis will increase the cost of dialysis, this will be offset by savings to both Medicare and patients.

I (My family member__________ or My friend______) have/has been on more frequent dialysis in (place)_____ since (date)_________confirms these findings.

On May 8th, Congressman Jim McDermott (D) and Congresswoman Jennifer Dunn (R) introduced HR1759, the “Kidney Patient Daily Dialysis Quality Act of 2001” to amend title XVIII of the Social Security Act to provide for payment under the Medicare program for more frequent hemodialysis treatments.

On behalf of dialysis patients throughout the United States, I urge the American Association of Kidney Patients to support this bipartisan legislation - HR1759. This is an important quality of care issue, as well as a choice issue for all ESRD patients.