Continuity

The treatment of chronic kidney disease is a medical success story that Fresenius Medical Care has contributed to substantially in the past few decades through new and improved treatment methods, innovative technologies, and a global network of dialysis centers. But new challenges are always around the corner. Continuously enhancing therapies, technical possibilities and the infrastructure remains a huge task.

Two long-serving employees and a clinician and scientist from Fresenius Medical Care, a nurse, and a dialysis patient share their personal experience and tell us what they see as the greatest advances in the past and the main goals for the future.

Continuity

What’s the first thing that comes into your
head when you hear the word “dialysis”?

Prof. Bernard Canaud

Nephrologist, Chairman of the EMEALA Medical Board,
Fresenius Medical Care

“Dialysis” immediately implies to me the most successful life-sustaining therapy in the field of medicine. Today, more than 2.2 million patients owe their survival to well-established dialysis treatment modalities.

Martina Heumann

Dialysis patient

What first comes to my mind is being dependent on a machine. And then, of course, the restrictions on my lifestyle. It is a big change in life that requires a lot of support, also on a personal level. It is especially important to have your partner behind you.

Gunther Klotz

Executive Vice President Central Europe,
Fresenius Medical Care

At Fresenius Medical Care, we have always made every effort to put the patient first. That’s why the first thing that comes into my head is the large and ever-growing number of dialysis patients who need constant intensive medical care in order to survive. But it also makes me think about the 19 years I have spent working for the Company. In this time, we have launched numerous projects to improve the care of dialysis patients.

Wolfgang Wehmeyer

Senior Vice President International Marketing & Medicine,
Fresenius Medical Care

We can’t cure with dialysis. All we can do is preserve life. That is a big difference compared to many other areas of medicine. Once patients lose their kidney function, it cannot be restored. Unless we dialyze, the patients will die within a few days. That is a pretty big psychological strain for patients. They generally regard time on a dialysis machine as lost time. The more strain dialysis puts on them, the more important the time between therapy sessions is. Quality of life moves into focus. We have to ask ourselves, what can we at Fresenius Medical Care do to help here?

Jürgen F. Martin

Nursing manager, Bensheim & Bürstadt Center
for Kidney and Hypertension Disorders

Dialysis is an effective treatment for prolonging the lives of our patients. For younger patients, it can bridge the gap until they get a transplant, whereas for older patients, dialysis usually means treatment for the rest of their lives.

Gunther Klotz

Executive Vice President Central Europe,
Fresenius Medical Care

Prof. Bernard Canaud

Nephrologist, Chairman of the EMEALA Medical Board,
Fresenius Medical Care

Jürgen F. Martin

Nursing manager, Bensheim & Bürstadt Center
for Kidney and Hypertension Disorders

Martina Heumann

Dialysis patient

Wolfgang Wehmeyer

Senior Vice President International Marketing & Medicine,
Fresenius Medical Care

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Looking back at your personal
experience with dialysis,
what has changed the most?

Wolfgang Wehmeyer

Senior Vice President International Marketing & Medicine,
Fresenius Medical Care

The most important change for me is that international quality standards have been introduced. As a result, the quality of dialysis has increased worldwide on a broad basis. In addition, innovative therapy methods such as hemodiafiltration (HDF) have been introduced that have been a key factor in reducing the strain of dialysis on patients.

Jürgen F. Martin

Nursing manager, Bensheim & Bürstadt Center
for Kidney and Hypertension Disorders

I started working in the dialysis sector 22 years ago. I’m now experiencing the fourth generation of dialysis machines. There have been huge advances in their development over the years. The treatment methods have improved, such as automatic blood-pressure measurement and blood-volume measurement. The latest dialysis machines now automatically detect dangers and warn users, which was rarely the case before. This is a big improvement in the safety and effectiveness of dialysis treatment to the benefit of our patients, who can be treated more individually.

Prof. Bernard Canaud

Nephrologist, Chairman of the EMEALA Medical Board,
Fresenius Medical Care

Dialysis has continuously evolved and is now standard in the field of renal replacement therapy. Looking back on my work in the 1960s, dialysis was largely experimental, but the treatment has progressed towards now being very much part of routine clinical practice. Dialysis has not only become more efficient but also significantly more reliable and much better tolerated due to decisive advances in technology. Importantly, the life expectancy of patients has also increased substantially. Furthermore, a major breakthrough around 20 years ago was the use of drugs to treat anemia, which afflicts many dialysis patients.

