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| Dr. Kam Kalantar, Professor of Medicine, UCLA |
"I also see enormous differences in the nephrology practice between us and them....While we are proud of using ACE inhibitors and angiotensin receptor blockers to slow the rate of chronic kidney disease progression, Taiwanese nephrologists implement half a dozen more interventions to this end, including low-protein diet reinforcement and monitoring, keto-analogues of amino acids, and charcoal derivatives to modulate uremic toxins. On the dialysis front, too, other countries appear to be ahead of us. In this country most of us have no clear idea what so-called “on-line hemofiltration” is, whereas in many other countries it has been practiced routinely in outpatient dialysis clinics for years. Our dialysis machines are outdated compared with those of some other nations. We do not allow our patients to eat during dialysis treatment, whereas meals are served routinely in many outpatient dialysis centers in other countries."
My response to Kam is that the US taking a more measured approach compared to Asian countries represents a strength not a weakness. After all, we have evolved from an era of norstrum and other so-called "magic cures" (e.g., see Warner's Kidney and Liver Cure ad) to a more organized marketplace of treatments that are backed by evidence. We should seek data from randomized trials wherever possible to support treatment recommendations rather than simply using interventions based on limited data and whims.
