Very Interesting!

Very Interesting!

Are the days of kidney dialysis numbered? | Health Tech - CNET News

Are the days of kidney dialysis numbered? Health Tech - CNET News

Causes, Growing Organs for people who need them.

Causes

Transplants!!!

                        Very Excited to report THREE Kidney Transplants in my system this past week! Two adults and one small child were the recipients. One of the adults received from a related donor and the others from the transplant list. The child was in need of a Kidney and a Liver and therefore received the liver transplant too! All these transplants done at Strong Memorial Hospital, University of Rochester, Rochester,NY.  Transplant, an awesome option!

Profile Pic

I have had for some time now this combination Pic/awareness banner for my profile Pic on facebook. I just wanted to throw this post up on my blog as an encouragement to others to use this and other awareness symbols in their social networking. I know that many are already doing this and that is fantastic! I just wanted to use this Blog vehicle to promote some more promotion! Below this text I will place the Donate Life banner I use so feel free to copy and paste it into where ever. In a future post I can provide some instruction  on how to combine a pic of your choice with a banner, logo or symbol. Remember use of certain Logos can be an issue.

Transplants!!!

In my Dialysis unit we have had three Patients that have received Kidney transplants in the last 3 months and one that is pending for July! OMG it is the Ultimate option!!! Please Donate Life if you Can!!!!

NKF - Great Story!

A Kidney Transplant Turns the Doctors into Patients

Dr. Andrew Levey, a leading nephrologist at Tufts University in Boston, has thoroughly described for hundreds of patients what to expect following a kidney transplant operation. These days, however, Levey speaks with a different authority–the expertise of one who’s walked in their shoes himself.
Last December, the editor of NKF’s American Journal of Kidney Diseases and leader of the Foundation’s workgroup that created the groundbreaking definition and staging system for chronic kidney disease, became a kidney donor himself. Levey donated a kidney as part of a three-pair “kidney swap” so that his wife, oncologist Dr. Roberta Falke, could receive a kidney.
Levey and Falke, who met as medical residents, knew that ultimately they would face the challenge of kidney failure. Like her father and two of her siblings, Falke suffers from a familial disorder, polycystic kidney disease, and she expected that her own kidneys probably wouldn’t continue functioning past middle age. Falke took meticulous care of her health, regularly visiting the doctor and getting immediate treatment for acute illnesses and infections. Knowing she was doing all she could, she focused on her roles as mother to her son, Isaac, and physician to the cancer patients who relied on her. She was able to banish thoughts of her disease until she developed symptoms related to enlarging kidney and liver cysts, and advanced kidney disease, over the past three years. Although she had to reduce her work hours, she continued to practice until the week before her transplant.
For Levey, though, too much knowledge wasn’t necessarily a good thing. As a kidney specialist, he was all too familiar with every possible complication that could occur. He found it hard to relax, even before Falke showed any symptoms, because he knew what lay ahead. As a husband, he felt duty-bound to help his wife, but he also felt powerless to help restore her health by giving her a kidney, because of incompatible blood type. What he learned throughout this process, though, was that there was a path he hadn’t counted on that could provide hope and ultimately, a solution.
Up until a year or two ago, Levey hadn’t entertained the thought of participating in a paired exchange program, where kidney recipients essentially swap kidneys from willing donors. While medically eligible to donate, each donor has an incompatible blood type or positive cross match test with his or her intended recipient. By agreeing to give kidneys to unknown but compatible recipients, the donors can enable a chain of transplants when previously no transplant would have been possible.
The couple wasn’t sure that paired donor exchange could be a practical reality, so they set about trying to find a donor from among family and friends. But as time wore on, everyone they had considered as a potential donor was eliminated for one reason or another. At the same time, paired donor exchange was becoming more common, and it soon became apparent that this might be the best way for Falke to receive the gift of life.
On December 15, 2009, Levey went under a knife, expertly wielded by his trusted colleagues in his own workplace, Tufts Medical Center. He donated his kidney to Peter Scheibe. Scheibe’s wife Susan donated her kidney to Hai Nguyen, and Nguyen’s wife Vy Yeng donated her kidney to Falke. Lying in the hospital bed, Levey was struck by how different it is to be the doctor who strides into the room to check in and walks right out the door, versus the patient who is laid up in bed.
“Since donating my kidney, I can tell people exactly what to expect every day post-transplant. I always tended to be close to my patients, but now our connection is so much more direct. They feel like I’m one of them. I have done something that they hope their family members will do or already have done, and they know how important it is to them. They really feel in a way like I’m part of their families,” says Levey.
“I have clinic once a week and now when I see patients, we spend the first half of the appointment talking about Roberta and me. Eventually, I have to ask, ‘are we going to discuss your case?’ Usually, they tell me, with a wave of the hand, that we’ll get to that the next visit. They’re far more interested in how the doctor who became a patient is doing.”
Falke too has been moved by the experience. “My cancer patients are so sick themselves, yet they are all concerned about me. They want to take care of me now and to know that I’m going to be okay. I’ve truly been touched by their outpouring of support.”
Falke says that doctors who experience serious illness get a taste of what patients go through. She feels it’s helpful to know where patients are coming from in terms of the fear, vulnerability and actual physical pain. “For now,” Falke smiles, “I’ve had more than my share of experience, but I still maintain that it’s good for doctors to be on the other side every once in awhile.”
Both Falke and Levey say the donation has brought them closer together and given them hope for their own future. They’ve always been involved with the National Kidney Foundation, but now they’re thinking about participating in more of the patient programs, such as the Kidney Walk and possibly even competing in NKF’s Olympic-style U.S. Transplant Games down the road.

