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Details: Category: Concerns | Published: 28 August 2014 | Hits: 1768

Fact Sheet presented to Colorado state legislators in 2007 supporting the need for Hemodialysis Technician Certification

1.  From ’91 to ’01 expenditures for End Stage Renal Disease nearly tripled, while the number of patients only doubled – yet deaths were up 123%

www.usrds.org Annual Data Report 2003 pg 172, population up 106%, deaths up 123% from ’91 to ‘01 (I should add the for-profit companies – such as Davita – were taking over this area of medicine during this time period)

"In 1991 Medicare expenditures were $5.8 billion, and non-Medicare costs from heath plans and other coverage were $2.2 billion—a total, then, of $8.0 billion from all sources (see Figure p.6 on page 17). By 2001, costs of the program had reached $22.8 billion, almost triple the earlier level of expenditures"
2003 USRDS Annual Data Report


2.  Mortality rate for hemodialysis patients is the highest in the industrialized world:
“The cumulative survival of Japanese hemodialysis patients is more than 2.5 times better than that of dialysis patients in the United States (U.S.). The difference is particularly pronounced in older    patients, being 4 times better in patients over the age of 50 years. The mortality in U.S. patients has increased from 10 to 25% over the last three decades, but has remained stable at around 10%    in Japan.”


“Japanese physicians also appear to be better trained in dialysis and to spend more time with their patients. The nursing shortage in the United States may also contribute to the increased mortality.”

- http://www.blackwell-synergy.com/doi/abs/10.1046/j.1492-7535.2003.00008.x

 

"There is no obvious difference in patient selection.  The Japanese accept almost as high a proportion of diabetic patients as does the United States, and the mean age of incident patients is higher in Japan."

http://www.ncbi.nlm.nih.gov/pubmed/19379344?dopt=Abstract

(above articles by Dr. Christopher Blagg – former Executive Director of Northwest Kidney Centers, where modern dialysis began – and Dr. Carl Kjellstrand – winner of a lifetime achievement award in hemodialysis)


“Gross mortality as a simple percent has been quoted by many investigators as being 24 percent in    the U.S., 12–14 percent in Europe, and 9 percent in Japan.” – USRDS 2006 ADR pg. 129

3,  Infection rates for this field of medicine have skyrocketed – USRDS 2006 ADR

vascular infections

Blue line is Hemodialysis vascular access infections
2006 ADR pg. 24 graph

Since 1993:
Pneumonia – up 12%
Cellulitis – up 20%
Bacteremia/septicemia – up 16%
2006 ADR pg. 130



Since 1991:
children age 10–19, mortality due to infection – up 19%
(children age 10–19, cardiovascular mortality – up 62%)
2006 ADR pg. 160

4.  Patients’ overwhelming complaint according to Colorado’s Department of Regulatory Agencies are needle sticks with the complication of infilitration (a needle can be inserted in one part of a vein and come out internally and possibly ruin an access – a person has only a limited number of accesses)

“In my many presentations to both the (Arizona) House and Senate, I brought along a pair of 14 & 15 gauge dialysis needles to permit the Health Committee Members (usually 10-14 individuals on each panel) to "physically see and touch" both the size and length of the dialysis needles, thus they would truly get a first-hand look to knew we were not talking about pin-size sewing needles. The goal was to allow each member to realize these needles were capable of causing death if used incorrectly and the only way to prevent injury or death was to have stringent and effective rules/laws in place to govern same.”

Dale Ester - person dealing with ESRD - testimony for Arizona   
SB1304 - bill for dialysis technician licensing

5. 25-50% of hospitalizations of hemodialysis patients are due to vascular access problems:

“About 25 to 50 percent of all hemodialysis patient admissions and hospital days are attributable to vascular access placement and related complications, contributing over $1 billion to total    Medicare inpatient costs annually”  Federal Center for Medicare and Medicaid Services press release, March 17, 2005

6.  Techs work under an RN’s license making the recruiting of RNs difficult for this field of medicine

“Techs who do not have adequate training have caused the death of patients.  In    states that do not    have tech licensing, the techs work under the RN license and  that puts the RN at risk of losing their license for a tech mistake. Hence many RN's do not want to work in a unit where the techs are putting the RN license on the line.  I sure don't!” Founding RN, DialysisEthics

7. Regulations promulgated by the Colorado Department of Health and Environment require one RN with at least one year of experience in the area of dialysis, to be in attendance in all certified dialysis facilities during operating hours. Due to the nursing shortage RNs with NO dialysis experience are many times in attendance.

8. Things that can go wrong with patients’ treatments:
•   Low potassium causing cardiac arrest
•   Needle infiltrations causing loss of current treatment and possible loss of access
•   Reused kidney filters not checked for cleaning fluid causing severe hemolosis and death
•   Blood not rinsed back to patient before going to the bathroom, patient can die
•   Water cultures not checked, patients become ill and require hospitalization
•   Figure for fluid removal calculated wrong - severe cramping can happen (seen described as worse than childbirth) or not enough fluid is removed and the patient ends up in the hospital in CHF

9.  According to the Department of Regulatory Agencies Hemodialysis Technicians starting pay is around $10.00 per hour
•   Radiological Technicians earn $22.77 per hour
•   Respiratory Therapy Technicians earn $19.08 per hour
http://www.dora.state.co.us/opr/archive/2006HemodialysisTechnicians.pdf  pg. 8

10. 2980 Dialysis Patients in Colorado
USRDS 2006 REF_06 Table J.12


quotes:

"From 1991 to 2001, the prevalent ESRD population
grew 106 percent, the total number of deaths 123 percent,"
2003 USRDS Annual Data Report

"In 1991 Medicare expenditures were $5.8 billion, and
non-Medicare costs from heath plans and other coverage were $2.2 billion—a total, then, of $8.0 billion from all sources (see Figure p.6 on page 17). By 2001, costs of the program had reached $22.8 billion, almost triple the earlier level of expenditures"
2003 USRDS Annual Data Report