Update on More Frequent and Longer Hemodialysis in North America

Annual Dialysis ConferenceTampa, FloridaMarch 1, 2005

Robert S. Lockridge, Jr. MDLynchburg Nephrology Physicians

History of More Frequent and Longer Hemodialysis in North America

Cedars-Sinai Hospital (Los Angeles, CA) Dr. DePalma

• Seven patients

• 1967 to 1970

• Daily dialysis: 5 treatments per week

• Duration: 4-5 hours per treatment

• Stopped due to reimbursement

History of More Frequent and Longer Hemodialysis in North America

Brooklyn Hospital (New York, New York) Drs. Snyder, Louis, Gorfien, and associates

• 10 patients

• 1975 to 1981

• Daily dialysis: 5 treatments per week

• Duration: 2 hours per treatment

• Stopped due to reimbursement

History of More Frequent and Longer Hemodialysis in North America

Toronto, Canada; Drs. Uldall and Pierratos• >75 patients • 1994 to present • Daily dialysis: 5 or more treatments/week • Duration: 7 to 10 hours per treatment• Dialysis at night while patients sleep (nocturnal)• Blood flow: 300 to 400cc per minute• Dialysate flow: 100 to 200cc per minute

History of More Frequent and Longer Hemodialysis in North America

Mountainview, California; Dr. Ting

• >40 patients

• 1996 to present

• Daily dialysis: 6 treatments/week in center

• Duration: 2 to 3 hours per treatment

• Patients selected with serious medical problems and dialysis intolerance

Daily/Nocturnal Dialysis in North America as of 1-1-98

Numbers of Patients per Program

Uldall / Pierratos 1994 Toronto, ON 17 Patients

Ting 1996 El Camino, CA15 Patients

Lockridge 1997 Lynchburg, VA2 Patients

Daily Dialysis from 1-1-98 to Present

As of 1-1-98 in North America there were: • Three centers doing daily/nocturnal dialysis• Total of 34 patients doing daily dialysis• Renal community did not buy into daily

dialysis• New technology was coming, but when?• Reimbursement in Canada and the US was

not supportive

Daily Dialysis from 1-1-98 to Present London Ontario Daily/Nocturnal Hemodialysis

Study: November 1998 to December 2001 Aksys clinical trials: 2000 NIH Daily Dialysis Task Force: April 2001 NxStage and Renal Solutions emerged: 2002 Hemo Study completed: 2002 Fresenius started to develop a home machine

Daily Dialysis from 1-1-98 to Present NIH/CMS agreed to support a randomized trial

of daily dialysis to start finally June 2005 Canadian government agreed to support other

nocturnal program Aksys PHD approved for home dialysis NxStage approved for use The renal community believes daily/nocturnal

dialysis is better

Daily/Nocturnal Dialysis in North America: Numbers of Patients per Program

As of 2-26-05

2

5

3

5

5 27 1

59

11

1

92

22

3 32 2

5

4

2

22 142

22

267

4

4

11

1

More Frequent and Longer Dialysis in North America as of 2-26-05

Number of patients doing daily/nocturnal dialysis:

•Nocturnal three times/wk in center 490

•Nocturnal three times/wk at home 15

•Nocturnal every other day at home 91

•Nocturnal four times/wk at home 14

•All five times or more per week 588

More Frequent and Longer Dialysis in North America as of 2-26-05

•Total number of centers doing

daily/nocturnal dialysis 150

•Total number of patients doing

daily/nocturnal dialysis 1198

Five or More Dialysis Treatments/week in North America

As of 2-26-05

1

4

1

2

5 27 1

32

2

51

11

11

2

1 1

11

213

1

1

1

Patients Receiving 5 or More Dialysis Treatments/week in North America as of

2-26-05 • Short daily: five or more

times/week in center 90

• Short daily: five or more times/week at home 212

• Nocturnal: five or more times/week at home 286

• Total daily/nocturnal patients in North America 588

Five or More Dialysis per week in North America > 10 Patients:Number of Programs

As of 2-26-05

1

31

24

2

1

1

11

Five or More Dialysis per week in North America > 20 Patients:Number of Programs

As of 2-26-05

1

1

2

2

1

Five or More Dialysis per Week in North America as of 2-26-05

• Number of centers doing five or more dialysis per week 55

• Number of centers doing five or more dialysis per week> 10 patients 17

• Number of centers doing five or more dialysis per week> 20 patients 7

Five or More Dialysis per Week in Canada as of 2-26-05

• Short daily five or more times/week in center 38

• Short Daily five or more times/week at home 19

• Nocturnal five or more times/week at home 173

• Total daily/nocturnal dialysis patients in Canada 230

Five or More Dialysis per Week in the United States

• Short Daily five or more times/week in center 52

• Short Daily five or more times/week at home 193

• Nocturnal five or more times/week at home 113

• Total daily/nocturnal dialysis patients in the United States 358

Conclusions Over the last 7 years, daily dialysis has been

accepted by the renal community as a better therapy

Reimbursement is still a disincentive for more frequent dialysis

There will be a bill introduced in Congress to pay for more frequent dialysis, your support is needed