25 Facts About Organ Donation and Transplantation. NKF.

The success rates of transplant surgery have improved remarkably, but growing shortages exist in the supply of organs and tissues available for transplantation. Many Americans who need transplants cannot get them because of these shortages. The result: some of these people die while waiting for that "Gift of Life."
Each year, the National Kidney Foundation develops special public education programs aimed at increasing public awareness of the need for organ and tissue donation. Learning more about organ and tissue donation will help every American to make an informed decision about this important issue. Here are some facts everyone should know:

1. 104,748 U.S. patients are currently waiting for an organ transplant; more than 4,000 new patients are added to the waiting list each month.
2. Every day, 18 people die while waiting for a transplant of a vital organ, such as a heart, liver, kidney, pancreas, lung or bone marrow.
3. Because of the lack of available donors in this country, 4,573 kidney patients, 1,506 liver patients, 371 heart patients and 234 lung patients died in 2008 while waiting for life-saving organ transplants.
4. Nearly 10 percent of the patients currently waiting for heart transplants are young people under 18 years of age.
5. Acceptable organ donors can range in age from newborn to 65 years or more. People who are 65 years of age or older may be acceptable donors, particularly of corneas, skin, bone and for total body donation.
6. An estimated 12,000 people who die each year meet the criteria for organ donation, but less than half of that number become actual organ donors.
7. Donor organs are matched to waiting recipients by a national computer registry, called the National Organ Procurement and Transplantation Network (OPTN). This computer registry is operated by an organization known as the United Network for Organ Sharing (UNOS), which is located in Richmond, Virginia.
8. Currently there are 58 organ procurement organizations (OPOs) across the country, which provide organ procurement services to 250 transplant centers.
9. All hospitals are required by law to have a "Required Referral" system in place. Under this system, the hospital must notify the local Organ Procurement Organization (OPO) of all patient deaths. If the OPO determines that organ and/or tissue donation is appropriate in a particular case, they will have a representative contact the deceased patient’s family to offer them the option of donating their loved one’s organs and tissues.
10. By signing a Uniform Donor Card, an individual indicates his or her wish to be a donor. However, at the time of death, the person's next-of-kin will still be asked to sign a consent form for donation. It is important for people who wish to be organ and tissue donors to tell their family about this decision so that their wishes will be honored at the time of death.
11. All costs related to the donation of organs and tissues are paid for by the donor program. A family who receives a bill by mistake should contact the hospital or procurement agency immediately.
12. Tissue donation can enhance the lives of more than 50 people. Donated heart valves, bone, skin, corneas and connective tissues can be used in vital medical procedures such as heart valve replacements, limb reconstruction following tumor surgery, hip and knee joint reconstruction and in correcting curvature of the spine.
13. In 2008, a total of 14,208 organ donors were recovered in the U.S. Of these, 7,990 were cadaveric donors, which represented a decrease over the total of 8,019 in 2006. Living donors decreased from 6,732 in 2006 to 6,218 in 2008.
14. Donor organs and tissues are removed surgically, and the donor’s body is closed, as in any surgery. There are no outward signs of organ donation and open casket funerals are still possible.
15. Acceptable organ donors are those who are "brain dead" (whose brain function has ceased permanently) but whose heart and lungs continue to function with the use of ventilators. Brain dead is a legal definition of death.
16. Organ transplant recipients are selected on the basis of medical urgency, as well as compatibility of body size and blood chemistries, and not race, sex or creed.
17. Advances in surgical technique and organ preservation and the development of more effective drugs to prevent rejection have improved the success rates of all types of organ and tissue transplants.
18. About 94.4 percent of the kidneys transplanted from cadavers (persons who died recently) are still functioning well at one year after surgery.
19. The results are even better for kidneys transplanted from living donors. One year after surgery, 97.96 percent of these kidneys were still functioning well.
20. Following are one-year patient and organ graft survival rates:

Organ		Patient Survival Rate		Graft Survival Rate
Kidney (cadaveric) Kidney (live donor) Liver		94.4% 97.9% 90.1%		89.0% 95.1% 82.0%

21. Following is a comparison of the numbers of organ transplants done in 2008 and the numbers of individuals who are on the national waiting list as of November 2009.

