LI doc eyes changes in dialysis treatment

Dismayed by the high death rate of patients on kidney dialysis in the United States, a Long Island doctor is suggesting people in this country might fare better -- and live longer -- if they spent more time each week getting the treatments.

"We may be delivering dialysis the wrong way," said Dr. Steven Fishbane, vice president of Network Dialysis Services at the North Shore-Long Island Jewish Health System.

Fishbane hypothesizes that U.S. dialysis patients are dying of strokes and heart attacks because of possibly thicker -- or as he puts it -- more viscous blood, which he thinks may be more prone to clotting and damaging the walls of blood vessels. He further hypothesizes that the problem could be due to the current dialysis schedule -- four hours a session, three days a week. Patients elsewhere in the world undergo dialysis either more frequently or for longer periods, preventing blood viscosity.

In a pilot trial he is now overseeing, using a new device that allows the doctor and his team to measure blood thickness, Fishbane is scanning blood vessels before, during and after kidney dialysis. He plans to develop the small trial into a larger investigation, which eventually he hopes will help change how dialysis is performed in the United States.

People with chronic kidney disease in this country currently spend about a dozen hours a week hooked up to a machine that performs the job their kidneys can no longer do -- flushing out extra fluid and wastes.

But patients in France, Japan and Australia spend more time -- up to eight hours a day, three times a week -- undergoing dialysis. As a result, they are less likely to die of a heart attack or stroke, Fishbane and a growing number of kidney specialists say.

In some French centers, Fishbane added, patients receive dialysis overnight, sleeping through the eight-hour treatment. The longer, more frequent method of treatment, he said, results in lower blood viscosity and less damage to the cardiovascular system, and is more consistent with natural kidney function.

More than 350,000 people in the United States are on kidney dialysis, state Health Department statistics show. Fishbane and the National Kidney Foundation estimate about 20 percent of U.S. dialysis patients die annually, usually of heart disease or stroke. In France and Japan, the death rate is about half that, research from a 2009 Harvard University analysis showed.

Citing statistics from the United States Renal Data System in Minnesota, Fishbane estimates the number of people in need of kidney dialysis could rise to 500,000 over the next 20 years.

Medicare's End Stage Renal Disease Program finances 80 percent of each individual's dialysis costs. The program has existed since 1973 when the U.S. dialysis schedule was developed. Without dialysis, patients would die.

In 2009, the federal government paid $9.2 billion for dialysis, according to the Medicare Payment Advisory Commission's report released in March.

A growing number of doctors have been advocating for two less-expensive methods, which can increase treatment frequency while lowering costs: home hemodialysis and peritoneal dialysis, also performed at home. Either method, Fishbane said, can be done while patients sleep. Federal estimates show 8 percent of patients dialyze at home.

Most people on dialysis have chronic kidney disease, usually because of diabetes or high blood pressure, said Dr. Steven Walerstein, medical director of Nassau University Medical Center in East Meadow.

Although kidney transplants are an option, the need exceeds availability of organs.