Hi, I haven’t been around here for a while, but am still trying to remain active in our quest. I just gave a speech the other night about home dialysis and the industry in general… It went well. In fact I ended up just winding it instead of reading the prepared remarks. Much thanks to Dr. Blagg and Proff. John Agar for their advice and help.

It is all but confirmed that Rep. James McGovern (D-MA) will co-sponsor this bill. I just got off the phone with a staff member. He has sponsored these bills in various incarnations over the years, so he was easy. I will meet with a staff member tommorow to hopefully finalize it. As Dr. Blagg said to me, we need all the co-sponors we can get. Just call your congressman and ask that they “re-sponsor” H.R 3096. Be informed, know your facts and give your own experiences. As we all know, and although I am not an ESRD patient, my spouse was, more dialysis is better. I have pushed and promoted these bills for years and although is she no longer alive I will do my best to get it through. It will be a tough fight to get this through but this time we do have a Republican that introduced it.

Here is some info if not already known:


Recommendation: Congress should enact legislation to make more frequent dialysis a treatment option available to all suitable patients in the Medicare ESRD Program

● The Medicare End-Stage Renal Disease Program covers some 400,000 patients and costs more than $17 billion annually. Some 325,000 patients are on hemodialysis, most for 3 times a week in a center. The annual mortality of U.S. hemodialysis patients has been 20% or more for many years, significantly worse than for patients in Europe, Australia, New Zealand and Japan.
● Data from more than 400 patients on more frequent hemodialysis has shown great improvements in patient well-being and quality of life. Patient survival is improved, cardiac and other complications reduced, appetite and energy are improved, symptoms during and between treatments greatly reduced, and there are significant reductions in hospitalizations and the use of erythropoietin (EPO), antihypertensive and other drugs needed by dialysis patients.
● Current reimbursement limits hemodialysis generally to 3 times a week, so precluding most suitable U.S. patients from enjoying the great benefits of more frequent dialysis.
● Although more frequent dialysis requires increased reimbursement for supplies, overall costs to Medicare would be reduced because of fewer hospitalizations and medications.
● NIH and CMS are beginning a small study of more frequent dialysis but this will not be complete until 2009. Suitable patients who are prepared to do more frequent dialysis should not have to wait until then.

Key elements of HR 5321, introduced by Rep. Charles Bass with Reps. Jim McDermott and Sam Johnson, is legislation to cover more frequent dialysis in the Medicare ESRD Program
● This proposes a 5-year pilot project to measure the impact of paying for more frequent hemodialysis at home or in-center on a declining scale for each treatment beyond 3 times a week and that sets spending caps on expenditure for each year of the project. Data must be collected on costs and on patients working status and MedPac is to examine the data at the end of the project. More frequent hemodialysis is defined as hemodialysis four or more times per week or equivalent treatment sessions requiring blood access.

● More frequent hemodialysis has been supported by the National Kidney Foundation, the American Nephrology Nurses Association and the Renal Physicians Association. The American Association of Kidney Patients encourages “development of new treatment methods which will result in improved quality of care and clinical outcomes for kidney patients.”
● All the many reports from the U.S. and elsewhere have shown more frequent short dialysis by day and long overnight dialysis are significantly better for patients than conventional 3 times a week dialysis. As a result, the governments of the Netherlands, the Province of British Columbia, Canada, and the State of Victoria, Australia, already support more frequent dialysis and the government of Australia actively supports increased utilization of home hemodialysis.
● Fewer than 10% of all patients who have experienced more frequent dialysis ever want to go back to 3 times a week dialysis.

We are two physicians who between have treated more than 100 patients with short daily and/or long nightly hemodialysis.

Christopher R Blagg MD, Robert S Lockridge MD,

John Francis Wissler Author Poignant Moments…A Caregiver’s Perspective

“ . . . I am brought back to earth with a jolt."-
Prof. John Agar, MBBS, FRACP


Thanks for your continued advocacy and this very timely post John. I will be in DC loobying for 5321 next Tuesday and had preparing a drop off sheet on my list of things to do today. This is very helpfull.

Diagnosed CKD: 1985
LR Transplant: 1988 - 1990
Incenter Hemodialysis: 1990 - 2001
High Dose Home Hemodialysis: 2001 - Present
HDP Target: 100

You go Bill! Get them to say YES! …

Gus Castaneda
Hemodialysis initial Start: 1978
Home Hemodialysis: 11/2004 - Present


We need this bill to pass. I know others have debated this incarnation on other boards and I understand the differences but in my opinion, experience and seeing results infront of you are paramount to NIH possible studies. We, our government is way behind the times on this subject.

Just a passing thought. John