Organ		Number of Transplants in 2008		Number of Patients on Waiting List* (of November 2009)
Kidney Kidney/Pancreas Pancreas Liver Heart Heart/lung Lung Intestine Total:		16,520 837 436 6,319 2,163 27 1,478 185 27,965		82,364 2,220 1,488 15,915 2,884 83 1,863 229 107,046

22. Of the 13,156 single kidney transplants performed in 2008, 5,968 were from living donors and the rest were from cadaveric donors. In addition, 837 kidneys were transplanted in combination with pancreas transplants.
23. Over 2,500 bone marrow transplants were performed in the U.S. in 2004. Marrow is collected from a pelvic bone using a special needle while the volunteer donor is under anesthesia. The majority of bone marrow transplants are done for leukemia.
24. In the United States fewer than 2.5% of patients with end-stage kidney disease undergo transplantation as their first treatment or therapy. The National Kidney Foundation is dedicated to educating kidney patients about the benefits of pre-emptive transplantation - when a person is able to go straight to transplant without dialysis they usually have good health outcomes.
25. 2008 was the first time in 20 years that there was a decline in the number of deceased donors used for transplants. Living donors in 2008 were at their lowest numbers since 2001.
26. Virtually all religious denominations approve of organ and tissue donation as representing the highest humanitarian ideals and the ultimate charitable act.

Shad Ireland Ever Inspiring

I have seen this presentation before and wanted to share it as this man is so motivating!

'JumpStart' uses retired Rochester officer's story to highlight kidney disease

(CARLOS ORTIZ staff photographer)

Jon Hand • Staff writer • April 29, 2010  JHAND@DemocratandChronicle.com

The current story line of the comic strip JumpStart has been pulled from the real-life health problems of retired Rochester police Officer Greg Raggi, a dialysis patient who has been in line for a life-saving kidney transplant for 3 ½ years.
Artist Robb Armstrong's strip, which is printed daily in the Democrat and Chronicle, features the lives of a fictional police officer, Joe, and his wife, Marcy, a nurse.
Since April 12, the strip has focused on Joe's "cop lifestyle" of eating fast fatty foods, working long hours and dealing with high stress. In the past few days, Joe and Marcy have discussed how that lifestyle can lead to diabetes and renal failure. In a subplot of the comic, Joe's partner, Crunchy, has left the fictional world of JumpStart to give his brother, Stanley (also a police officer), a kidney because Stanley has diabetes.
Armstrong said he developed the story line after a phone call from Mike Mazzeo, a friend and longtime partner of Raggi's in the narcotics unit of the Rochester Police Department.
Mazzeo, who is also the president of the Locust Club, the city police officer's union, first met Armstrong last year during a dust-up over a strip by Armstrong depicting a police shooting. The strip ran about the same time two city officers were shot and some in the community criticized Armstrong and the newspaper for being insensitive.
Mazzeo disagreed and publicly came to Armstrong's defense.
A bond was formed and the next time Mazzeo talked to Armstrong, he was asking him to help his friend, Raggi, and bring awareness to a problem many officers are concerned about.
"It's something that has affected many of us," said Mazzeo, who spent many hours taking his own father to dialysis treatments.
At least one other retired Rochester officer, Stan Prewasnick, is on dialysis and a third, Lt. Lou Genovese, died this past year after spending a year on dialysis, Mazzeo said.
Armstrong said he loved the idea right away.
"I have people walking up to me all the time saying, 'This is so funny, you have to write about it in JumpStart,'" Armstrong said from his home in Pasadena, Calif. "Mike came up to me and told me about something that wasn't funny but was so important. I said: 'Wow, this isn't just good for JumpStart, this is perfect.'"
Dr. Carlos Marroquin, a transplant surgeon from Strong Memorial Hospital, said no studies have been done to calculate whether police officers have a higher incidence of renal failure compared to other professions. But it's clear, Marroquin said, poor diet and stress can be a harmful combination.
"Clearly it is an issue, given the lifestyle, the stress, the dietary habits of a police officer," said Marroquin, who, at Mazzeo's invitation, spoke to union members in March to discuss kidney health and the safety of becoming "live donors." Donna Dixon, education director for the local chapter of the National Kidney Foundation, also spoke to the officers.
For his part, Raggi acknowledges that many of his old habits as an officer likely "caught up with him."
"I'm sure, eating the way I did, sleeping the way I did, middle shifts, night shifts, waking up early for court, it all took a toll on me," he said. "I'm not complaining. I loved it. But I wish I'd known better."
He retired in 1993 after 20 years in the department, and was diagnosed with Type 2 diabetes in 1995. The symptoms became more prevalent following a heart attack in 2004 and he went on the donor list in 2006.
He began peritoneal dialysis about 18 months ago, which requires Raggi to attach a tube leading from a suitcase-sized machine to a permanent tube in his abdomen each night for about nine hours while he sleeps. The process takes the place of the natural function of Raggi's kidneys, to filter toxins from his blood.
"I feel OK. I have good days and bad days; my doctor tells me to hang in there," said Raggi.
Doctors told him to expect it to take four to five years to find a donor kidney from the date he was placed on the list.
That surgery would change his life, he said. He's been looking forward to one thing, in particular.
"We never travel anymore because of the dialysis," he said. "I'd like to take a trip with my wife."
JHAND@DemocratandChronicle.com

See Social Networking can be Very Good!

