Why does the U.S rank last in kidney care? It may come as a surprise to many kidney patients but the United States has fallen behind the industrialized world when it comes to care for those suffering from kidney failure. This country is ranked LAST among seven industrialized nations for dialysis outcomes. The first year mortality rate for Americans is much too high at 22 percent compared to 16 percent in Europe and only 9 percent in Japan.

What does this mean to you and me when we enter a dialysis unit and what is AAKP doing about it? Kidney care today is where the nursing home industry was 20 years ago and the uneven quality in kidney treatment and dialysis centers is comparable to the unacceptable conditions seen in nursing homes in the 1980s.

This is why AAKP has put Quality Improvement as its number one public policy issue this year. AAKP supports measures that will increase the quality of health and quality of life for over 20 million Americans living with kidney disease. With these thoughts in mind AAKP strongly supports the following:

DIALYSIS CENTER ISSUES – There is a large variation in the quality of care provided at dialysis centers across the country. In some cases, staff are unlicensed and inadequately trained and no registered nurse in on the premises. Congress should call for a GAO study to document the variations in standards of care, licensing of staff, training and availability of registered nurses, dieticians, social workers, etc. Increased composite rates should be directly related to patient health outcomes. For after all, “Quality is Job One” when it comes to our care!

FISTULA FIRST – Although AV fistula access has twice the success rate of other graft accesses, it is only used for a small percentage of the time. AAKP strongly supports CMS’ “Fistula First” initiative. However, Medicare coverage does not begin until a patient is at end stage renal disease and AV fistulas should have been placed months earlier. AAKP believes Medicare coverage should be allowed for fisulae before ESRD eligibility.

QUALITY OF LIFE – The experience of other countries shows that several other factors in addition to just “cleaning blood,” such as treating depression, are critical to enhancing the quality of life for kidney patients. CMS needs to design and emphasize the importance of Quality of Life clinical measures as part of renal replacement therapy.

HOME DIALYSIS – Some patients prefer and have better health outcomes by receiving home dialysis. A Medicare demonstration project extending coverage to home dialysis could document the better clinical outcomes that often result from home dialysis and pave the way for increased payment for this treatment option.

In addition to these issues surrounding quality improvement for dialysis patients, AAKP has two other public policy issues on its agenda this year. They include:

LIFETIME COVERAGE OF IMMUNOSUPPRESSIVE DRUGS – Medicare coverage should be provided for the life of a kidney transplant to reduce the number of graft failures and reduce the need for dialysis and re-transplant. No one should loose their kidney because they cannot afford their medications.

STUDY INCENTIVES FOR ORGAN DONATIONS – AAKP supports modernizing incentives to meet the needs of kidney patients. We want Health and Human Services to conduct a study of the feasibility of financial incentives (such as travel expenses for donors) to increase the number of organ donations.

There is much to be done on behalf of fellow patients and our year will be busy. However, with your support, your voice and your help we can get much accomplished. All kidney patients deserve to have a good quality of health and life. Together we can make a difference in patients' outcomes.