I feel like I have answered these questions many times here before … but … here it is, once more …
Re your dialysis patients who, for whatever reason, have to have dialysis in clinic … Do they have better access to more frequent dialysis than clinic patients here in the US?
No! Sadly, the 4 x 3 model … which really originated from a US Senate decision (ie: an administrative + financial one) back in 1972 and, in modern parlance, went ‘viral’ around the world to become ‘the standard’ … remains with us today as ‘conventional dialysis’.
Here in Australia and New Zealand, we have long recognized the advantages of home dialysis … and I won’t go through them yet again except to say: freedom of access to longer, more patient-friendly dialysis hours, to more frequent dialysis sessions … etc.
This has led to ANZ having a logarithmically higher home dialysis ‘ethic’ than elsewhere in the world. We ARE the outliers – but we are happy to be so. It has allowed more of our patients to access non-facility-based care.
But – our facility-based patients still have the long break. They still have to weather ‘weekends’, they are still exposed to the ‘killer break’ that Carl Kjellstrand so long ago described, so many times jhas emphasized, and so often has spoken of (with passion, conviction and pleading for it to be recognised) at every meeting he has been to … but, oddly, which seems to have only just been ‘discovered’ by ‘the community’ in a paper in the NEJM (2011: 365: 1099-1107) … sighs … doesn’t it rot your socks!
Our governments (all governments) were quick to embrace 3 x 4 all those years ago.
To now go to a facility-based ‘alternate day regimen’ would mean Sunday dialysis! Staff wages here – and likely elsewhere – are higher on Sundays. The costs of alternate day dialysis would add 1/7th more, every 2 weeks, to the costs of dialysis consumables and even more to the costs of wage and salaries. Doctors also like to have occasional weekends off (even this one!) … and so are also ‘scarcer’ at weekends.
No governments – neither yours nor ours – show any enthusiasm to fund the extra day per week.
Here, where all dialysis is ‘free’ (to the population, but not to the government), it has been just as difficult (no – it has been impossible) to shift the juggernaut set in motion all those years ago in 1972 that became 3 x 4.
That, Michelle, is the way of politics, funding, and entrenched positions around the world.
A small number of our (local) patients … four years ago, more than ½ the patients who were on short daily clinic-based dialysis (2.5-3.0 hr x 6/week) in the whole of Australia (12/22 at that time) were here in Geelong. I haven’t looked at the data for this since but don’t think it has changed much!
So … no … our (clinic) patients do not have better access to more frequent dialysis than clinic patients in the US?
Do most clinics in Australia open every day so that there is not this long interdialytic period that is so dangerous?
As above … no. Would that it were different – but it isn’t.
And, it’s not likely to change in the foreseeable future – even though Australia is the by far and away the most economically secure and prosperous of all western nations in the current parlous state of world finance and is not facing the problems you have in Europe and the US. Despite our economic security, it is not something that our goverment is likely to consider any time soon.
Is in-clinic nocturnal hemo widely available?
No … it is NOT done here. As I have often written here, we send our patients home! There was a brief ‘experiment’ with in-facility NHD in Queensland (2006-2009) but it ‘fell over’ within a couple of years and that program has reverted to home-based care.
There are some moves to rekindle interest and enthusiasm for small in-centre NHD programs here and there … but none have gotten off the ground to date. NHD is, here, done at home.
We have some mobile dialysis clinics happening – and that’s exciting – but its’ too early yet to know how successful these will be.
How is your in-clinic hemo treatment different from that which is available to US patients?
As often stated here at this site … but i will say it again … we dialyse longer.
The mean dialysis time here is 275 minutes. In Japan, it is even longer.
You dialyse nationally for < 220 minutes (more like 210). We don’t use Kt/V-based dialysis. All dialysis staff are all trained nurses – most with dialysis/renal certification. The ratio is 3.5 patients/nurse. Our trainee nephrologists must – by curriculum – train in dialysis, in PD, in HD and in home care (both HD and PD).
All care is provided by hospital–based, academically-linked services, It is not-for-profit care. Company-run dialysis (ie: for profit) is rare here … and the few clinics that are run, struggle to make ends meet on the reimbursements paid by government. I have written about these differences here many times … but there (again) are the major differences though the list of differences could continue.
Again, it would be cool if there were someway that Dori and Brian at HDC could file or subject-categorise some of these recurring answers to lessen my writing time … its just been a BIIIG week here! … but I sometimes have that creeping feeling that I have said all this before.
That is the problem with the answering of individual questions for individual patients - the questions are often the same as those that have been asked before. While for you, the question (and the answer) may seem new and fresh, for me the answers can seem a little repetetive. I have raised the FAQ concept with Dori before - maybe I need to again. Looking back, there have now been 124 separate threads with 711 posts (1/2 of which have presumably been mine) … and as you know, I tend to give long answers! …