title: Major difficulties the US nephrologist faces in providing adequate dialysis.
abstract: OBJECTIVE
  To identify the major difficulties nephrologists in the US face in providing adequate dialysis.
  
  
  METHODS
  To identify the perceived obstacles to achieving adequate dialysis in the US, 30 clinical support specialists responsible for nursing education and training were polled. Their responses together with those found in the recent literature were summarized and analyzed.
  
  
  RESULTS
  The obstacles identified fell into the following major categories: (1) economic; (2) personnel shortage; (3) education, and (4) cultural. The principal specific difficulties identified in providing adequate dialysis were the provision of sufficient time and frequency of dialysis, adequate volume control and vascular and peritoneal access.
  
  
  CONCLUSIONS
  The obstacles we currently face are serious but can be conquered through better understanding of the problems and education of professionals, patients and payers. The simple improvement in two specific areas, the creation of more native arteriovenous fistulae and growth of home dialysis, are identified as the highest priorities to overcome these obstacles.
authors.affiliation: Fresenius Medical Care North America, 95 Hayden Avenue, Lexington, MA 02420, USA. Jose.Diaz-Buxo@fmc-na.com
authors.forename: Jose A
authors.initials: JA
authors.lastname: Diaz-Buxo
authors.forename: Terri L
authors.initials: TL
authors.lastname: Crawford-Bonadio
mesh_terms: D019538:Health Care Surveys; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000628:therapy*; D006278:Medicare / Q000191:economics / Q000592:standards; D009398:Nephrology / Q000191:economics / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards; D006435:Renal Dialysis / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D014481:United States; D000078329:Workforce