Renal Replacement Therapy and Incremental Hemodialysis for Veterans with Advanced Chronic Kidney Disease

Kamyar Kalantar-Zadeh, Susan T. Crowley, Srinivasan Beddhu, Joline L.T. Chen, John T. Daugirdas, David S. Goldfarb, Anna Jin, Csaba Kovesdy, David J. Leehey, Hamid Moradi, Sankar D. Navaneethan, Keith C. Norris, Yoshitsugu Obi, Ann O'Hare, Tariq Shafi, Elani Streja, Mark L. Unruh, Tushar J. Vachharajani, Steven Weisbord, Connie M. Rhee

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Each year approximately 13,000 Veterans transition to maintenance dialysis, mostly in the traditional form of thrice-weekly hemodialysis from the start. Among >6000 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, the receipt of care within the VA system is associated with favorable outcomes, potentially because of the 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 with the 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 might preserve RKF, prolong vascular access longevity, improve patients’ quality of life, and be a more patient-centered approach, more consistent with “personalized” dialysis. Broad implementation of incremental dialysis might also result in more Veterans receiving care within a VA dialysis unit. Controlled trials are needed to examine the safety and efficacy of incremental hemodialysis in Veterans and other populations; the administrative and health care as well as provider structure within the VA system would facilitate the performance of such trials.

Original languageEnglish (US)
Pages (from-to)251-261
Number of pages11
JournalSeminars in Dialysis
Volume30
Issue number3
DOIs
StatePublished - May 1 2017

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Renal Replacement Therapy
Veterans
Chronic Renal Insufficiency
Renal Dialysis
Dialysis
Kidney
Delivery of Health Care
Patient Transfer
Health Expenditures
Medicare
Information Systems
Blood Vessels

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Kalantar-Zadeh, K., Crowley, S. T., Beddhu, S., Chen, J. L. T., Daugirdas, J. T., Goldfarb, D. S., ... Rhee, C. M. (2017). Renal Replacement Therapy and Incremental Hemodialysis for Veterans with Advanced Chronic Kidney Disease. Seminars in Dialysis, 30(3), 251-261. https://doi.org/10.1111/sdi.12601

Renal Replacement Therapy and Incremental Hemodialysis for Veterans with Advanced Chronic Kidney Disease. / Kalantar-Zadeh, Kamyar; Crowley, Susan T.; Beddhu, Srinivasan; Chen, Joline L.T.; Daugirdas, John T.; Goldfarb, David S.; Jin, Anna; Kovesdy, Csaba; Leehey, David J.; Moradi, Hamid; Navaneethan, Sankar D.; Norris, Keith C.; Obi, Yoshitsugu; O'Hare, Ann; Shafi, Tariq; Streja, Elani; Unruh, Mark L.; Vachharajani, Tushar J.; Weisbord, Steven; Rhee, Connie M.

In: Seminars in Dialysis, Vol. 30, No. 3, 01.05.2017, p. 251-261.

Research output: Contribution to journalArticle

Kalantar-Zadeh, K, Crowley, ST, Beddhu, S, Chen, JLT, Daugirdas, JT, Goldfarb, DS, Jin, A, Kovesdy, C, Leehey, DJ, Moradi, H, Navaneethan, SD, Norris, KC, Obi, Y, O'Hare, A, Shafi, T, Streja, E, Unruh, ML, Vachharajani, TJ, Weisbord, S & Rhee, CM 2017, 'Renal Replacement Therapy and Incremental Hemodialysis for Veterans with Advanced Chronic Kidney Disease', Seminars in Dialysis, vol. 30, no. 3, pp. 251-261. https://doi.org/10.1111/sdi.12601
Kalantar-Zadeh K, Crowley ST, Beddhu S, Chen JLT, Daugirdas JT, Goldfarb DS et al. Renal Replacement Therapy and Incremental Hemodialysis for Veterans with Advanced Chronic Kidney Disease. Seminars in Dialysis. 2017 May 1;30(3):251-261. https://doi.org/10.1111/sdi.12601
Kalantar-Zadeh, Kamyar ; Crowley, Susan T. ; Beddhu, Srinivasan ; Chen, Joline L.T. ; Daugirdas, John T. ; Goldfarb, David S. ; Jin, Anna ; Kovesdy, Csaba ; Leehey, David J. ; Moradi, Hamid ; Navaneethan, Sankar D. ; Norris, Keith C. ; Obi, Yoshitsugu ; O'Hare, Ann ; Shafi, Tariq ; Streja, Elani ; Unruh, Mark L. ; Vachharajani, Tushar J. ; Weisbord, Steven ; Rhee, Connie M. / Renal Replacement Therapy and Incremental Hemodialysis for Veterans with Advanced Chronic Kidney Disease. In: Seminars in Dialysis. 2017 ; Vol. 30, No. 3. pp. 251-261.
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