Reflections on the Boston Meeting from across the 49th Parallel

As a Canadian observer and participant, I offer the following opinions about the recently concluded Boston meeting concerning the morbidity and mortality of dialysis in the United States of America.First, I congratulate Americans for having the courage to execute a meeting that catalyzed a disturbing discussion about imperfect technologies and poor patient outcomes in their country. Thank you Drs. Steinman, Parker, and Hull and members of the steering committee. Canada has never had such a meeting. Although our mortality rates are lower than the United States (1), key intermediate outcomes show signs of getting worse over time (2). In a setting with universal health insurance, our central venous catheter (CVC) rate has reached an appalling 45% in prevalent patients, and we have no fistula-first initiative (3,4). This is our national tragedy. There is much for America to be commended about.The conference concluded with the assertion that the science is clear and that the next steps are fairly obvious. As stated by the giants of the field and supported by the rank and file, it appears there is a pragmatic consensus about the major …