Laconia doctor fighting over prescribing of kidney dialysis drug

A local kidney specialist has been cited by The Boston Globe as being on the front line of an effort to save the federal government's Medicare program more than $500-million a year. Dr. Noshi Ishak was featured in a Oct. 24 article about the common practice of administering the drug Epogen intravenously, rather than through a beneath-the-skin injection that could reduce the amount of the drug needed for effective treatment by as much as 30-percent.

Noshi told the Globe that dialysis clinics throughout the country are needlessly wasting Epogen because it improves their bottom line. Patients at his Laconia dialysis center — the Central NH Kidney Center at 87 Spring Street — are administered doses of the drug by injection, and Noshi told the newspaper it remains in the body longer when administered that way — so you need less.

Epogen is a synthetic hormone that replenishes oxygen-carrying red blood cells and restores energy in patients with kidney failure. Medicare spends $2-billion a year on reimbursements for Epogen prescriptions, the most of any drug.

The Globe reported the dialysis industry is dominated by two for-profit chains that operate a total of 2,750 clinics. They both use the intravenous method. Representatives of the companies say they do so because their patients are already hooked up to IV tubes for dialysis, which makes it more convenient.

The average annual cost of Epogen for a dialysis patient was about $6,000 in 2002, according to a study published in the American Journal of Kidney Disease. About 95-percent of the nation's 325,000 dialysis patients receive Epogen intravenously.