Conn. mayor donates kidney to Facebook friend

AP – Kidney recipient Carlos Sanchez poses for a photograph at his home in East Haven, Conn., Wednesday, April …

By STEPHANIE REITZ, Associated Press Writer Stephanie Reitz, Associated Press Writer – Wed Apr 21, 7:32 pm ET

HARTFORD, Conn. – Politicians long ago discovered the uses of Facebook. East Haven Mayor April Capone Almon found something else there: a constituent who needed her kidney. Capone Almon, 35, had more than 1,600 "friends" on Facebook last year when she saw one of them, Carlos Sanchez, post a status update saying his friends and relatives had all been tested and couldn't donate a kidney. She knew him casually through activities and friends in the New Haven suburb of East Haven, but they weren't so close that she had heard he was ill. Sanchez, a 44-year-old father whose kidneys were failing because of diabetes, sent out the request on Facebook only hesitantly and on his doctor's suggestion. He worried people might pity him — and certainly hadn't pinned his hopes on finding a donor that way. He didn't have long to wait. Capone Almon was the first person to respond. "I sent him a private message and just said, 'Hey, I'll try. I'll get tested,'" Capone Almon said Wednesday. "I really felt from the very beginning that I was going to be a match and a donor. I don't know why, but I just knew it." Sanchez had no such certainty. "I thought she was joking. The mayor of East Haven would offer me her kidney?" said Sanchez, an office administrator. "She responded back and said, 'I am serious, I am willing to get tested.' "I wasn't putting too much faith in it," he said. "I didn't want to get my hopes high. But at a point she made me feel so comfortable that I started feeling maybe this was meant to be." Capone Almon, a Democrat, was running for second term as mayor at the time but kept the details of her medical plans a secret. She won the election as they awaited word on when she could donate the kidney, saying they grew as close as family during the lull. "I know he voted for me, too," she joked. The operation was set only after Capone Almon passed a battery of tests and was given a long explanation of the process, which involved three small incisions near her ribcage and a scar similar to that of a cesarean section. "What the doctors said to me is, 'Your recipient is already sick and we're not going to make you sick to make him somewhat better,'" she said. "They do not compromise the donor's health in any way, shape or form." Their tenuous connection was cemented into a lasting bond April 8, when doctors at Yale-New Haven Hospital removed Capone Almon's left kidney and transplanted it into Sanchez. They were released from the hospital in less than a week and are expected to make full recoveries. His insurance paid for both their surgeries, and the mayor is back on the job in this middle-class city of about 30,000. Capone Almon said that she fields questions almost daily from people asking whether she's worried her one remaining kidney might someday fail, but that she's confident enough in modern medicine and her own health — especially after the numerous tests — that she barely gives it a thought. "I don't want people to see this as something larger than life," she said. "There's nothing special about me. Anybody can try to do this, and if it's meant to be, you'll be a match and a donor and you can really help someone." Michael Lawlor, an East Haven attorney and longtime friend of Capone Almon's, said she kept the details of her plans private for a long time, even as he and others quizzed her to ensure she recognized the serious nature of the donation. "I remember saying, 'Wow, that's really something. I wonder if she's really thought through the fact that it might actually be a match,'" said Lawlor, the area's state representative to the General Assembly. "Almost everybody says the same thing: I don't know if I would do that if it wasn't a relative ... but she said, 'No problem,'" he said. "When she found out she was a match, she was genuinely happy and truly excited to do it."

Transplant!!!!!

Many of you may remember Keith Barr from our 2010 Geneseo Kidney Walk - his outgoing personality and creative advertising caught all of our attentions!!

We are very excited to announce that Mr. Barr received notice last Wednesday that a kidney was available to him - and he received his transplant on Thursday. I spoke with Keith today and he said he is feeling great! We want to send a congratulations to him and his family - we are all so excited for you and wish you the best!

Keith promised to attend the Geneseo Kidney Walk next year with a sign that says "Received My Kidney 1 year ago!"

We are all very excited to see Keith and the rest of our great kidney walkers next year!

Thanks, 
 http://organdonor.gov/

Michelle Castrogiovanni

Division Special Events Manager

National Kidney Foundation

Serving Upstate New York

Patient Champion Series: I wanted to share some of these awesome human stories that FMC has shared with me.

