A REBUTTAL TO "A BETTER OPTION FOR DIALYSIS PATIENTS."

IN-HOME HEMODIALYSIS MACHINES ARE NOT A VIABLE OPTION TO THE MAJORITY OF IN-CENTER HEMODIALYSIS PATIENTS. MEDICARE PROMULGATED REGULATIONS TO ESTABLISH IN-CENTER HEMODIALYSIS CENTERS IN THE EARLY 1970s, BECAUSE IN-HOME HEMODIALYSIS ON A LARGE SCALE WAS NOT MEDICALLY SOUND AND LOGISTICALLY PRACTICAL TO DIALYZE THOUSANDS OF HEMODIALYSIS PATIENTS.

FOR IMMEDIATE RELEASE

Pasadena, CA- March 11, 2003- The February 3, 2003 headline of the article published in the Los Angeles Times Health Section titled, A Better Option for Dialysis Patients" by Linda Marsa, Times staff writer, is misleading.

She refers to a very small number of healthy hemodialysis patients that could benefit from in-home hemodialysis machines.
                                                        
Figures for 2001 indicate there were approximately 288,000 dialysis patients in the United States. As of 2001 the Southern California Renal Disease Council Network 18 (Network 18) boundaries included 21,795 dialysis patients total. Network 18 consists of 13 California counties from the Mexican and Arizona/Nevada borders to the Central California Coastal/Inland areas.

The racial breakdown is: Hispanic 39.6%; White 28.5%; Black 17.8%; Asian 11.5%; Other 2.7%.

Approximately 65 percent are senior citizens over 55 years of age. Generally, senior citizens over 55 years of age do not want anything to do with in-home dialysis of any kind. Most senior citizen hemodialysis patients suffer from various combinations of multiple medical problems, such as, chronic renal failure, large vessel disease, diabetes, and hypertension. They require constant close monitoring by the hemodialysis care team consisting of nephrologists, nurses, technicians, social workers and dieticians. The care team cannot make home calls three times a week 4 hours each time to visit thousands of dialysis patients.

Cherry Wu, MSW, dialysis social worker for Fresenius Medical Care San Gabriel Dialysis Center says, another critical issue not discussed in the Times article is there are three types of access sites: catheters, grafts, and fistulas.

When patients initially begin hemodialysis, they need a catheter placement, which only an RN can perform pursuant to the California Department of Health Services regulations. Fistulas and grafts can be connected to patients by certified technicians and nurses only pursuant to the regulations. This rules out family members connecting patients to hemodialysis machines in their homes."
                                                    
Wu also says, there are those who would say that the families can be trained to administer and monitor hemodialysis patients. This is a myth, because most families are not sophisticated enough to handle this medical burden. Another
concern is someone from an in-home hemodialysis machine company would have a difficult time trying to train a patient and family with a language barrier. Due to the fact that most hemodialysis patients are elderly, oftentimes,their memory ability is impaired. Often they dont have any family support systems."
                                                        
The general public and elected officials are not aware of the complex medical complications. For example, Labs and other biomed diagnostic tests have to be completed on a regular basis that require computer and other hi-tech equipment. This hi-
tech equipment cannot be placed in the patients homes because it would be cost prohibitive.

The publishing of the February 3, 2003 article is untimely,because it would have one believe that there is a better option for all hemodialysis patients coming soon. Another reason that it is untimely is because all state providers are facing a 15% state budget cut. Many in-center hemodialysis patients depend on Medi-Cal to help pay for in-center hemodialysis treatments, as well as, the Medi-Cal Non-Emergency Medical Paratransit Program that shuttles hemodialysis patients from their residences to the dialysis centers round trip.

Kent Thiry, CEO, and Chairman of the Board of DaVita Inc. says , the Times article refers to a 2000 study by Canadian governmental scientists who have pioneered the use of nocturnal dialysis. They claimed to show better outcomes regarding mortality rates and kidney transplants for non-profit
hemodialysis centers than for profit in-center hemodialysis centers in the USA in an article published in the Journal of the American Medical Association.
                                                        
However, the study by Wolfe of the University of Michigan disputes the Canadian study by Devereaux. The University of Michigan study by Wolfe indicates that for profit in-center hemodialysis outcomes were the same."
                                                                
DaVita, Inc. provides dialysis services for those diagnosed with chronic kidney failure, a condition also known as end stage renal disease (ESRD). We serve 43,000 patients in 33 states and the District Colombia from 490 outpatient dialysis centers that we currently operate. DaVita also provides acute inpatient dialysis services in over 280 hospitals across the country.
                                            
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