Gunther Klotz

Executive Vice President Central Europe,
Fresenius Medical Care

The most important thing is that the quality of treatment has improved. In hemodialysis, for example, open-pore high-flux membranes are now the standard. Their filtration characteristics are similar to those of a kidney. The membranes used are more biocompatible, especially those made of polysulfone. Fresenius Medical Care was one of the driving forces behind the use of these membranes. The major technical advances in the last two decades have led to the availability of peritoneal dialysis, an alternative, effective and safe renal replacement method that has significantly increased the range of dialysis treatment options. Our Company has steadily evolved, too. For example, there always have been – and still are – new challenges that make it exciting and interesting to work here. This is certainly one reason for the low staff turnover rate. For instance, there are still lots of employees here who I have known since I started working here 19 years ago.

Martina Heumann

Dialysis patient

I first started dialysis in 1983. Back then, we were instructed on how to help set up and dismantle the machine, and afterwards we had to wash everything and clear away the bed. It was very strict and impersonal. There was no conversation at all. We were not allowed to go into the treatment room in street clothes, so I always had to get changed first. It was a very difficult time for me. I had major problems with my circulation. When I got home after treatment, I couldn’t manage the stairs to the first floor without stopping. Things are different now. I feel less stressed, I’ve got more energy and suffer fewer side-effects. Also, everything is much friendlier these days. I can talk to the doctors, which matters a lot to me.

If you had one wish, in what specific
area would you like to see progress being
made in the treatment of kidney disease?

Gunther Klotz

Executive Vice President Central Europe,
Fresenius Medical Care

The actual dialysis technology is very sophisticated nowadays. If I were a patient, I would wish for easy, safe, and pain-free vascular access. That still has not been solved yet. Usually, to obtain vascular access in patients, we have to use thick dialysis needles that enable a blood flow of up to 400 ml per minute. This is extremely unpleasant for patients. And it also puts a psychological strain on them, as problems with the access can be life-threatening.

Wolfgang Wehmeyer

Senior Vice President International Marketing & Medicine,
Fresenius Medical Care

I would welcome every extra hour that patients get to themselves. We cannot reduce the actual dialysis time any further, but we can cut down the time before and after dialysis. To do this, we need to move the treatment closer to the patient. All aspects of renal replacement therapy have been created for a hospital environment. The technology is designed for use by specialist staff. Although there are dialysis machines with simplified operating functions, the entire system still needs to be easier for patients to use themselves. That is a technical challenge. It is a matter of incorporating dialysis staff’s specialist knowledge into the development of the machine, also with regard to emergency situations.

Martina Heumann

Dialysis patient

Over the years, you learn to be content with what you have. After all, dialysis means living. I can grow old on it if I follow the rules. That makes it different to other severe illnesses. But sometimes, I do wish I could have a slightly better quality of life. For example, I would love to go swimming again. And of course, I hope that research continues making improvements for patients.

Prof. Bernard Canaud

Nephrologist, Chairman of the EMEALA Medical Board,
Fresenius Medical Care

Ever since my early days of treating patients with endstage renal failure, I realized that these patients had a clear need to thrive, and not just to survive. As a doctor, I dream of changing the fortunes of renal patients suffering from a devastating and life-long disease. Therefore my particular wish would be: firstly, to detect signs of kidney disease even earlier to prevent kidney deterioration; secondly, to develop new therapy approaches for combatting uremic toxicity; and finally, to enhance immunotolerance of kidney transplants and make advances towards finding a cure with methods such as regenerative medicine.

Jürgen F. Martin

Nursing manager, Bensheim & Bürstadt Center
for Kidney and Hypertension Disorders

Vascular access is a major topic for dialysis patients. We are treating increasingly older patients whose blood vessels are in poor condition. I would hope for progress to be made here. Everything else has already steadily improved.

Dialysis treatment is regarded
as being technically matured and reliable.
Even so, are there any areas in which
you expect further progress to be made?

Wolfgang Wehmeyer

Senior Vice President International Marketing & Medicine,
Fresenius Medical Care

We are only at the beginning in terms of research and development. The kidney is our role model. So far, we have only invented individual components and tried to minimize their side-effects. However, a real artificial organ only works if there is a connection between these elements. The next major step would be to close this loop so that it works without any external assistance, as is the case with the kidney. That is still some way off, but we are making progress in all areas and are learning to bundle this knowledge. This is the future: How can we link all information to ultimately create an artificial organ? Information technology is a particularly important factor in this process, especially in terms of assessing individual patient data and linking it up with the reference data documented in the scientific field.

Prof. Bernard Canaud

Nephrologist, Chairman of the EMEALA Medical Board,
Fresenius Medical Care

Currently, dialysis therapies cannot mimic the natural kidney. In future, innovative technologies will facilitate the implementation of applications including integrated monitoring and feedback systems particularly for the treatment of sicker and more fragile patients. Simultaneously, advances are required in drug and concomitant therapies.

