The Home Dialysis Central Topic of the Month is “NIH More Frequent Dialysis Studies in a Nutshell.” In my judgment these studies represent a temporizing, “Let’s study the problem” response to the overwhelming evidence of the pronounced benefits of more frequent vs. thrice-weekly dialysis. I suspect their real purpose is to provide an excuse for CMS to delay reimbursement for more frequent dialysis for many years. As I understand it, the first four years of the NIH program will be spent determining if patients can, in fact, be successfully randomized between the two groups. If so, then the subsequent five years will be devoted to the comparative study.
The first result will be to confirm a decade from now what we already know – that patients on more frequent dialysis live much longer and lead much higher quality lives than those on thrice-weekly dialysis. The second result will be that most of the patients now on thrice-weekly dialysis will be dead by the time the report is published and CMS has finally exhausted excuses not to cover this superior mode of treatment for ESRD patients.
The policy choice to pursue these studies rather than immediately cover more frequent dialysis and thus save countless lives seems unconscionable. I have written to the Inspector General of the Department of Health and Human Services requesting that the Secretary commission an independent ethics review of this policy choice by CMS and NIH. At the heart of the issue is the conflict between the optimum economic model for dialysis and the optimum clinical model for dialysis. My letter is much too long to publish here, but I would be happy to send anyone who is interested in this subject a copy if you will email me at email@example.com.