Whether an increased likelihood of inadequate hemodialysis results in a higher mortality rate for heavier patients than for smaller patients is mere conjecture at this time, but it is worth noting that the mortality rate for women receiving hemodialysis is lower than that for men. End-stage renal disease is the only major disease for which the cost of care is funded by the government, and the acceptance criteria consist of diagnosis alone. Reimbursement from Medicare for hemodialysis has decreased while labor costs have escalated. Furthermore, in the United States, reimbursement for hemodialysis is given per session of hemodialysis. The end-stage renal disease program may illustrate some of the potential problems with switching patients who have chronic illnesses to programs that reimburse by capitation.
Further research is needed to establish the role of economics in inadequate hemodialysis.
Moreover, most hemodialysis in the United States is now being provided by for-profit corporations, and this trend is accelerating. Our findings underscore the need to individualize hemodialysis prescriptions so that they account for body mass as an important variable. Glomerular number and size in relation to age, kidney weight, and body surface in normal man. Walter F, Addis T. Organ work and organ weight. J Exp Med.