On July 1, Medicare proposed a dramatic and disappointing reduction in dialysis payment rates that could jeopardize local dialysis care. As a dialysis professional I am responsible for some of the sickest and most vulnerable patients in Maryland, those with kidney failure who depend on dialysis three times each week to stay alive. Most people on dialysis, regardless of age, have Medicare. The new Medicare cuts worry me. The cost impact could result in reduced dialysis services and clinic closures at a time when kidney disease is rising in our state. Currently there are 13,138 Maryland residents suffering with kidney failure, an increase of approximately 15 percent since 2005. These cuts will be hardest on rural and inner city clinics where Medicare populations are highest.