PETER LUNDIN

Participants in this panel included: Mary Demick, Silver Spring, Maryland, end-stage renal disease (ESRD) since 1973. While working for the Federal Government, she experienced all forms of ESRD treatment and now has a new transplant. Michael Demick, Silver Spring, Maryland, ESRD since 1981. A schoolteacher, he has had three transplants, the last functioning for 13 years. He has also experienced peritoneal dialysis and conventional hemodialysis (HD). Dale Ester, Glendale, Arizona, ESRD since 1991. Patient advocate and volunteer, he has produced websites for patient education and mutual benefit. He currently has a transplant. Kris Robinson, Tampa, Florida, ESRD since 1987. She is the Executive Director of the American Association of Kidney Patients (AAKP) and was on peritoneal dialysis before receiving a kidney from her father.

George Harper, Rome, Georgia, has had ESRD since 1980. A home HD patient, he arranged the panel but was unable to attend because he was testify-ing at the State Senate. Peter Lundin, Brooklyn, New York, moderated the panel. He has had ESRD since 1966. A nephrologist and past president of AAKP, he had a kidney transplant for more than 5 years and has now returned to conventional HD.

The panelists all agreed that control of treatment was most important to them and a matter of survival. They also want-ed to be sure that all treatment options were available to them, including daily dialysis. The panel uniformly recognized the importance of getting enough dialysis treatment in order to feel well. They would like to feel at least as well on dialy-sis as they do with their transplants, and would be willing to accept longer and more frequent dialysis treatments if that is what is required. Patients who value good health and long life should seek the treatment that best secures them.

Peter Lundin added several issues about which patients’ concerns might have to be assuaged. He raised more questions about areas of patient concern than answers on how to persuade patients to try longer or daily therapies:

	Time/frequency of treatment: What else in one’s life would one have to give up to spend more time on dialysis? Does a patient feel it necessary to have intermittent breaks from the dialysis routine? Machine utility is an important component. It is a question of lifestyle. Some patients will be on dialysis for the rest of their lives.
	Access: What risk does more frequent dialysis impose for access damage or loss? This is a long-term problem. Successful use of catheters, fistulas, and grafts for daily dialysis on a short-term basis (2 – 3 years) has been demonstrated. Catheters are not without risks for blood vessel damage and infection. The survival of fistulas and grafts could be foreshortened by frequent use. What about those who most fear needle sticks?
	Overdialysis: Daily dialysis is said to provide a more normal internal (physiologic) milieu for dialysis patients; however, dialysis does not provide a reabsorptive function for essential blood elements. Could there be excess removal, especially with long nocturnal dialysis?
	Bioincompatibility: No dialysis membrane is perfectly biocompatible. There are complications of bioincompatibility to dialysis patients. Will better removal of beta-2- microglobulin delay amyloid accumulation, or will amyloidosis develop faster if stimulated produc-tion is further increased? Will immune function improve with more-frequent dialysis, or be dam-aged by more-frequent exposure to artificial membranes?

The panelists, as knowledgeable, long-term consumers of ESRD care, uniformly expressed a desire to dialyze daily should the need arise.

During discussion, those who made comments and asked questions were all enthusiastic advocates of daily dialysis.