What does this trip through dialysis history teach us?

[jester]

What does this trip through dialysis history teach us?

Conventional, current haemodialysis (HD) is commonly for 4-5 hours, 3 times/week (4x3). But, in the main, conventional “ maintanance” dialysis is dialysis …

 In the providers’ time, by the providers’ rules, at the providers’ convenience

In addition …It imposes conformity of lifestyle by restricting choice....It limits outcomes by enforcing unimaginative regimes

The future of HD should aim to be …

In the users’ time, by the users’ rules, at the users’ convenience

… And the user is you, the patient with kidney failure

 Ideal dialysis should at least offer ‘optimal’ options, Ideally, there should be options in HD, ranging from …

      4-5hr x 3/wk                                           (centre/satellite/home)

      Daily, short-hour, 5-7 days/wk               (centre/satellite/home)

      Long, slow, nocturnal 3.5 nights/wk     (centre sleep-over/home)

       Long, slow, nocturnal 6-7 nights/wk     (home)

Richard C/O Jessie


Deleted identical post in "home dialysis".  Do not make identical posts.  Rerun - Moderator

[angieskidney]

I thought this post would have the history with a title like that. Are you planning on posting some history> Dialysis  over the years? How it has evolved?

[stauffenberg]

In some areas of Europe, in-center hemodialysis is available only between the hours of 9 AM and 5 PM, for the convenience of the employees, who want a normal work day, and the employers, who do not want to pay overtime rates.  That this schedule means that the patient cannot have a normal life, or will have enormous difficulty holding any ordinary job, does not seem to interest anyone in power.

In Canada, the government would rather save money for the taxpayer than provide convenient dialysis centers, so when one Senator who was on dialysis had to do a lot of her work in Toronto, where there was no surplus dialysis capacity to accommodate her, the government had to pay to fly her back and forth between Toronto and her home dialysis unit in Ottawa three times a week!  Three years before I obtained a transplant I was offered a good job in Toronto, at a time when I lived about 250 miles outside of the city.  When I tried to arrange for dialysis in Toronto, I was told that the waiting list for a place in the city itself was as long as the waiting list for a transplant in some countries, and was offered instead a place in a dialysis unit in Ajax, a two-hour trip outside the city.  In addition, dialysis was available there only up to 6 PM, so my ability to work would have been destroyed.  I was only able to take the job after I got a transplant.

[jester]

Hi stauffenberg... I'd like to know the name of the senator... if you can.... we live in northern ontario  .... because of geography Jess is not "eligible" to take part in the ( NIH,farce ) study that is underway at Humber, London and TO General.... I refer to the study as a farce because it is just that... but that's another subject... anyway's I have a meeting with my MPP's coming up and the name would help !  Richard  C/O  Jessie 

[Zach]

In Canada, the government would rather save money for the taxpayer than provide convenient dialysis centers, so when one Senator who was on dialysis had to do a lot of her work in Toronto, where there was no surplus dialysis capacity to accommodate her, the government had to pay to fly her back and forth between Toronto and her home dialysis unit in Ottawa three times a week!

A major city such as Toronto has no surplus dialysis capacity?  Stauffenberg, in the past you told us that Canada had such a great Health Care System.

Here in the United States, there is no major urban city that has "no room at the inn."  If there is a need, a new center comes on-line.  Many centers across the country have 6am/6pm shifts to accommodate those patients who work or go to school.  The hours are not set for the "convenience of the employees, who want a normal work day."  Not bad for the country you scorn all the time.

[MattyBoy100]

In some areas of Europe, in-center hemodialysis is available only between the hours of 9 AM and 5 PM, for the convenience of the employees, who want a normal work day, and the employers, who do not want to pay overtime rates. That this schedule means that the patient cannot have a normal life, or will have enormous difficulty holding any ordinary job, does not seem to interest anyone in power.

I believe I have commented on statements such as the above before.  I live in the UK and these are my centre's times:

Sunday  - shut

Mon/Weds/Fri - 0730 - midnight.

Tues/Thurs/Sat - 0730 - 1900

The nurses are not paid overtime rates for working late, it is covered in their contracts.  The ones who work full-time work 10 hr shifts 4 days a week.  For out of hours, there is always someone on call from the unit to get in touch with or who attends the hospital if needed.

