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Update on More Frequent and Longer Hemodialysis in North America  <ul><li>Annual Dialysis Conference </li></ul><ul><li>Tam...
History of More Frequent and Longer Hemodialysis in North America <ul><li>Cedars-Sinai Hospital (Los Angeles, CA)  Dr. DeP...
History of More Frequent and Longer Hemodialysis in North America <ul><li>Brooklyn Hospital (New York, New York)  Drs. Sny...
History of More Frequent and Longer Hemodialysis in North America <ul><li>Toronto, Canada; Drs. Uldall and Pierratos </li>...
History of More Frequent and Longer Hemodialysis in North America <ul><li>Mountainview, California; Dr. Ting </li></ul><ul...
Daily/Nocturnal Dialysis in North America as of 1-1-98 Numbers of Patients per Program Uldall / Pierratos   1994 Toronto, ...
Daily Dialysis from 1-1-98 to Present <ul><li>As of 1-1-98 in North America there were:  </li></ul><ul><ul><li>Three cente...
Daily Dialysis from 1-1-98 to Present <ul><li>London Ontario Daily/Nocturnal Hemodialysis Study:  November 1998 to Decembe...
Daily Dialysis from 1-1-98 to Present <ul><li>NIH/CMS agreed to support a randomized trial of daily dialysis to start fina...
Daily/Nocturnal Dialysis in North America:  Numbers of  Patients per Program As of 2-26-05 2 5 3 5 5 2 7 1 5 9 11 1 9 2 2 ...
More Frequent and Longer Dialysis in North America as of 2-26-05 <ul><li>Number of patients doing daily/nocturnal dialysis...
More Frequent and Longer Dialysis in North America as of 2-26-05 <ul><ul><li>Total number of centers doing  </li></ul></ul...
Five or More Dialysis Treatments/week in  North America As of 2-26-05 1 4 1 2 5 2 7 1 3 2 2 5 1 1 1 1 1 2 1 1 1 1 2 1 3 1 ...
Patients Receiving 5 or More Dialysis Treatments/week in North America as of 2-26-05  <ul><ul><li>Short daily:  five or mo...
Five or More Dialysis per week in North America  >  10 Patients: Number of Programs As of 2-26-05 1 3 1 2 4 2 1 1 1 1
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  <ul><ul><li>Number of centers doing  </li></ul></ul><ul><ul...
Five or More Dialysis per Week in Canada as of 2-26-05  <ul><ul><li>Short daily five or more  </li></ul></ul><ul><ul><li>t...
Five or More Dialysis per Week in the United States <ul><ul><li>Short Daily five or more  </li></ul></ul><ul><ul><li>times...
Conclusions <ul><li>Over the last 7 years, daily dialysis has been accepted by the renal community as a better therapy </l...
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  1. 1. Update on More Frequent and Longer Hemodialysis in North America <ul><li>Annual Dialysis Conference </li></ul><ul><li>Tampa, Florida </li></ul><ul><li>March 1, 2005 </li></ul><ul><li>Robert S. Lockridge, Jr. MD </li></ul><ul><li>Lynchburg Nephrology Physicians </li></ul>
  2. 2. History of More Frequent and Longer Hemodialysis in North America <ul><li>Cedars-Sinai Hospital (Los Angeles, CA) Dr. DePalma </li></ul><ul><ul><li>Seven patients </li></ul></ul><ul><ul><li>1967 to 1970 </li></ul></ul><ul><ul><li>Daily dialysis: 5 treatments per week </li></ul></ul><ul><ul><li>Duration: 4-5 hours per treatment </li></ul></ul><ul><ul><li>Stopped due to reimbursement </li></ul></ul>
  3. 3. History of More Frequent and Longer Hemodialysis in North America <ul><li>Brooklyn Hospital (New York, New York) Drs. Snyder, Louis, Gorfien, and associates </li></ul><ul><ul><li>10 patients </li></ul></ul><ul><ul><li>1975 to 1981 </li></ul></ul><ul><ul><li>Daily dialysis: 5 treatments per week </li></ul></ul><ul><ul><li>Duration: 2 hours per treatment </li></ul></ul><ul><ul><li>Stopped due to reimbursement </li></ul></ul>
  4. 4. History of More Frequent and Longer Hemodialysis in North America <ul><li>Toronto, Canada; Drs. Uldall and Pierratos </li></ul><ul><ul><li>>75 patients </li></ul></ul><ul><ul><li>1994 to present </li></ul></ul><ul><ul><li>Daily dialysis: 5 or more treatments/week </li></ul></ul><ul><ul><li>Duration: 7 to 10 hours per treatment </li></ul></ul><ul><ul><li>Dialysis at night while patients sleep (nocturnal) </li></ul></ul><ul><ul><li>Blood flow: 300 to 400cc per minute </li></ul></ul><ul><ul><li>Dialysate flow: 100 to 200cc per minute </li></ul></ul>
  5. 5. History of More Frequent and Longer Hemodialysis in North America <ul><li>Mountainview, California; Dr. Ting </li></ul><ul><ul><li>>40 patients </li></ul></ul><ul><ul><li>1996 to present </li></ul></ul><ul><ul><li>Daily dialysis: 6 treatments/week in center </li></ul></ul><ul><ul><li>Duration: 2 to 3 hours per treatment </li></ul></ul><ul><ul><li>Patients selected with serious medical problems and dialysis intolerance </li></ul></ul>
  6. 6. 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, CA 15 Patients Lockridge 1997 Lynchburg, VA 2 Patients
