Bandages will not fix a fractured system of chronic kidney disease care: Why the Dialysis PATIENTS Demonstration Act cannot be supported by the transplant community

The Dialysis PATIENTS Demonstration Act (DPDA) was introduced in September 2016 to improve care co-ordination and reduce hospitalization in the US dialysis population. The DPDA proposes a dialysis focused integrated care model where dialysis providers administer all care to dialysis patients enrolled in this model. Opposition to the bill raises concerns about reduced access to transplantation as there are financial disincentives to refer patients to transplant in this model, amongst other limitations. Drs. Gill and Wiseman address these limitations and propose the need for comprehensive, patient centred models that incorporate improved CKD care and timely consideration of transplantation to improve health outcomes and cost savings.