Mortality and Duration of Hemodialysis Treatment-Reply

In Reply.— Qureshi's letter raises the issue of dialysis time per week as well as per session, given that not all patients undergo dialysis three times a week. Our data could not control for actual perweek durations. Still, dialysis other than three times a week is rare ( 5 More important, the data indicate that patients in each of our treatment-time groupings (short, conventional, and long) typically received similar numbers of treatments per week. Specifically, the means and medians of Medicare dialysis payments per period are almost identical across the groups, and payment closely correlates with the number of treatments in our data, given that the "composite rate" is prospectively fixed per treatment. Dialysis is provided by physician prescription. If a prescription or its fulfillment is inadequate, the only person who can change that is the patient's physician. The complex relationship between the attending nephrologist and facility management requires further