Recent studies and surveys underscore need for better communication between doctors and kidney patients.

Nearly 50% of dialysis patients and their caregivers surveyed by the National Kidney Foundation said that their health care providers have less time for them now than in the past, and they would like to spend more time discussing their lab goals and progress with their health care team than they currently do. Although it is bad news that dialysis patients have less time with their health care providers, perhaps a result of changes in the way clinics are paid for their services, it is good to know that so many patients want to be more involved in their care. 

More and more studies have surfaced showing the risks associated with kidney failure and dialysis, and one of the best tools to combat these risks is patients' own knowledge of their disease and treatment. Patients should know how to interpret their lab values, and the steps they can take to reach lab goals. Of course there will always be some noncompliant patients, no matter how much education they are given about their disease and treatment. And lower reimbursement rates are not suddenly going to change. But it is unacceptable that patients who want to be involved in their care cannot get enough time with their health care team to properly do so. 

A New England Journal of Medicine study that shows the danger of the two-day dialysis break that goes along with conventional thrice-weekly sessions has gotten a lot of attention this week. Some patient advocates are calling for more frequent dialysis, but the response is generally the same: patients' preferences to dialyze less, and a strict payment system are barriers to more frequent care. CMS has made it clear that a randomized control trial is required to prove that more frequent dialysis is cost effective, so the payment barrier cannot be overcome easily, though it should not be ignored. But the patient barrier can be alleviated. And patients can take steps, like limiting fluids and following the proper diet, to make the two-day dialysis break less dangerous. Every dialysis clinic should make patient education a priority. If it was, we might see more patients adhering to their treatment protocol, wanting to stay in the chair longer, and maybe even want to start dialyzing at home.