Marian Carr

Age 41 • Kansas City, Mo. • Featured on March 24, 2010 
Helping Other Patients With Ambitious Work Ethic
Marian Carr, a 41-year-old dialysis patient, was diagnosed with end stage renal disease (ESRD) in July 2002. She went on dialysis and shortly after regained her kidney function for nearly five years. Marian then returned back to dialysis in 2007, had an unsuccessful kidney transplant in 2009, and now receives in-center hemodialysis at Fresenius Medical Care Kansas City Dialysis. The cause of her kidney failure is unknown, although her father had kidney trouble too.
Despite her struggles with ESRD, Marian has persevered and continues to set and accomplish ambitious goals. She firmly believes that people should live the life they want to have, and not let health restrictions or setbacks get in the way.
Among many academic accomplishments, Marian completed her doctorate in psychology and obtained an International Counseling Certification from the Viktor Frankl Institute of Logotherapy – all while managing her dialysis schedule. As part of her doctoral thesis, she developed a counseling model for dialysis patients. Marian is currently active in two nonprofit organizations, as president of the local Minority Donor Awareness Group, and board chair of the Renaissance Education Group in Durham, N.C., which provides education programs for disadvantaged high school students.
To accommodate Marian’s rigorous schedule and numerous travels for work and vacation, she utilizes the Fresenius Medical Care Patient Travel Service. She has traveled all across the U.S., including trips to Dallas, New Orleans, Boston, Florida, Indiana, Michigan, California and North Carolina.
When she's not working, Marian enjoys reading and spending lots of time with her family. She is the eldest of four children and has two nieces and two nephews. This year, Marian and her friend have started a small business to provide counseling and training services for adults, and they plan on expanding it.

Patient Champion Series: I wanted to share some of these awesome human stories that FMC has shared with me.

Tanysha Pitts

Age 33 • Tampa, Fla. • Featured on March 23, 2010
Nighttime Dialysis Allows Patient to Dream Big

Tanysha Pitts, a 33-year-old Tampa, Fla., resident, is living her dream, and likes to spread the word that anything is possible on dialysis. Tanysha, who has had kidney failure for almost 20 years as a result of a case of prolonged strep throat, is an in-center nighttime dialysis patient at Fresenius Medical Care Tampa North. Her unique treatment schedule (dialyzing overnight), which she began in 2008, has enabled her to pursue her education as a full-time medical student at Sanford Brown Institute.
Tanysha's dedication to her studies as medical assistant and to her dialysis treatment inspires patients and staff alike at her facility. Her passion for the medical field and her goal to one day work with people with chronic illnesses stems from her personal experience with kidney disease. Tanysha says she sees many young people starting dialysis who feel their lives have changed forever, but she is there to tell them a different story. Tanysha talks to her fellow patients about their dialysis treatment options and encourages them to try the nighttime program, sharing her success on the treatment plan and how they can fulfill their own dreams.
Tanysha will graduate from Sanford Brown Institute with her medical assistant certification in late March 2010, and plans on pursuing another degree in nursing or social work. In addition to school, Tanysha enjoys cooking, spending time with her friends, volunteering at various organizations and attending church services.

National Kidney Foundation!

Double Donation: Husband and Wife Each Give Gift of Life

When Marcus and Monica Gilbert decided to purchase a Charley’s Grilled Subs franchise in a food court at a Utah mall, the idea of saving two lives was not in their business plan. Yet, that is exactly what resulted. Together, this couple, married seven years, has shared many successes --owning a thriving business, raising four healthy children and, within a 16-month span, giving the gift of life through kidney donation to two individuals.
Like many married couples, Marcus and Monica balance their days between running after their four children -- Jessica, Taylor, Christian and Emma –and managing a business. Unlike many married couples, they found the time and opportunity to each donate a kidney.
It all began when Marcus hired 17-year old Juan Delgado to work at one of his Charley’s Grilled Subs franchises. Marcus was determined to help Juan and his family, knowing that he had a difficult schedule to work around while undergoing thrice-weekly dialysis treatment. He even arranged a few fundraisers at Charley’s to defray Juan’s rising medical costs. But Marcus was still not satisfied with his results and decided to take his efforts one step further and get tested to become his employee’s kidney donor. After hearing that he was a perfect match, Marcus and Juan underwent successful kidney transplant surgery in September 2008.
“I felt I was in a good spot to donate and that I couldn’t pass up on the opportunity of giving someone so young his life back,” said Marcus.
After watching her husband donate his kidney without a hitch, Monica decided she too wanted to be a living donor. So she underwent tests with the goal of donating her kidney to anyone in need.
A few weeks later, Monica was notified that she was a match for a 44-year old named Pepe Sione Lee, a husband and father from Salt Lake City. Pepe’s kidneys had failed due to diabetes and he had been receiving dialysis treatment for 18 months. On February 11, 2010, Monica successfully donated a kidney.
In recognition of Monica’s gift, Pepe and his wife are planning a luau party this summer—just around the time when Juan plans to graduate from high school. Like both their kidney recipients, Marcus and Monica have returned to their daily routines with plenty of energy, which they will use to continue to chase their children around the house.

Our friend Jim Sloand to the Ways and Means Commitee.

