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10.1111/sdi.12601

http://scihub22266oqcxt.onion/10.1111/sdi.12601
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C5418081!5418081!28421638
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suck abstract from ncbi


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pmid28421638      Semin+Dial 2017 ; 30 (3): 251-61
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  • Renal Replacement Therapy and Incremental Hemodialysis for Veterans with Advanced Chronic Kidney Disease #MMPMID28421638
  • Kalantar-Zadeh K; Crowley ST; Beddhu S; Chen JL; Daugirdas JT; Goldfarb DS; Jin A; Kovesdy CP; Leehey DJ; Moradi H; Navaneethan SD; Norris KC; Obi Y; O?Hare A; Shafi T; Streja E; Unruh ML; Vachharajani T; Weisbord S; Rhee CM
  • Semin Dial 2017[May]; 30 (3): 251-61 PMID28421638show ga
  • Each year approximately 13,000 Veterans transition to maintenance dialysis, mostly in the traditional form of thrice-weekly hemodialysis from the start. Among >6,000 dialysis units nationwide, there are currently approximately 70 Veterans Affairs (VA) dialysis centers. Given this number of VA dialysis centers and their limited capacity, only 10% of all incident dialysis Veterans initiate treatment in a VA center. Evidence suggests that, among Veterans, receipt of care within the VA system is associated with favorable outcomes, potentially due to enhanced access to healthcare resources. Data from the United States Renal Data System Special Study Center ?Transition-of-Care-in-CKD? suggest that Veterans who receive dialysis in a VA unit exhibit greater survival compared to non-VA centers. Substantial financial expenditures arise from the high volume of outsourced care and higher dialysis reimbursement paid by the VA than by Medicare to outsourced providers. Given the exceedingly high mortality and abrupt decline in residual kidney function (RKF) in the first dialysis year, it is possible that incremental transition to dialysis through an initial twice-weekly hemodialysis regimen preserves RKF, prolongs vascular access longevity, improves patients? quality of life, and is a more patient-centered approach and consistent with ?personalized? dialysis. Broad implementation of incremental dialysis may also result in more Veterans receiving care within a VA dialysis unit. Controlled trials are urgently needed to examine safety and efficacy of incremental hemodialysis in Veterans and other populations, and the administrative and health care as well as provider structure within the VA system would facilitate the performance of such trials.
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