Position statement on dialysis economics from the 2nd Congress of the Internatio

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LI, P. K.-T., CHEUNG, W. L., LUI, S. L., BLAGG, C., CASS, A., HOOI, L. S., LEE, H. Y., LOCATELLI, F., WANG, T., YANG, C.-W., CANAUD, B., CHENG, Y. L., CHOONG, H. L., FRANCISCO, A. L. d., GURA, V., KAIZU, K., KERR, P. G., KUOK, U. I., LEUNG, C. B., LO, W.-K., MISRA, M., SZETO, C. C., TONG, K. L., TUNGSANGA, K., WALKER, R., WONG, A. K.-M., YU, A. W.-Y. and On Behalf of the participants of the Roundtable Discussion on Dialysis Economics in the 2nd Congress of the International Society for Hemodialysis held in Hong Kong in August 2009 , Increasing home-based dialysis therapies to tackle dialysis burden around the world: A position statement on dialysis economics from the 2nd Congress of the International Society for Hemodialysis. Hemodialysis International, no. doi: 10.1111/j.1542-4758.2010.00512.x
http://onlinelibrary.wiley.com/doi/10.1111/j.1542-4758.2010.00512.x/abstract

• The global increase in end-stage renal failure patients poses significant stresses on health care systems around the world.
• The current worldwide provision of the majority of renal replacement therapy via in-center hemodialysis (HD) is costly.
• The provision of home-based therapies, as either home HD (HHD) or peritoneal dialysis (PD), is less costly than in-center HD, in most parts of the world.
• Home therapies provide a level of empowerment to patients that impact positively on their patient outcome and quality of life.
• Proactive predialysis patient education on the availability of dialysis modalities including in-center HD, home-based HD, and home-based PD programs (continuous ambulatory peritoneal dialysis [CAPD] and automated PD) should be enhanced in order to improve patient choice regarding their dialysis regimen.
• The dialysis community should engage with local governments and Health Authorities to discuss the planning and provision of dialysis modalities with a view to providing the most cost-effective therapies.
• Local governments and Health Authorities should actively plan the increase use of home dialysis modalities in order to maximize health care resources for treating end-stage renal disease (ESRD) patients.
• Academic training of both doctors and nurses on home dialysis therapies especially for PD should be enhanced in order to promote more home dialysis.

Introduction
The number of patients with ESRD requiring renal replacement therapy is increasing at a rapid pace throughout the world as a result of population aging, extended life expectancy of ESRD patients, and a global epidemic of diabetes mellitus (DM).1,2 It is estimated by the end of 2010 that the global population of dialysis patients will exceed 2 million, with the 10-year treatment cost ending 2010 to be around US$1.1 trillion.3 The escalating demand for maintenance dialysis therapy is placing a very heavy burden on the health care systems in many countries. Concerns have been raised as to whether funding will be adequate to provide dialysis therapy given the growing number of ESRD patients.4
During the 2nd Congress of the International Society for Hemodialysis held in Hong Kong in August 2009, academic nephrologists, health care officials, and nephrology society representatives from Hong Kong, Australia, China, Italy, France, Japan, Korea, Macau, Malaysia, Singapore, Spain, Taiwan, Thailand, and the United States participated in a roundtable discussion on dialysis economics. The focus of the roundtable discussion was on ways to tackle the dialysis burden around the world. This paper summarizes the views expressed by the participants of the Roundtable Discussion on how to deal with the rising demand for dialysis.

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Conclusion

The growing demand for dialysis therapy to treat ESRD patients is placing a heavy financial burden on the health care systems worldwide. The current funding for provision of dialysis therapy will not be sustainable in the long run. One potential solution to alleviate this burden is wider utilization of home-based dialysis therapy, which is more cost effective than hospital-based or center-based HD and at the same time provides patient empowerment with at least as good outcomes, both in terms of hard endpoints and quality of life. Such approaches, however, require changes in the health care reimbursement systems in many countries so as to increase the incentive for the clinicians or hospitals to initiate CAPD, APD, or HHD for their patients. It is hoped that governments and providers embrace these philosophies to allow more patients to be treated with dialysis given the constraint of a limited health care budget and we call on providers to engage nephrologists to assist in the development of these programs. Given the current data suggesting benefits of home dialysis therapies over in-center dialysis, there is paucity of well-designed randomized trials comparing the clinical outcomes and cost effectiveness of home vs. in-center dialysis. More research in the field is recommended.

[MooseMom]

Are there ever any academic papers written that don't end with "More research is recommended."?

Why didn't these people come ask me to sit in on their conference?  I could have told them this!

To ease the financial burden of dialysis, some things other than the ones listed can be done...

1.  Make sure people have access to good pre-dialysis care so that they delay the onset of dialysis or perhaps avoid it altogether.  There should be an all out war on diabetes.  The number of people who need dialysis needs to decrease, and if people could have better access to preventative care, this could only help.

2.  Do whatever is possible and ethical to increase the number of kidneys available for transplantation.  This should NOT be a competition between dialysis and transplantation, rather, a concerted effort to keep people healthy with optimal dialysis while awaiting transplantation while at the same time making the public more amenable to donation.  Again, the idea is to get/keep as many people as possible off dialysis in the first place.  Aim for pre-emptive transplantation when warranted and appropriate.

3.  I'm hopeful that in the not too distant future, we will be able to grow new organs to replace crap ones.  Make dialysis obsolete.  Oh my...wouldn't that be incredible?

I realize that this conference dealt with hemodialysis in particular, but if your aim is to reduce the financial burden of dialysis, we need to look outside the box, so to speak.