Nocturnal Dialysis- Dr. John Agar-Chief Medical Director-Barwon Clinics-Australia

Trauma Columnist · Feb 19, 2012

In my practice I do discuss nocturnal dialysis but it is not available in my area.

NDXUFan · Feb 19, 2012

In my practice I do discuss nocturnal dialysis but it is not available in my area.

I was not trying to mean, I was just saying it is a much better option than conventional dialysis. I am very happy that you do discuss Nocturnal Dialysis, that means you are a good Nurse. :) You are right, it is not available in many areas and that is a shame. It would be much better for the people on dialysis and it would hold down costs.

merlee · Feb 19, 2012

I just don't get it. When I started dialysis nursing in 1981, there were a variety of modalities available. I believe that MDs set the standard and the MDs who are strong enough to leave their ego out of it will make sure that modalities that are patient-driven, such as PD and home hemo, are available to every patient who is appropriate.

Even 30 years ago, it was obvious that some well-educated, confident families opted for PD and home-hemo. When I briefly worked in an out-pt unit in 1994, I was dismayed to find that many were discouraged from these options because of vague and misleading info.

In many cases, those that did home modalities had much better lives overall. And that is without benefit of years of research.

If only we could keep the doc's egos out of the treatment decision.

Trauma Columnist · Feb 20, 2012

Merlee - I politely disagree with you. The physician's egos have nothing to do with it - its all about what is reimbursed. Medicare is who sets the standard that the physicians must follow.

NDXUFan · Feb 20, 2012

Merlee, many Nephrologists DO encourage home dialysis because they know and realize it will be much, much better for the patient. Medicare(Taxpayers) would save a fortune with Nocturnal and Home Nocturnal Dialysis. I know that some on here believe that I think dialysis should be an auto-disability, not so. With Nocturnal dialysis, many or the majority of patients would be able to work. :) With being able to work, they would be able to obtain private employer health insurance. :) The patient and the clinic would have a win-win situation. With the majority of dialysis patients able to work and obtain private employer health insurance, this would allow those more mature folks who could not work, to be able to have Nocturnal Dialysis, because the vast majority of individuals on dialysis would be able to pay with private insurance, a win-win. :)

BelgianRN · Feb 21, 2012

There was some talk a few years back to start nocturnal dialysis in our ICU's so that during the day patients could come out of bed and get diagnostic measures done without having to wait for dialysis to be over or dialysis halted early because of test "XYZ" and generally they are too tired afterwards. But in the end it was blown off because of the added cost for personnel due to the night shift bonus for the dialysis RN and resistance from the team of RN's that didn't want to do night shifts regularly.

NDXUFan · Feb 22, 2012

I guess the patient does not come first.

Trauma Columnist · Feb 22, 2012

NDXUFan - I do respectfully disagree that the patient's don't come first. Dialysis is expensive care. Like other care (think transplants, cancer care, care for premature infants) it is a drain on an already overloaded system.

madwife2002, BSN, RN · Feb 22, 2012

I disagree too-the patients do come first in my company, yeah we want to break even and maybe make a profit so we can grow. However everything we do is to improve the quality of patient care, provide great dialysis and improve outcomes.

I do believe that the government has the best intentions in paying more to dialysis units for better outcomes, however they do not realize that some of their schemes can prevent quality care being given.

Nocturnal dialysis is being discussed at great length in my company-unfortunately it is the patients who are not interested in it as they want to be home with their family and those who work come in on the late shift

NDXUFan · Feb 23, 2012

We agree, dialysis is very, very expensive care. I guess what I do not understand why transplants are not really being pushed. The cost of a transplant is on average $18,000 per year and the cost of In-Center dialysis is $70,000 per year. I am not sure why the medical establishment would have such a hissy fit if the donor made money. Having worked in a public assistance building, they claim that people will take advantage of the poor, that is always a big excuse, however, you can give the donor many things, besides cash. Scholarships for tuition at a 2 year community college(Think community colleges are a great resource), tax-free earnings, free health care, and on and on. The hospitals are making a good or great profit from kidney transplants, not sure why they are so obsessed with other people making people. Yes, profit is not a dirty word and they are entitled to make money, not a Marxist. Socialism has never and will never work in any society. Costs would come down if we had a free medical market, not the current socialist market. It was estimated that you could pay a donor $95,000 for a kidney transplant and still come out ahead(Wall Street Journal). It is also estimated that we will save $10-$15K per year per patient, with the new technology coming down the pike, along with transplants without immune system suppressing medications(Stanford) or Massachusetts General Hospital(Boston).

If Nocturnal at night is available and they do not take it, crap on them. Sometimes, you have to do things in life, you just do not like, I would be the first one in the door.