Which dialysis modality would you use?


by Rich Berkowitz…


There have been a few surveys which have asked nephrologists which dialysis modality they would use if they required dialysis themselves.  90% have chosen one of the home modalities, yet only 10% of their patients are at home.   There obviously is a disconnect between what nephrologists would do versus what they prescribe for others.  We have heard reasons such as nephrologists haven’t been educated enough about home dialysis, but that doesn’t ring true if they are able to decide that is what they would do.  We have also heard that nephrologists spend more time with and for their home patients instead of the once a month five minute chair side visit in the center before going on to another patient, and that they would rather spend less time than more.

For the last several years I have had the opportunity to speak at professional renal conferences, both domestically and internationally.  I always start with a simple question asking for a the attendees to raise their hands.  The question to the professional in attendance is whether they would do conventional hemodialysis.  Mind you, this is the modality 90% of their patients do.  I have never seen even one hand raised in response to the question.  I am both happy and sad.  I’m happy that these nephrologists have the sense to reject this modality and sad they don’t seem to see it fit for their patients.  I wonder why they believe their lives are more valuable than the ones under their care.  I don’t believe I am being unfair.

However, I don’t know how the executive leadership of the LDOs and for-profits would answer.  I’m not even sure if they ever have been asked.  What we do know is that they are responsible for the lives of hundreds of thousands of dialysis patients.  Maybe it’s time to find out.

We do know that one of the CEOs of the LDOs has made statements that totally confound me.  Although he made nearly $28M last year running this dialysis behemoth, he also has said “it’s not about the patient” (1:09:30 mark) and “if one has kidney failure, you die unless you’re one of the fortunate few that gets a transplant”.  I know if I went to one of his company’s centers, I would be concerned.  I would be wondering what kind of care I was receiving.

So now is the time to come clean for all executives of these corporations.  Which modality would you use if you needed to be on dialysis?  Just simply respond to this post below.  I’m not looking for a long answer.  Just tell us who you are, your position and what you would do.

One thought on “Which dialysis modality would you use?

  1. I watched the DaVita CEO make the statement “It’s not about the patient” during a lecture where he outlined creating a great business environment for the workers. What he said was any business can achieve that – a healthcare setting with patients is not required. And in the end, a great business environment makes for better outcomes – in the dialysis environment it accounts for better patient care and if you look at published data, DaVita ranks top for many outcomes in the industrie. DaVita also puts a lot of effort into growing its home patient population!

    So, while Mr. Berkowitz has legitimate concerns, and I do commend him for being a voice for dialysis patients, it’s not only a bit cheap to take a sentence or two out of context to advance one’s own agenda, but in the long run can hurt the person’s credibility.

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