PRE-DIALYSIS EDUCATION

To educate kidney disease patients about dialysis and transplant options prior to complete loss of kidney function, and to help them manage co-morbidities and to prepare for the financial and emotional issues associated with kidney failure. 

 

Over 475,000 Americans have complete, irreversible kidney failure (end-stage renal disease) and need dialysis or a transplant to survive.  Once kidney failure occurs, most patients qualify for Medicare coverage regardless of age or disability.  Dialysis and transplantation are costly treatments.  Only 1% of the Medicare population has end-stage kidney failure, but they account for 7% of total Medicare costs, according to the U.S. Renal Data System.   

 

The National Kidney Foundation (NKF) maintains that both the complications and costs of kidney disease can be reduced if appropriate education is provided before dialysis begins or transplantation occurs.  Most kidney patients do not receive training and information on dialysis or transplantation prior to the complete loss of kidney function.  Current Medicare regulations do not require or reimburse education on treatment options until a patient is receiving dialysis.

 

A goal of the Surgeon General’s Healthy People 2010 initiative is to increase the proportion of chronic kidney patients who receive counseling on nutrition, treatment choices and cardiovascular care 12 months prior to the start of dialysis.

 

NKF is requesting that Congress establish a Medicare pre-dialysis education benefit.  About half of all new kidney patients have Medicare status (due to age or disability) prior to receiving dialysis or a transplant, and would qualify for the education benefit.  Pre-dialysis education would include a maximum of six sessions, reimbursed by Medicare, and would cover the following:
 

• an overview of kidney function, including complications associated with declining kidney function (anemia and bone disease), and the risks of diabetes and heart disease;
• a review of transplant and dialysis options, including a discussion of vascular access alternatives for dialysis, whether to go on the transplant waiting list, and identifying a living kidney donor; and
• other issues specific to the needs of the patient such as economic issues, payments for treatment, insurance, nutrition and coping skills.

 

Bills have been introduced by Sen. Blanche Lincoln (D-AR) and Susan Collins (R-ME) (S.432) and Rep. Mark Kirk (R-IL) and Jim McDermott (D-WA) (H.R. 1245) to establish a pre-dialysis education benefit.  In addition, the Kidney Care Quality and Education Act of 2007 (S.691; H.R.1193) includes a provision for a similar Medicare pre-dialysis education benefit.