Please don't statements such as the one quoted above to be fact as it is a generalisation and Europe is a VERY big place.  Although it is written well, it may not be true.

[angieskidney]

I am in Canada and there is no "normal work day" for dialysis nurses here.

My unit is open til 10pm but even so .. I have had nurses stay over time without overtime pay because she put me before her job (I couldn't breathe because of Pneumonia and Edemia at that time). In my unit (not the hospital unit which has more accomidations) there are 3 shifts so it is easy to work around jobs.

These are my center's times:

Sunday - Closed (except for Christmas Eve or New Years Eve when Christmas Day/New Year's Day falls on a Monday).

Mon/Weds/Fir - 0600 - 2200

Tuesday/Thurs/Sat - 0600 - 2200

Canada is a VERY big country and I can't speak for every unit in this country. I can only speak for the ones I have been in. 

[stauffenberg]

The 9-5 working day at dialysis centers I was talking about is what I often encountered in Europe, not in Canada, where the hours are usually 7 AM to 11 PM.  Dialysis is far better overall in Canada than in the U.S., since there is no profit-motive to encourage dialysis suppliers to cut corners on the services they are required to provide their patients.  For this reason, the death rate on dialysis in Canada is 13% per year, while in the U.S. it is 24% a year.  This same difference can be found in all countries where there is socialized medicine rather than for-profit dialysis care, and indeed, in the small number of dialysis centers in the U.S. which are run on a not-for-profit basis, the death rate is comparable to that in countries with socialized medicine.

The problem with Canadian healthcare is not that there is socialized medicine, but that there is not enough of it.  While the U.S. spends 15% of its GNP on healthcare to treat only 86% of its population, Canada spends only 9% of its GNP on healthcare to treat 100% of its population, and one of the resulting shortfalls is that dialysis center capacity is not as rationally distributed for the needs of the population as it should be.

Unfortunately I can't remember the name of the Canadian Senator who had to be flown back and forth between Toronto and Ottawa three times a week for treatment, but I do know that there is considerable difficulty providing adequate renal care in Northern Ontario, and that many patients have to make the long trip down to the south of the province for transplant follow-up care.

[jester]

Thanks for trying ... eventually I'll Get her name just a bit more research but I will get it ... and your right here in the north we are subjected to in-centre or PD both of which are inferior as compared to nocturnal .... but we will continue the battle for what we believe in

Jester

[meadowlandsnj]

The 9-5 working day at dialysis centers I was talking about is what I often encountered in Europe, not in Canada, where the hours are usually 7 AM to 11 PM.  Dialysis is far better overall in Canada than in the U.S., since there is no profit-motive to encourage dialysis suppliers to cut corners on the services they are required to provide their patients.  For this reason, the death rate on dialysis in Canada is 13% per year, while in the U.S. it is 24% a year. 

Is there a difference in who gets dialysis care? I mean it seems everyone no matter what physical shape they're in can get dialysis in the US, no matter how sick they're not denied.  In Canada maybe not everyone is eligible for dialysis--it's not a guarantee you're going to be able to get it.  Sometimes I think the statistics are skewed by this.  I don't know how it works on other countries.

Donna

[stauffenberg]

About twenty-five to thirty years ago there still was a shortage of dialysis machines, staff, and stations, even in industrialized countries, but this has not been the case for a long time now.  Since then, anyone and everyone can have dialysis if they want it, as long as they are in an industrialized country.  As a student I did statistical research in a dialysis center in Germany in the mid-1980s; and I was a dialysis patient myself in the United States, Canada, and England from the mid-1990s to 2005, and I can say from my experience that the patient population in all four countries, three with socialized medicine, one without, was identical, having a large share of people with multiple disabilities, extreme old-age, gross obesity, total dementia, etc.

[meadowlandsnj]

About twenty-five to thirty years ago there still was a shortage of dialysis machines, staff, and stations, even in industrialized countries, but this has not been the case for a long time now.  Since then, anyone and everyone can have dialysis if they want it, as long as they are in an industrialized country.  As a student I did statistical research in a dialysis center in Germany in the mid-1980s; and I was a dialysis patient myself in the United States, Canada, and England from the mid-1990s to 2005, and I can say from my experience that the patient population in all four countries, three with socialized medicine, one without, was identical, having a large share of people with multiple disabilities, extreme old-age, gross obesity, total dementia, etc.

Thank you for answering my question. 

Donna