Testimony By James Sloand, M.D., Statement

Statement of James Sloand, M.D., Medical Affairs U.S., Baxter Healthcare

My name is James Sloand, M.D. and I direct medical affairs for renal services at Baxter Healthcare for the U.S.  I have also been a practicing physician for over 30 years. Baxter’s renal business has long served the needs of people with end stage renal disease (ESRD). ESRD is the most serious form of kidney disease and occurs when the kidneys lose approximately 85-90 percent of their natural function.  Kidney disease is life threatening and requires treatment in order to remove toxins from the bloodstream.  In 1956, the company introduced the first commercially available and disposable dialyzer to act as an artificial kidney in hemodialysis.  Nearly 20 years later, Baxter pioneered peritoneal dialysis a primarily home-based treatment for ESRD patients that is used all over the world.
The development of kidney dialysis therapy and the many improvements made to it over the past several decades have vastly improved survival for patients with end-stage renal disease.  Improvements in the care of patients with kidney disease, for example, have meant that more individuals are undergoing dialysis therapy for longer periods.[1]  As such, total costs will continue to rise as the prevalence of patients on dialysis increases, (estimated to increase by 62% by 2020.[2] )
Finding a way to delay entry into dialysis and to lower the costs of car­ing by preventing hospitalizations for people with chronic kidney disease (CKD) is critical to reducing health care spending.  Patients can play an important role preventing deterioration in health once they have been diagnosed with a chronic condition. Building in patient self-management and empowerment through provider reimbursement policies may be key to reducing costs.[3]
A patient with end stage renal disease has  two different options for renal replacement therapy (dialysis) if a pre-emptive renal transplant is not available: treatment at home with either peritoneal or home hemodialysis  or by in-facility hemodialysis.  Home peritoneal dialysis is underutilized in the U.S. compared with (for example) Canada (7.6% in U.S. versus 37% in Canada in 2005).  A recent study of nephrologists indicated that if maximizing survival, wellness and quality of life were the most important factors in deciding mode for dialysis, 33% should be on PD.[4]  The underutilization of PD in the U.S. may thus have a negative impact on quality of life for patients that might otherwise use this modality and the data show that this deficiency increases costs to the Medicare program:

• MedPAC said in a recent report "Home dialysis offers several advantages related to quality of life and satisfaction to those patients who are able to dialyze at home.”[5]  
• The Centers for Medicare and Medicaid Services states that, "If 5 percent additional patients were to opt for home peritoneal dialysis, which provides added health and quality of life benefits….the potential savings for these 5 percent additional patients could be as much as $295 million."  (Page 20471 Final Regulation on the Medicare Conditions of Coverage for End-stage Renal Disease Patients).  [Note: these savings are through reduced hospitalizations and improved outcomes and over 10 years would result in at least $3 billion in savings.]

A lack of education about different modalities has been one of the significant reasons for underutilization in the U.S.  In fact, only 25% of patients on hemodialysis ever remember receiving information about peritoneal dialysis as an option.[6]  The provision of information to patients is also associated with greater willingness to adhere to therapies[7] and may include delayed progression to ESRD.[8]
 In 2008, the Congress added an education benefit to the Medicare program to educate patients in the final stages of kidney diseases to delay the onset of dialysis and to increase the information on dialysis options for care.  The benefit allows up to six educational sessions for Stage 4 kidney disease patients including instruction on the management of co-morbidities, with the goal of delaying the need for dialysis.  The educational sessions are also required to include a discussion of the treatment options available to patients.  The Centers for Medicare and Medicaid Services (CMS) now has responsibility for implementing this important benefit.  It is my hope that they recognize the need for a collaborative model between the physician and his staff where both contribute to the process to ensure that the therapy is as the law requires: individualized and aiding the patient in managing complications and co-morbidities of kidney failure.
I recommend that Congress further improve the management of kidney disease within the Medicare program by recognizing the direct link with the initial coverage under the Medicaid program for the low-income.  However, almost one-third of all new starts in dialysis begin in Medicaid and then transition after three months to Medicare.   Data show that Medicaid patients are less likely to have access to nephrologists and to critical information on diet.[9]  Increasing information to empower patients on how to manage their co-morbidities and significant metabolic issues-- prior to kidney failure-- is both equitable (increasing patient satisfaction) and, by reducing avoidable hospitalizations during the months immediately preceding and following the initiation of dialysis, it reduces costs for Medicaid program. 
Therefore Congress should specify that Stage 4 CKD patients should be part of targeted Medicaid case management services.[10]  In this instance, the case manager (a nurse or social worker) could ensure through community outreach that Medicaid eligibles with Stage 4 CKD have access to information on kidney disease, to kidney care providers, and they evaluate whether patients are receiving the appropriate information.  Further, similar to the recently enacted Medicare physician and practitioner model for renal education, the case manager would refer the Medicaid eligible to a physician for training on managing their co-morbidities, diet and metabolic issues, as well as the modalities of care and preparing for the appropriate access for dialysis.  It could also be a required case management activity for Medicaid managed care plans, through a case manager and through separate payments to physicians. 
In addition, prevention should be a cornerstone of all aspects of the health care system rather than an afterthought. This shift requires a fundamental change in the way providers are reimbursed in the system to reward those that are increasing the value of the health care services and reducing preventable admissions.  The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requirement on pay for performance was an important step, as discussed further in my testimony as follows on vaccines for patients with end-stage kidney disease. Dialysis patients have long been recognized as a vulnerable and an underserved population that would benefit from immunizations.  Since 1995, hospitalization rates for dialysis patients for infection have risen 19 percent overall, and 28% for African Americans. The rates of death due to infection are also highest among African Americans.  Studies show that vaccination will result in reduced risk of hospitalization and death from infections.  As a result, the CDC has recommended that all dialysis patients and staff be immunized to improve anti-microbial resistance. 
Patients with ESRD are under immunized (60% in 2002 and no significant improvement in the reported data since then [11]), with an even lower rate for the dual eligible population.  A CMS objective is to increase the annual ESRD patient influenza vaccination rate to 90% by 2010.  Vaccines are cost effective overall for the population over 65, reducing costs by $117 per person.[12]  Specifically, vaccinations reduce the risk of any hospitalization for hemodialysis patients by 7% (see chart below.)

