WASHINGTON—Howard University Hospital (HUH), and American Renal Associates, LLC (ARA), announced today that effective March 1, 2012, HUH and ARA began a partnership to jointly own and operate Howard University Dialysis, LLC, located in the hospital at 2041 Georgia Ave. NW, Washington, DC 20060.

HUH has a longstanding tradition of providing extraordinary care dating back to 1862 when it opened its doors in converted army barracks. Originally called Freedmen’s Hospital, HUH has traditionally provided the highest in quality care to Washington residents as well as being a refuge for people who have been denied medical care elsewhere.

HUH CEO Larry Warren said the hospital is thrilled about its partnership with ARA.

“Among other things, ARA brings a depth and breadth of understanding of dialysis facility operations as well as a management team that fits so well with what we were looking for in a partner,” Warren said. “Our facility will continue in the HUH tradition and provide high quality dialysis services to those in need in the DC and surrounding areas.”

Joseph Carlucci, CEO and co-founder of ARA, echoed Warren’s sentiments.

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Published: May 08, 2012

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WASHINGTON -- Researchers attending this year's National Kidney Foundation clinical sessions will get a glimpse of early data on whether a new method of reimbursement for intravenous dialysis medications is having an impact on care.

An analysis of data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) will look at whether there have been any changes in specific labs -- including anemia, phosphorus, and parathyroid hormone -- since the Centers for Medicare and Medicaid Services (CMS) began 'bundling' payments, according to Linda Fried, MD, chair of the program committee.

"It's too early to see an impact on hospitalizations," Fried told MedPage Today, "but we can see whether there's been a shift in lab values over the last year."

Bundling went into effect in January 2011; it establishes a single payment rate for dialysis and all medications given intravenously during dialysis, such as erythropoiesis-stimulating agents (ESAs), iron, and vitamin D.

Nephrologists were initially concerned that the policy would limit treatment options, especially for black patients with end-stage renal disease (ESRD), who tend to require higher doses of ESAs.

Starting in January 2014, oral medications given for ESRD-related complications, including phosphate binders, oral iron, and oral vitamin D, are going to end up in the bundle as well.

"If you get one payment no matter how much drug you use, the expectation is that there are going to be economic forces that will tend to push the use down," Fried said. "That might not be a bad thing, or it might impact care."

Another topic on the agenda will be controversial draft criteria from the United Network for Organ Sharing (UNOS) that sought to overhaul the way donor kidneys are allocated. The debate will be led by two researchers heavily involved in the controversy -- Kenneth Andreoni, MD, of Ohio State University, who was on the UNOS guideline committee, and Lainie Friedman Ross, MD, PhD, of the University of Chicago, a major critic.

The new recommendation suggests giving the highest-quality kidneys to the 20% of recipients with the longest estimated survival time, with the rest would be matched by the ages of the donor and recipient. Critics have charged that the new criteria give more kidneys to younger patients, discriminating against older ones.

"If you shift [the system] to take into account life expectancy, you end up shifting organs to younger people, and that caused controversy," Fried said.

She added that the guideline, which was released in February 2011, is currently being rethought as the committee tries to balance all the concerns. No date is set for release of a revamped guideline.

The meeting will also feature a special session that looks at the management of diabetes patients with ESRD.

There's been much talk about personalized treatment in type 2 diabetes, most recently with European and American organizations urging a less algorithmic approach.

"If you have a patient with advanced kidney disease, perhaps we should back off [HbA1c] targets to avoid the hypoglycemia risk," said Fried, especially since diabetics with kidney disease are more likely to get low blood sugar.

Researchers are also questioning whether this population should rely on a completely different measurement -- glycated albumin -- for assessing care instead of HbA1c.

A study reported last year by Barry Friedman, MD, of Wake Forest University, and colleagues, found that glycated albumin was a better predictor of hospitalization and mortality in diabetes patients with ESRD than HbA1c or serum blood sugar.

"HbA1c is much more stable in a non-kidney disease patient, so it may not be the best marker," Fried said.

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“Most go to clinics because of a lack of awareness of home dialysis and the other is the fear of doing it at home,” Soi said in a telephone interview. “When you have clinics, there is an incentive to have patients. That’s why I came to Johnstown in the 1990s — I was a proponent of home dialysis even with others moving away from it. Now they are moving back to home dialysis.”

Hong Kong has the most usage of home dialysis versus clinics — about 80 percent. In Canada, 20 to 30 percent of people on dialysis use the home system. The U.S. peaked at 15 percent of patients on home dialysis in the 1980s and 1990s. It is now down to only 10 percent.

Home dialysis is less expensive — $50,000 a year compared with $73,000 a year for dialysis in clinics.

People who chose home dialysis and their home support person need to be trained in the procedure.

“You are not alone — there is a full team that supports you: nurses, dietitians, a social worker and a kidney specialist,” Soi said. “A plan of care is set up. It is pretty intensive training. We can also provide respite care (when the caregiver needs a break) or find a care

partner if you live alone.”

Home dialysis also takes less time.

“It’s very convenient at home. I can do it when I want and not miss work,” Hoffman said. “It’s better than going to a clinic. It’s a lot less of a hassle. I absolutely recommend it.”

People are even able to travel while on home dialysis. Soi has one patient who went on a hunting trip in Canada. He took the portable machine with him and the supplies were mailed out.

“You can scheduled your life around your activities,” he said. “Your life is no longer ruled by dialysis.”

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