Dancing around Elephants

The Possible Impact of the Us Prospective Payment System (“Bundle”) on the Growth of Peritoneal Dialysis

“…I think that, among the unenlightened and those biased against home dialysis, such a backlash could occur. That concern is partly addressed in the papers discussing the barriers to home dialysis (6-8). Chui et al (9) tell us that, even when PD technique fails, PD costs less than in-center HD.…”

“…Many barriers to increasing the utilization of home dialysis in the United States remain (6)(7)(8). The financial incentives created by CMS have probably been the stimulus for the growth in home dialysis in general (Table 1) and in PD in particular (Table 2).…”

Growing a Peritoneal Dialysis Program from 2 to 30 Patients in 2 Years

“…However, in our cohort, peritonitis, catheter malfunction and volume overload were responsible for 22% of transfers compared to 55% in the study. Lastly, to address the elephant in the room – failure to educate US nephrology trainees – as pointed out by Dr. Golper in his editorial (5), we are well-equipped and committed to train our fellows in this dialysis modality. The same statement can be made for PD nurses.…”