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4 Renal & Urology News 

october 2013

From the MEDICAL DIRECTOR Editorial Advisory Board

The Future of Dialysis in the U.S.


ach year approximately 110,000 new patients start chronic dialysis treatment in the U.S. This public health metric is known as the end-stage renal disease (ESRD) incidence rate. Over the past 10 years the annual ESRD incidence rate per million U.S. population has remained stagnant or even shown sporadic downward trends. More interestingly, and probably for the first time in this country, the absolute number of new dialysis patients per year has declined despite ongoing population growth. Does this mean that the growth of the dialysis industry in the U.S. will come to a grinding halt? Additional factors may contribute to re-shaping the future of the dialysis industry, including changes in practice pattern and finances. There has been a recent trend to initiate dialysis treatment later in the course of chronic kidney disease (CKD) progression. This new approach is inspired by a number of recent studies that suggest no favorable effect or even harmful outcomes upon earlier dialysis initiation. Some data suggest that in very old CKD patients a more conservative approach without dialysis treatment may be the better approach. These new views, no matter how controversial they are, have already started impacting our practice pattern. There are additional challenges with chronic dialysis therapy in the U.S., especially if the government’s imminent plans to cut the dialysis treatment reimbursement by 9.4% are implemented in 2014. Since dialysis patient attrition is quite high given the regretfully high mortality of 20% annually in the U.S., along with high kidney transplantation rates and patient withdrawals, the decline in the ESRD incidence rate will likely mean that for the first time in our history we may see increasing numbers of vacant hemodialysis (HD) seats during our dialysis rounds. This may be a new phenomenon for American nephrologists, but Canadian and British colleagues are quite familiar with it, and this has led to trimming some HD shifts and ultimate closure of many dialysis clinics without a replacement. In the U.S., the struggle may further be intensified by recent trend to transition more patients from HD to the better incentivized peritoneal dialysis and the recent emergence of new dialysis clinics at every corner of the block in town by the competing dialysis chains. The latter observation suggests that rival dialysis companies have not yet felt the need for better coordination of plans and efforts as a unified front. Even more vulnerable may be the independent dialysis centers, although it is hard to predict which sector will be affected most. The only effective way to counter these unavoidable trends is to improve dialysis patient survival and to lower hospitalization. Kam Kalantar-Zadeh, MD, MPH, PhD Professor & Chief Division of Nephrology & Hypertension University of California Irvine School of Medicine Orange, Calif.

Medical Director, Urology

Medical Director, Nephrology

Robert G. Uzzo, MD, FACS G. Willing “Wing” Pepper Chair in Cancer Research Professor and Chairman Department of Surgery Fox Chase Cancer Center Temple University School of Medicine Philadelphia

Kamyar Kalantar-Zadeh, MD, MPH, PhD Medical Director, Nephrology Professor & Chief Division of Nephrology & Hypertension University of California, Irvine School of Medicine Orange, Calif.


Urologists Christopher S. Cooper, MD Director, Pediatric Urology Children’s Hospital of Iowa Iowa City R. John Honey, MD Head, Division of Urology, Endourology/Kidney Stone Diseases St. Michael’s Hospital University of Toronto Stanton Honig, MD Associate Clinical Professor of Surgery/Urology University of Connecticut School of Medicine, Urology Center New Haven J. Stephen Jones, MD, FACS Chief of Surgical Operations Professor of Surgery CCLM Cleveland Clinic Regional Hospitals Jaime Landman, MD Professor of Urology and Radiology Chairman, Department of Urology University of California, Irvine James M. McKiernan, MD Assistant Professor of Urology Columbia University College of Physicians and Surgeons New York City Kenneth Pace, MD, MSc, FRCSC Assistant Professor Division of Urology St. Michael’s Hospital University of Toronto Ryan F. Paterson, MD, FRCSC Assistant Professor Division of Urologic Sciences University of British Columbia Vancouver, Canada

Anthony J. Bleyer, MD, MS Professor of Internal Medicine/Nephrology Wake Forest University School of Medicine Winston-Salem, N.C. Suphamai Bunnapradist, MD Director of Research Department of Nephrology Kidney Transplant Research Center The David Geffen School of Medicine at UCLA R. Michael Hofmann, MD Associate Professor and Medical Director, Living Kidney Donor Program University of Wisconsin School of Medicine and Public Health, Madison Csaba P. Kovesdy, MD Associate Professor of Clinical Medicine University of Virginia, Charlottesville Chief of Nephrology Salem VA Medical Center Salem, Va. Edgar V. Lerma, MD, FACP, FASN, FAHA Clinical Associate Professor of Medicine Section of Nephrology Department of Medicine University of Illinois at Chicago College of Medicine, Chicago Allen Nissenson, MD Emeritus Professor of Medicine The David Geffen School of Medicine at UCLA, Chief Medical Officer, DaVita Inc. Rulan Parekh, MD, MS Associate Professor of Pediatrics and Medicine University of Toronto Robert Provenzano, MD Chief, Section of Nephrology St. John Hospital and Medical Center, Detroit Robert S. Rigolosi, MD Director, Regional Hemodialysis Center Holy Name Hospital, Teaneck, N.J. Lynda Anne Szczech, MD, MSCE Medical Director, Pharmacovigilence and Global Product Development, PPD, Inc. Morrisville, N.C.

Renal & Urology News Staff Editor Jody A. Charnow Executive editor Marina Galanakis Senior editor Delicia Honen Yard Web editor Stephan Cho Editorial coordinator Candy Iemma Art director Andrew Bass Group art director, Haymarket Medical Jennifer Dvoretz VP, audience development and operations John Crewe Production manager Brian Wask Production director Kathleen Millea Product manager, digital products Chris Bubeck Circulation manager Paul Silver National accounts manager William Canning Editorial director Jeff Forster Publisher Dominic Barone VP medical magazines and digital products Jim Burke CEO, Haymarket Media Inc. Lee Maniscalco Renal & Urology News (ISSN 1550-9478) Volume 12, Number 10. Published monthly by Haymarket Media, Inc., 114 West 26th Street, 4th Floor, New York, NY 10001. Periodicals postage paid at New York, NY, and an additional mailing office. The subscription rates for one year are, in the U.S., $75.00; in Canada, $85.00; all other foreign countries, $110.00. Single issues, $20.00. Postmaster: Send address changes to Renal & Urology News, c/o DMD Data Inc., 2340 River Road, Des Plaines, IL 60018. For reprints, contact Wright’s Reprints at 1.877.652.5295. Copyright: All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise) without the prior written permission of Haymarket Media, Inc. Copyright © 2013.

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Renal & Urology News October 2013 Issue  
Renal & Urology News October 2013 Issue  

Clinical news for nephrologists and urologists.