Three barriers prevent better dialysis.

• Position: Kidneys - Hemodialysis treatment research - Brief Article - Statistical Data Included

A clinical trial at Case Western Reserve University School of Medicine, Cleveland, Ohio, demonstrates that identifying and overcoming three barriers--underprescription of dialysis by physicians, use of intravenous catheters to provide treatment, and shortening of treatment time by patients--greatly improves the quality of hemodialysis treatment, a finding that may help the 33,000 Americans receiving suboptimal doses. Hemodialysis is used to treat people with kidney failure. In the process, blood is removed from the body and pumped into a machine that filters out toxic substances from the blood and then returns the purified blood to the person. The randomized, controlled study showed that educating physicians and patients about these barriers resulted in a twofold increase in dialysis dose compared to conventional care.

Virtually all dialysis treatment is paid for by Medicare, even for patients younger than 65. Despite Federal expenditures of $18,000,000,000 annually, the mortality rate among American hemodialysis patients is the highest in the industrialized world at 23% per year. (European and Japanese hemodialysis patient mortality rates run 10-15% annually.) One-sixth of the 200,000 Americans undergoing hemodialysis treatment do not receive an adequate dialysis dose, it was bund.

The study, involving 169 patients from 29 hemodialysis facilities, identified and addressed each barrier separately. If dialysis prescriptions turned out to be too low, a study...