Influenza vaccine delivery and effectiveness[13]
Hospitalization	Reduction in Risk
-Any cause -Influenza -Bacteremia -Respiratory infection	-7%
	-16%
	-24%
	-12%

Mr. Chairman, I request that your Committee urge CMS to include a measure concerning the percentage of vaccines, which is a national Quality Forum, for use in the pay for performance system that is required under the new dialysis payment system, effective January 2011.  The statute provides for flexibility in the measures to be used for dialysis pay for performance, but does not specifically require vaccination for influenza as a measure.  Given that spending on hospital services for patients undergoing dialysis was $7.05 billion a year in 2006, the estimated savings for an increase up to the CMS influenza vaccine target would be $150 million a year, or roughly $800 million over 5 years.  This could be a key part of aligning incentives for excellence of care for providers in the Medicare program and also for reducing disparities for vulnerable kidney patients.
Thank you for this opportunity to submit testimony for the record on health care reform and reforming the delivery system.

---

[1] “Technological Change and the Growth of the Health Care System”, Congressional Budget Office, January 2008.
[2] Gilbertson and Collins, USRDS (the NIH US Renal Data System).
[3] “The Healthcare Delivery System: A Blueprint for Reform, from Chapter 5, Second Generation Consumerism: Increasing Consumer Activation to Improve Health Outcomes and Lower Costs for Patients with Chronic Disease by Judith Hibbard, and Katherine Hayes, J.D., Center for American Progress
[4] Mendelssohn et al, 2001
[5] MedPAC
[6] Golper, 2001 
[7] Swatz, Robinson, Davy and Poltoski, 1999
[8] Golper, 2001
[9] Solid, Collins, USRDS, Minneapolis, Medical Research Foundation, 2007
[10] Case management is not the direct provision of medical and related services, but rather is assistance to help beneficiaries receive care by identifying needed services, finding providers, and monitoring and evaluating the services delivered.1 Targeted case management (TCM) refers to case management that is restricted to specific beneficiary groups. Targeted beneficiary groups can be defined by disease or medical
condition, or by geographic regions, such as a county or a city within a state. Targeted populations, for example, may include individuals with chronic physical or mental illness, developmental disabilities, or other groups identified by a state and approved by the Centers for Medicare and Medicaid (CMS). TCM and case management are optional services that states may elect to cover, but which must be approved by CMS through state plan amendment (SPAs).  CRS Report to Congress: Medicaid Targeted Case Management Benefits, March 27, 2008
[11] One large chain recently reported an 85% vaccination rate.
[12] The Efficacy and Cost Effectiveness of Vaccination against Influenza among Elderly Persons Living in the Community, Nichol et al, NEJM September 1994).
[13] Odds ratios for the impact of vaccinations on mortality and morbidity in hemodialysis patients during the period 1998-1999 from  “Influenza vaccine delivery and effectiveness in end stage renal disease”, Gilbertson et al, Kidney International, 2003

Patient Champion Series: I wanted to share some of these awesome human stories that FMC has shared with me.

Harvey Jones
Age 56 • Greensboro, N.C. • Featured on March 18, 2010

Dialysis Patient Uses Voice to Inspire Peers, Legislators           


After years on the road as a singer with Al Green, Mary J. Blige, Hall & Oates, Michael McDonald and many others, Harvey Jones wasn’t about to let kidney failure stop his momentum. Rather, he embraced his diagnosis and puts all his extra energy into helping other chronic kidney disease patients.

Since beginning dialysis in June 2001, Harvey continues to sing all over the United States, as well as internationally. Over the past 19 years, he has been on in-center hemodialysis, peritoneal dialysis and received a transplant which his body rejected after 8 years. Harvey is currently on in-center hemodialysis, and is on the kidney transplant waiting list.

Being on the road, traveling from one music venue to another makes it hard for Harvey to sit still. He owns a publishing company, enjoys reading and is also a minister. In order to keep physically fit, he walks two to three miles a day.

One of Harvey's most rewarding activities is his participation in an end stage renal disease (ESRD) patient support group in Greensboro, N.C., called the Dialysis Action Committee (D.A.C.). The D.A.C. is a nonprofit which provides patient support through celebrations and picnics, kidney disease screenings with the local National Kidney Foundation chapter, and meetings with local legislators about laws that impact the ESRD community.

