As the web editor for NN&I, I spend a lot of time online reading what other people are writing about nephrology. This new bi-weekly summary is intended to highlight the important stories from and about the kidney care community and offer a place to analyze and discuss them, as well as dive deeper into some of the issues we are covering on our website and in the pages of our magazine. NN&I’s success as a resource is tied to information and feedback we get from members of the renal community, so please, use our site's commenting section to speak your mind, and always feel free to email me or our executive editor Mark Neumann.

CNN covers DaVita fraud case
On Nov. 29, CNN posted a video about a whistleblower lawsuit against DaVita that alleges the dialysis provider purposefully wasted the iron drug Venofer to bill Medicare for more vials. In the video the two whistleblowers, former DaVita clinic medical director Alon Vainer, MD, and former DaVita nurse Daniel Barbir, explain how they believe the company put protocols in place that told nurses to only use small doses from 100mg vials of Venofer, and throw away the rest. The suit alleges that DaVita made upwards of $800 million off of this practice.

The CNN video is a bit misleading, as it seems to imply that this case is a new one, when in fact it has been going on in one form or another since 2007. The New York Times covered it in July 2011.

If the allegations are true, it would be one of the largest cases of Medicare fraud in the country, a point Wolf Blitzer makes early on in the video. DaVita denies any wrongdoing and plans to fight the allegations. DaVita's Senior Director of Communications Skip Thurman told NN&I that every time less than a full vial was used, it was done so for clinical reasons, not for profit. Since the allegations were made, the FDA has banned using a single vial for more than one patient. Thurman said the federal government has already investigated these issues, and decided there was no wrongdoing. Bill Myers, a spokesman for DaVita, also told The New York Times that Medicare had approved their dosing plans. The federal government did decline to join the lawsuit, and Thurman said this points to a weakness in the case. But Pat Burns with the watchdog group Taxpayers Against Fraud told CNN he thought it pointed to the federal government's lack of resources.

It is not the first time a dialysis company has been accused of this kind of behavior. In fact DaVita settled a similar suit from Texas, this time involving the anemia drug Epogen, in July. Part of the rationale behind the ESRD payment bundle, which took effect in January 2010, was to prevent this kind of abuse; both of these cases involve drug dispensing when CMS was paying for drugs outside the bundle.

Blog highlights need for patient education
Last week NN&I covered a Temple University study that demonstrated decreased kidney function is associated with decreased global cognitive ability, abstract reasoning, and verbal memory. A dialysis patient blogger brought to my attention a blog post that talks about this very issue. The blog, DevonTexas, covers topics relevant to dialysis and CKD patients and helps fill the education void.

The post offers a glimpse of what is was like to have CKD and experience symptoms, but not really know the significance of what that means.

"By 2005, I was in some serious trouble but I still wasn’t aware of what was going on … I was constantly cold, perpetually tired, easily winded, my skin itched everywhere and, most importantly, I couldn’t concentrate and was often confused in my thinking which most affected my work as a computer programmer. I later discovered that this is due to the build up of toxins in the blood that my under-functioning kidneys were not removing."

It's a shame that someone could be experiencing symptoms this severe, and have a diagnosis, but still not have the tools to understand the significance of the disease.

"Too often people end up in kidney failure without knowing they were experiencing CKD,” the blogger writes. “I was 'fortunate' to know I was going through CKD but frankly, no one said a thing about what that meant. I, as a patient, was totally uninformed and, if anyone should know what the diagnosis meant, I should have. That’s why I started this blog. I want to inform people about kidney disease, CKD, and dialysis."

Can the kidney care community do more to help educate CKD patients as they progress through the disease?