Living Well on Dialysis Down Under

January 15, 2009
Living Well on Dialysis Down Under

By Peter Laird, MD

Most Americans when we consider Australia draw to mind crocodiles, great white sharks, kangaroos, the great barrier reef and the daunting outback. In many ways, Americans share a kindred spirit with the ranchers and explorers of Australia from our own old west heritage. The same can do attitude that made our wild west great is still present among our Australian and New Zealand brethren whose lands continue to instill the frontier spirit. Overcoming adversity in these locations is in many ways more a matter of attitude than anything else.

Unfortunately, the independent and self sufficient mindset we once widely shared here in America is now found in only isolated pockets of the Rocky Mountains and perhaps in Texas where everything is bigger (that is if you ignore Alaska). The can do mindset that once made American dialysis programs the envy of the entire world has likewise been supplanted by complacency with the mediocrity of dialysis adequacy and meeting the standard annual mortality rate of 24% “as expected.” Something is now missing in American dialysis programs where relatively few nephrologists are the least bit familiar with the proven benefits of quotidian dialysis.

Fortunately, this lack of leadership in the summed total of American nephrology is now being supplanted by leaders in several other nations despite the well noted individual efforts of some long suffering American dialysis advocates. The can do spirit of nephrology and dialysis advocacy is most noted by the impressive results that Australia and New Zealand have recently compiled in their ANZData registry. (This is analogous to America’s USRDS registry.)

Australia and New Zealand have achieved up to a 2% annual mortality rate for those patients dialyzed over 20 hours each week. This is easily accomplished with home hemodialysis programs and it is likewise duplicated in those in center units with extended dialysis duration.

While American dialysis units feel satisfied to achieve the standard 24% annual mortality rate, the can do Aussies are surpassing the complacency of American nephrologists with the simple knowledge that increased frequency and duration of dialysis saves lives. It is time once again for America to draw upon the foundations that Scribner and other pioneers of dialysis laid down for all to emulate instead of remaining deadlocked with this dance with death due to the intransigence of dialysis adequacy and expected death rates.

It is time for the can do American spirit to reinvigorate individual nephrologists here in the United States to solve our last place international statistics and grab the bull by the horns and simply prescribe for your patients what our government controlled dialysis industry will not. Simply increasing all patients from 3 hours average dialysis to 4 hours average dialysis per session led my unit to reduce mortality from nearly 20% annually several years ago to that of 7% for 2008. It was not CMS that prescribed this change in dialysis treatment, but instead a dedicated, individual nephrologist who recognized the simple truth that he could increase patient survival by increasing dialysis duration as a common practice for all of his patients.

CMS does not prescribe a single dialysis treatment. No matter what policies that CMS advocates or does not advocate, there is no hindrance for any individual nephrologist to be able to take matters into their own hands and start prescribing increased dialysis duration immediately. Nephrologists are individually accountable.

http://www.billpeckham.com/from_the_sharp_end_of_the/2009/01/dialysis-in-australia.html