Harvey receives a tremendous amount of support from his family. He has been happily married for 38 years and is a father of three. He also loves his local dialysis care team and facility, and says, “I wouldn’t dialyze anywhere other than Fresenius Medical Care.”

Harvey’s goal is to assist others living with ESRD and help them embrace their diagnosis, and remain optimistic and happy. “Attitude and laughter are part of the medicine needed to help you live with kidney failure," he says.

Licorice Chemical Question as related to Transplant!

Licorice May Block Effectiveness Of Drug Widely Used By Transplant Patients

ScienceDaily (2009-03-31) -- Chemists in Taiwan are reporting that an ingredient in licorice -- widely used in various foods and herbal medicines -- appears to block the absorption of cyclosporine, a drug used by transplant patients to prevent organ rejection. This drug interaction could potentially result in illness and death among transplant patients and others taking cyclosporine and licorice together, they caution. ... > read full article

FMC- Patient Champion Series

I wanted to share some of these awesome human stories that FMC has shared with me.

Ronnie Glasper, a 38-year-old dialysis patient from Monroe, La., believes taking a proactive role in your health care is one of the keys to a successful life on dialysis. Ronnie has been on dialysis for two years because of kidney failure related to juvenile diabetes. He receives hemodialysis treatments at the Fresenius Medical Care Northeast Louisiana dialysis facility.
Every three days, when Ronnie arrives at the facility, he visits with the other patients, asking how they are doing and sharing information he has learned regarding kidney disease. He believes that, ultimately, your health is your own responsibility. He encourages dialysis patients to take an active role in their health care by asking questions, learning how the machines work, and understanding all of their dialysis needs. Currently, he’s a Network Patient Representative and has been nominated to be a member the Fresenius Medical Care Patient Advisory Board.
Beyond his support of fellow dialysis patients, Ronnie is an inspiration to children and adults through his work at Big Brothers Big Sisters of Northeast Louisiana. As a case manager, he matches children with mentors, who provide them with guidance and support. He also volunteers as a mentor. For Ronnie, having an activity he enjoys outside of dialysis is extremely important, and he advises other patients to find that outlet. Ronnie loves to read and research his family’s genealogy. That hobby takes him frequently to his hometown of Clayton, La., with the help of the Fresenius Medical Care Patient Travel Service.
Ronnie is currently on the waiting list for a kidney and pancreas transplant. His ultimate goals are to educate young people and give back to the community. That includes raising awareness about kidney health among adolescents.
 

Kidney Walk to call attention to organ donors

Caroline McKay wants people to know kidney donation changes lives, but it won’t impact the day-to-day life of a donor.
“Even three years later you can’t tell that I’m functioning with one kidney,” she says.
There is very thorough testing performed on potential donors and a healthy donor should experience a relatively quick recovery and continue regular activities with no side effects from the surgery.
“The only potential downfall for me would be the rare case that one of my family members would need a kidney, I wouldn’t have one to donate,” explains McKay.
McKay generously donated her kidney to a high-school classmate, Danny Bonner, whose sole kidney was failing.
At their 20-year reunion, his classmates held a silent auction to raise money for his medical costs, and awareness of his condition. Bonner had been on dialysis every other day for years, his health deteriorating.
All of his family members and his girlfriend were unable to donate due to age, health problems, or incompatibility. The two were not close in high school, but that did not matter to McKay. She just wanted to help.
She approached him after the silent auction at the reunion and told him her intentions. She knew at that point that she was the same blood type, but still needed to go through further physical tests.
“When people come forward to help you like that, it’s hard to describe the feeling,” said Bonner.
“When someone is willing to give up a part of their body to help you…it’s like a miracle.”
Following the surgery, McKay needed to avoid heavy lifting for a few months, a minor setback as a server at Applebee’s and a house-painter.
McKay is leading a team, “Givers of Hope,” in the upcoming kidney walk in Geneseo for the National Kidney Foundation. So far she has raised $1,000, 80 percent of her initial goal.
She is interested in becoming more active in raising awareness of kidney disease and organ donation. According to the National Kidney Foundation, one in nine people in the Livingston County area has chronic kidney disease and there are 400 people on the kidney transplant waiting list at Strong Memorial Hospital.
Proceeds from the kidney walk provide funding for free kidney check-ups, kidney health classes, Kidney Kinship patient support programs, professional medical programs, kidney transplant options, and local research grants. Take Care of Your Kidneys So They Can Take Care of You.

This is only the second year that a kidney walk is being held in Geneseo, to be held Friday, March 26 at SUNY Geneseo in the Wilson Ice Arena. Registration begins at 6 p.m. and the walk begins at 7 p.m.
The walk last year raised nearly $20,000 and with 21 teams already registered this year, the local NKF chapter hopes to raise $25,000, according to Special Events Manager Michelle Castrogiovanni.
For more information on how to participate or to donate, visit donate.kidney.org or call Michelle at 697-0874, ext. 30.