Kalantar-Zadeh, a member of the Dialysis Advisory Group for the American Society of Nephrology, says that at his two centers, which provide dialysis treatment to about 300 patients, those who have higher protein intake and higher serum albumin levels tend to live longer. That seems to make the most difference, he says.
That's not inconsistent with the Spiegel study, he adds. "If you have better interaction between the physicians and staff with the patients, and more dieticians counseling the patients, you may see better nutritional status," Kalantar-Zadeh says. "Patients who say 'my appetite is good' tend to be happier and live longer."
Also at his center, he says, patients are advised to be on dialysis a bit longer, usually 4 to 4.5 hours, instead of the usual 3.5.
It's obvious that the federal government wants to get a better handle on costs and quality with ESRD centers. On July 30, it announced a new bundled payment system for all renal dialysis services.
Since this disease represents such an enormous burden on hospitals, physicians, and Uncle Sam, not to mention the patients who are dying, it's well worth the effort to figure out what may be working.