Jürgen F. Martin

Nursing manager, Bensheim & Bürstadt Center
for Kidney and Hypertension Disorders

Our patients who are increasingly older and extremely ill are a major challenge for the nursing staff. These patients often suffer from many secondary diseases such as diabetes and all the associated complications. This has to be taken into account when fitting out a dialysis center. The requirements have been fulfilled extremely well at our new center in Bürstadt. The patients are aware of this and feel very much at ease.

Gunther Klotz

Executive Vice President Central Europe,
Fresenius Medical Caree

State-of-the-art, highly efficient and patient-friendly technology is still used all too rarely. Take hemodiafiltration, for example. Worldwide, there are still many suitable patients who are not being treated with this very effective method. Many people still have the impression that the necessary technology is expensive and cumbersome. This has not been the case for a long time. We need to communicate this even more clearly.

Where do you see the biggest
challenge in the treatment of kidney disease
in the next few years?

Gunther Klotz

Executive Vice President Central Europe,
Fresenius Medical Care

One of the biggest challenges of our aging society is to ensure that the growing demand for healthcare services remains affordable overall. With greater public awareness, kidney disease could be detected at an earlier stage, thus delaying the use of renal replacement methods. At the same time, renal replacement therapy ought to be structured in such a way that all patients in the world in need can have access to suitable treatment.

Prof. Bernard Canaud

Nephrologist, Chairman of the EMEALA Medical Board,
Fresenius Medical Care

The greatest challenges are of a social and economic nature. Social, because kidney disease is constantly increasing in an aging society. In fact, kidney failure is a widespread and exponentially growing disease that is putting a strain on healthcare systems – and not just in economic terms. Different approaches should be developed to ensure access to dialysis treatments despite this. These should include integrated services and nursing approaches as well as more effective self-treatment options.

Wolfgang Wehmeyer

Senior Vice President International Marketing & Medicine,
Fresenius Medical Care

The biggest challenge are the patients who are not yet on dialysis. By no means all patients with end-stage renal disease around the world are being treated. Many people die because the right care is not available to them. The best quality is worthless if it doesn’t reach the patients. The aim must be complete care for everyone worldwide. With our innovative strength, we should be able to provide this from an economic and organizational viewpoint.

Jürgen F. Martin

Nursing manager, Bensheim & Bürstadt Center
for Kidney and Hypertension Disorders

When treating a large number of elderly and very ill patients, we must ensure that the equipment and care they receive are appropriate. These days, employees need to be trained in aspects that were not an issue ten years ago because there were not so many very old, in some cases even demented, patients. Another point is that more and more patients come from hospitals with multi-resistant bacteria and have to be isolated. This must be taken into account when planning new centers, primarily in the form of special isolation areas. Conservation of resources is another challenge: Waste prevention is a big issue in dialysis. The latest generation of machines already uses less electricity and water. These are savings that don’t impact the treatment quality, yet help to lower costs.

Martina Heumann

Dialysis patient

I find that early detection of diabetes and precautionary monitoring of kidney levels are important. People should think about adopting a healthier lifestyle, as kidney failure is often also a lifestyle illness.

Where do you see dialysis in ten
years’ time? And what will
be Fresenius Medical Care’s role?

Gunther Klotz

Executive Vice President Central Europe,
Fresenius Medical Care

In dialysis, as in many areas of medicine, high treatment quality helps to avoid unnecessary costs. High-quality dialysis prevents complications during and after dialysis and leads to fewer concomitant diseases. Dialysis providers should not be paid solely for performing dialysis, but also for the outcomes. This is best done with flat-rate reimbursement, where dialysis providers have to pay all costs associated with dialysis. We must work harder to convey this message to health insurance companies.

Jürgen F. Martin

Nursing manager, Bensheim & Bürstadt Center
for Kidney and Hypertension Disorders

I hope that dialysis will become even more individual because the machines can gather and evaluate even more information on the patient. This would make it possible to identify the best treatment method and correct settings for every single patient and translate them into suggestions for individual treatment.

Wolfgang Wehmeyer

Senior Vice President International Marketing & Medicine,
Fresenius Medical Care

In future, dialysis will increasingly come to the patient rather than the other way round. This does not mean that the therapy will necessarily move into the living room, but it will be carried out more locally, for example where elderly people live.

Prof. Bernard Canaud

Nephrologist, Chairman of the EMEALA Medical Board,
Fresenius Medical Care

Dialysis in the next decade will see an ongoing increase in the age and sickness levels of patients treated. Patients for whom a transplant is not an option need high-quality technologies and particularly intensive care in conjunction with their therapy. By offering dialysis products and services from a single experienced source, guided by a holistic philosophy, we at Fresenius Medical Care can play a key part in covering the complete lifecycle of kidney failure patients.

Martina Heumann

Dialysis patient

Perhaps it will be possible to reduce the dialysis time after all. For younger patients, there should be more services like peritoneal dialysis or overnight dialysis. However, patients also need to look into this themselves.