As practicing clinicians in the United States, we generally feel privileged, with access to a highly developed and pioneering medical care system along with an advanced and cutting-edge technology in the world’s largest economy.
Many obese dialysis patients are asked to lose weight to qualify for kidney transplantation. If such usual weight reduction programs as dieting or anti-appetite medications do not work, some patients will be introduced to more aggressive interventions such as bariatric surgery.
Traditional nephrology training makes us believe that it is good practice to start maintenance dialysis therapy sooner rather than later. Nevertheless, recent data indicate that we may encounter yet another “old-practice-was-wrong” paradigm shift.
Many nephrologists feel increasingly bewildered by heightened discussion about the upcoming bundling system for dialysis patients. The dialysis industry is a unique and giant enterprise serving nearly a half million Americans with end-stage renal disease (ESRD).