Is Fresenius Subjecting Patients in the United States to Dangerously High-Speed Dialysis Treatments?

On May 4, the Frankfurter Rundschau published an article, “Fresenius Medical Care: Blutwäsche im Schnelldurchlauf?”, which raises serious questions about the dialysis treatment practices used by Fresenius Medical Care (FMC) in the United States. The article is based on research done by the US trade union SEIU – United Healthcare Workers West (SEIU-UHW). Using publicly available data obtained from official sources and directly from patients, the union accuses the German medical group FMC of subjecting its patients to millions of dangerously high-speed dialysis treatments, which leaves them more susceptible to negative health outcomes, including cardiac events and death.

The speed at which fluid is removed from the body through dialysis is called the ultrafiltration rate (UFR). UFR is measured as the amount of fluid removed during dialysis (ml) divided by the dialysis treatment time (h) and the patient’s weight (kg). Studies have shown a significant association between a UFR > 10 ml/h/kg and increased mortality risk, even stronger effects were found at UFR > 13 ml/h/kg[1]. An analysis by SEIU-UHW estimates that the UFR exceeded 13 ml/h/kg for millions of treatments at FMC facilities in the US. Between 2016 and 2019 alone, SEIU-UHW estimates that more than eight million treatments at FMC clinics in the USA had a UFR above 13 ml/h/kg.

The Fresenius Global Union Alliance is shocked by these findings. Even worse is the fact that the company has been aware of the risk since at least 2011. SEIU-UHW points to an internal Fresenius memo addressed to the medical directors of its dialysis centers which highlights the connection between a shorter treatment time, a high UFR and the associated increased risk of mortality.  Fresenius’ own experts recommended a UFR of less than 10 ml/h/kg. The SEIU-UHW analysis indicates that patients at Fresenius clinics continued to receive dialysis with UFR rates greater than 10 ml/h/kg even after the company was aware of the potential risks.

In the article, FMC rejects the accusation.  They assert that each dialysis treatment is based on a physician’s prescription for each individual patient. David Miller from SEIU-UHW notes that. “Fresenius and their medical directors are responsible for the delivery of patient care in their clinics, including providing an individualized assessment of a patient’s needs that reevaluates components of a patient’s prescription, such as the UFR, when the patient experiences symptoms that might indicate the prescription needs to be adjusted. FMC needs to deliver treatments the company is certain that follows their guidelines to protect patients.”

David Boys, Deputy General Secretary of Public Services International, points out: "It's shocking that Fresenius puts patients' lives and health at risk just to make more profit. In other countries such as Germany they don't dare to do that. Are American patients worth less than other patients? We stand with our colleagues in the USA and call on Fresenius to ensure safe patient care in its clinics worldwide."

For Alke Boessiger, Deputy general Secretary of UNI Global Union, “this case shows once more, why we need a strong and binding due diligence legislation – for human rights, workers’ rights and patients’ safety. Companies such as Fresenius must be held accountable.

[1] Flythe, J., Kimmel, S., & Brunelli, S. (2011) Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality. Kidney International, 79(2), 250-257.