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on-line hemodiafiltration
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<Why???>
posted
Can someone please explain why study after study is published on renalweb.com that depicts on-line hemodiafiltration as being superior to hemodialysis yet on-line hemodiafiltration is not offered in the US?

If patients that use on-line hemodiafiltration are healthier then isnt the overall cost of treatment less expensive due to lessor need of ancillary medications?
 
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<Read the article>
posted
Check out the JASN article from last week-

"There is some controversy on the potential benefits of OL-HDF in mortality risk reduction. Retrospective, observational studies suggested that OL-HDF could improve patient survival,12–15 although two recent, prospective, randomized studies failed to demonstrate a survival advantage of OL-HDF over hemodialysis."
 
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<The truth is out there>
posted
By Genevra Pittman

NEW YORK | Thu Feb 14, 2013 5:34pm EST

NEW YORK (Reuters Health) - A more thorough dialysis technique may help prevent deaths due to heart conditions and infections in people with advanced kidney disease, according to a new study.

Known as hemodiafiltration, that method is better able to clean the kidneys of larger toxins than standard dialysis, which mainly removes small molecules. When not removed from the kidneys, larger toxins could play a role in inflammation and cholesterol buildup, researchers said.

People on dialysis are most likely to die of complications such as heart disease and infection, according to Dr. Francisco Maduell, the study's lead author from the University of Barcelona in Spain.

Maduell said hemodiafiltration has been available in Europe for almost two decades and more recently in Asia and Canada as well. The Food and Drug Administration gave the okay for the first hemodiafiltration devices to be marketed in the United States less than a year ago.

About 350,000 people in the U.S. are on dialysis. Dialysis machines do the work of healthy kidneys for people with end-stage renal disease, filtering clean fluid into the kidneys and toxins out. Many people stay on dialysis for months or years while waiting for a kidney transplant.

For the new study, Maduell and his colleagues randomly assigned 906 people currently on dialysis in Spain to remain on their normal regimen or switch to hemodiafiltration.

Over the next two years, just under 40 percent of those participants left the study because of a kidney transplant, a change in dialysis unit or another reason.

Of the remaining kidney disease patients, 207 died.

Death rates over three years were 27 percent among patients on standard dialysis, compared to 18 to 19 percent for those on the more thorough filtration method.

In particular, people getting hemodiafiltration were less likely to die of infections. That group also had fewer deaths from cardiovascular disease, although the finding could have been due to chance, the researchers wrote Thursday in the Journal of the American Society of Nephrology.
 
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<Even Fresenius knows>
posted
ONLINE HDF can help reduce the risk of mortality

A study initiated by Fresenius Medical Care has shown that using ONLINE Hemodiafiltration (ONLINE HDF) to treat patients with chronic kidney failure can lead to a significantly lower risk of mortality compared to treatment with standard hemodialysis. The study was presented in 2005 at the European Dialysis and Transplant Association (EDTA)/ European Renal Association (ERA) Congress in Istanbul. Prior to the study, it was already known that ONLINE HDF could contribute to reducing cardiovascular complications, which account for about 50 percent of all deaths among dialysis patients. In addition, ONLINE HDF therapy has the advantage of improving the control of blood pressure and anemia, a lack of red blood cells.

During HDF, the machine removes more water from the blood than during "normal" hemodialysis. The additional liquid is continually replaced with an ultra-pure electrolyte solution. Thus, the machine exchanges a high volume of fluid during treatment and removes the liquid together with metabolic toxins from the blood. As in normal dialysis, differences in concentration between the dialysis solution and the blood are also used to filter the toxins from the blood. Overall, ONLINE HDF allows for a more efficient and gentle treatment.

More patients should benefit from ONLINE HDF in the future
 
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<But....>
posted
Fresenius does not have FDA approval for their OL-HDF, neither does Gambro.
 
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<why????>
posted
Why does the US insist on slowing and painfully killing off their dialysis patients when there is a better treatment available????
 
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<Guest>
posted
Current US standards for dialysis water are lower than Europe and Canada and can't guarantee pure enough water for online HDF. You aren't likely to see much online HDF in the US until water quality standards become more stringent. OL-HDF manufacturers aren't going to bother getting 510K's on their devices until there is a market for them.

As the above poster noted, most of these journal articles, including those cut and pasted above, contain a sentence or paragraph that casts some doubt on the result. Are they convincing enough to justify a few hundred thousand $ of capital investment per clinic? Or, as other studies and articles suggest, does home dialysis offer better results and quality of life and the industry starts spending millions on moving patients out of the clinics?

...and can't forget about the bundle. OL-HDF is more expensive.
 
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<Colin R>
posted
quote:
Current US standards for dialysis water are lower than Europe and Canada and can't guarantee pure enough water for online HDF. You aren't likely to see much online HDF in the US until water quality standards become more stringent.


Not only that, in Europe, US water quality wouldn't be suitable for High Flux dialysis, let alone OHDF.
 
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<It's almost always about money>
posted
The real reason why the US is the only rich country where there is no HDF therapy is because HDF costs more to deliver than HD. Dialysis in the US is delivered by for-profit companies (for the most part) that have no incentive to provide a better treatment to their patients if it does not increase their profits. With the bundle the chances are even smaller now.
 
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<Why???>
posted
Wouldn't a treatment that makes patients healthier be more cost efficient in the long run and more efficient in terms of the bundled payment as other ancilliary treatments will no longer be needed.
 
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<belvedere>
posted
Not sure why you insist on pushing your agenda in the Technical Forum. We repair/maintain the equipment. We certainly don't make the big decisions like this.
 
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<Why???>
posted
I am just trying to understand the issues and do not know where to turn. I apologize as I now understand this is not the correct forum. My Dr is of no help in understanding as he is oblivious to the existance of anything other than hemodialysis. I do internet research in hope of finding a healthier life and find out about ol-hdf and then learn there is no knowledge about it in the US....something doesn't seem right...maybe I am just senile??? I am sorry...I will search for a new forum to learn on.

quote:
why you insist on pushing your agenda in the Technical Forum. We repair/maintain the equipment. We certainly don't make the big decisions like this.
 
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I've been in this field of medicine since 1975 and I think the source of the biggest problems in this field is that the patients have never developed an effective voice in the shaping of their system of care.

Has there been one signficant change in the dialysis field in the last 30 years that has been driven by patients?
 
Posts: 64 | Registered: 15 April 2006Report This Post
<Colin R>
posted
quote:
We repair/maintain the equipment. We certainly don't make the big decisions like this.


May be true, but what is wrong with having some idea of the bigger picture and having an opinion?
 
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<Colin R>
posted
quote:
Originally posted by Gary Peterson:
I've been in this field of medicine since 1975 and I think the source of the biggest problems in this field is that the patients have never developed an effective voice in the shaping of their system of care.

Has there been one signficant change in the dialysis field in the last 30 years that has been driven by patients?


OK, but isn't this true of all fields of medicine?
 
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