AKF supports all kidney patients’ access to health information and education, to quality care, including treatment choices, and to affordable medication and health insurance coverage.

More than 300,000 Americans with end stage renal disease rely on dialysis to keep them alive. Seventy-five percent of these patients depend on Medicare as primary payer for their dialysis treatments. (Source: Abt Associates, “Updating the 2002 Composite Rate for Dialysis Treatments,” August 1, 2001)

Medicare currently reimburses for up to 3 hemodialysis treatments per week. Over 200 small studies have shown more frequent (both short daily and slow nocturnal) hemodialysis provides significantly improved clinical and quality of life outcomes for patients using them, often compared to these patients’ experience with thrice weekly conventional hemodialysis. Increasing numbers of patients in the U.S. have been using more frequent hemodialysis, with the number of weekly treatments ranging from four to six. Published reports and analyses of these two modalities continue to show improved clinical results and increased patient satisfaction. Reports also point to reduced hospitalization, decreased medication requirements and, when reported, some medication, and in-patient hospital cost savings to Medicare.

However, these varied studies have been based on small numbers of selected patients. The National Institutes of Health and the Centers for Medicare and Medicaid Services have now awarded project funding for two multi-center clinical trials to determine feasibility of randomizing patient samples. One trial will include patients on short (1.5-2 hours) hemodialysis. The second trial will include patients undergoing long nocturnal dialysis. Both groups will be compared to a case-mix adjusted control group of patients on conventional dialysis

Given the well-documented benefits of more frequent hemodialysis, the American Kidney Fund supports patient access to this treatment modality. Because of the uncertainty surrounding cost implications and randomization feasibility, AKF awaits the results of the NIH feasibility clinical trial scheduled for completion within four years. Without earlier legislation or regulatory action providing reimbursement for more frequent hemodialysis, AKF intends to advocate for CMS reimbursement of more frequent hemodialysis, if 1) the clinical results from the experimental group in the randomization trial tend to be as good or better than those of the control group receiving traditional dialysis, and 2) the total per patient annual costs to Medicare tend to be no more for the more frequent dialysis patients than the total costs of the control group of traditional dialysis patients.