[Financial incentives and dialysis]

Chronic renal replacement therapy by hemodialysis costs 55,000 Euros per year and constitutes the upper limit of a cost-effective treatment. Since reimbursement for dialysis is high, every patient who is in need of it will receive dialysis. Nephrology outside the hospital, however, is moving into a progress trap. Financial incentives tempt physicians to avoid complex or delicate treatments such as immunosuppression of IgA nephritis. The decision to forgo or withdraw dialysis and the referral to kidney transplantation conflict with the nephrologists' economic interests. High-tech medicine needs a shift in thinking since not all medically possible diagnostic and therapeutic procedures can be financed anymore. The costs urge to do more for prevention and treatment of kidney disease. Alternative possibilities to extend the cost-effective kidney transplantation should be discussed without moral rigorism. Since it is in competition with other cost-intensive disciplines, it is hard for nephrologists to start with the required mind-changing process.