In America, most dialysis (kidney failure) patients are treated via hemodialysis. The technique has been around a while, the equipment infrastructure is in place, and the reimbursement rates provided by Medicare means the treatment costs have to be moderate.
So, while a newish technique shows great promise (mortality is 17.3% v. 21.9%; those with cardiovascular disease had a 42% lower death rate), it’s not likely to be taken up here in America anytime soon.
Those test results arose from a 30 month trial of 1360 patients at 61 hospitals across Europe. (CONVINCE, lead hospital UMC Utrecht in conjunction with the University College of London, Peter Blankenstijn, lead author: Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure). The renal treatment technique used is called hemodiafiltration- a transport phenomenon combination of both diffusion and convection; the fluid balance in the patient is maintained by an infusion of sterile, non-pyrogenic replacement fluid into the patients blood.
Hemodialysis routinely fails to remove larger molecule toxins from the blood (since it relies on diffusion); hemodiafiltration, which employers convection and diffusion, is capable of removing the larger molecules. (One should note that hemodiafiltration cannot be administered to all patients, since it needs a higher blood flow rate.)
Assuming that Medicare would adjust the rates, a slew of new delivery machines would have to be ordered and installed to provide hemodiafiltration to the patients. Even so, the special fluid costs for the pyrogen free-fluid injection would probably put the patient over the Medicare reimbursement rate.
Not all improvements can be effected in a financially secure fashion… Maybe we should change those rules.
I sometimes wonder how much longer before our medical system collapses completely. And how many years it would take for Medicare to adjust reimbursement rates for this particular treatment. Not that we should complain, in a way – I can remember back to the days before Medicare covered those with end stage renal care. It’s scary that some want to return to the “good old days”.
Good points, Alana!