CLEVELAND - A new clinical trial demonstrates that identifying and overcoming three barriers greatly improves the quality of hemodialysis treatment, a finding that may help the 33,000 Americans now receiving suboptimal doses of hemodialysis. According to an article in the April 17 issue of "The Journal of the American Medical Association"("JAMA"), the three barriers are under-prescription of dialysis by physicians, use of intravenous catheters to provide treatment, and shortening of treatment time by patients. The randomized controlled trial showed that educating physicians and patients about these barriers resulted in a two-fold larger increase in dialysis dose compared to conventional care. The studys method of identifying and overcoming barriers to quality care may also be applicable to other chronic conditions such as asthma or heart disease.

Virtually all dialysis treatment is paid for by Medicare, even for patients younger than 65 years old. Despite annual federal expenditures of $18 billion, the mortality rate among American hemodialysis patients is the highest in the industrialized world at 23 percent per year. European and Japanese hemodialysis patient mortality rates are much lower at 10 to15 percent per year. The high mortality rate among American patients is in part due to the fact that one-sixth of the 200,000 Americans receiving hemodialysis treatment do not receive an adequate dialysis dose. Hemodialysis is used to treat people with kidney failure. In the process, blood is removed from the body and pumped into a machine that filters out toxic substances from the blood and then returns the purified blood to the person.

The researchers, led by Ashwini Sehgal, M.D., from the Case Western Reserve University School of Medicine, identified three barriers to adequate dialysis, showed that it is possible to overcome the barriers, and demonstrated that overcoming barriers resulted in higher quality treatment. The study, involving 169
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Contact: George Stamatis
gxs18@po.cwru.edu
216-368-3635
Case Western Reserve University
16-Apr-2002

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