  7. 7. Daily Dialysis from 1-1-98 to Present <ul><li>As of 1-1-98 in North America there were: </li></ul><ul><ul><li>Three centers doing daily/nocturnal dialysis </li></ul></ul><ul><ul><li>Total of 34 patients doing daily dialysis </li></ul></ul><ul><ul><li>Renal community did not buy into daily dialysis </li></ul></ul><ul><ul><li>New technology was coming, but when? </li></ul></ul><ul><ul><li>Reimbursement in Canada and the US was not supportive </li></ul></ul>
  8. 8. Daily Dialysis from 1-1-98 to Present <ul><li>London Ontario Daily/Nocturnal Hemodialysis Study: November 1998 to December 2001 </li></ul><ul><li>Aksys clinical trials: 2000 </li></ul><ul><li>NIH Daily Dialysis Task Force: April 2001 </li></ul><ul><li>NxStage and Renal Solutions emerged: 2002 </li></ul><ul><li>Hemo Study completed: 2002 </li></ul><ul><li>Fresenius started to develop a home machine </li></ul>
  9. 9. Daily Dialysis from 1-1-98 to Present <ul><li>NIH/CMS agreed to support a randomized trial of daily dialysis to start finally June 2005 </li></ul><ul><li>Canadian government agreed to support other nocturnal program </li></ul><ul><li>Aksys PHD approved for home dialysis </li></ul><ul><li>NxStage approved for use </li></ul><ul><li>The renal community believes daily/nocturnal dialysis is better </li></ul>
  10. 10. Daily/Nocturnal Dialysis in North America: Numbers of Patients per Program As of 2-26-05 2 5 3 5 5 2 7 1 5 9 11 1 9 2 2 2 3 3 2 2 5 4 2 2 2 1 4 2 22 2 6 7 4 4 1 1 1
  11. 11. More Frequent and Longer Dialysis in North America as of 2-26-05 <ul><li>Number of patients doing daily/nocturnal dialysis: </li></ul><ul><ul><li>Nocturnal three times/wk in center 490 </li></ul></ul><ul><ul><li>Nocturnal three times/wk at home 15 </li></ul></ul><ul><ul><li>Nocturnal every other day at home 91 </li></ul></ul><ul><ul><li>Nocturnal four times/wk at home 14 </li></ul></ul><ul><ul><li>All five times or more per week 588 </li></ul></ul><ul><ul><li> </li></ul></ul>
  12. 12. More Frequent and Longer Dialysis in North America as of 2-26-05 <ul><ul><li>Total number of centers doing </li></ul></ul><ul><ul><li>daily/nocturnal dialysis 150 </li></ul></ul><ul><ul><li>Total number of patients doing </li></ul></ul><ul><ul><li>daily/nocturnal dialysis 1198 </li></ul></ul>
  13. 13. Five or More Dialysis Treatments/week in North America As of 2-26-05 1 4 1 2 5 2 7 1 3 2 2 5 1 1 1 1 1 2 1 1 1 1 2 1 3 1 1 1
  14. 14. Patients Receiving 5 or More Dialysis Treatments/week in North America as of 2-26-05 <ul><ul><li>Short daily: five or more </li></ul></ul><ul><ul><li>times/week in center 90 </li></ul></ul><ul><ul><li>Short daily: five or more </li></ul></ul><ul><ul><li>times/week at home 212 </li></ul></ul><ul><ul><li>Nocturnal: five or more </li></ul></ul><ul><ul><li>times/week at home 286 </li></ul></ul><ul><ul><li>Total daily/nocturnal </li></ul></ul><ul><ul><li>patients in North America 588 </li></ul></ul>
  15. 15. Five or More Dialysis per week in North America > 10 Patients: Number of Programs As of 2-26-05 1 3 1 2 4 2 1 1 1 1
  16. 16. Five or More Dialysis per week in North America > 20 Patients: Number of Programs As of 2-26-05 1 1 2 2 1
  17. 17. Five or More Dialysis per Week in North America as of 2-26-05 <ul><ul><li>Number of centers doing </li></ul></ul><ul><ul><li>five or more dialysis per week 55 </li></ul></ul><ul><ul><li>Number of centers doing </li></ul></ul><ul><ul><li>five or more dialysis per week </li></ul></ul><ul><ul><li>> 10 patients 17 </li></ul></ul><ul><ul><li>Number of centers doing </li></ul></ul><ul><ul><li>five or more dialysis per week </li></ul></ul><ul><ul><li>> 20 patients 7 </li></ul></ul>
  18. 18. Five or More Dialysis per Week in Canada as of 2-26-05 <ul><ul><li>Short daily five or more </li></ul></ul><ul><ul><li>times/week in center 38 </li></ul></ul><ul><ul><li>Short Daily five or more </li></ul></ul><ul><ul><li>times/week at home 19 </li></ul></ul><ul><ul><li>Nocturnal five or more </li></ul></ul><ul><ul><li>times/week at home 173 </li></ul></ul><ul><ul><li>Total daily/nocturnal </li></ul></ul><ul><ul><li>dialysis patients in Canada 230 </li></ul></ul>
  19. 19. Five or More Dialysis per Week in the United States <ul><ul><li>Short Daily five or more </li></ul></ul><ul><ul><li>times/week in center 52 </li></ul></ul><ul><ul><li>Short Daily five or more </li></ul></ul><ul><ul><li>times/week at home 193 </li></ul></ul><ul><ul><li>Nocturnal five or more </li></ul></ul><ul><ul><li>times/week at home 113 </li></ul></ul><ul><ul><li>Total daily/nocturnal dialysis </li></ul></ul><ul><ul><li>patients in the United States 358 </li></ul></ul>
  20. 20. Conclusions <ul><li>Over the last 7 years, daily dialysis has been accepted by the renal community as a better therapy </li></ul><ul><li>Reimbursement is still a disincentive for more frequent dialysis </li></ul><ul><li>There will be a bill introduced in Congress to pay for more frequent dialysis, your support is needed </li></ul>
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