Mortality and the length of dialysis

Article Abstract:

A commentary is offered concerning a report in the February 20, 1991 issue of The Journal of the American Medical Association that studied the relationship between death and the duration of hemodialysis (a treatment for kidney failure where the blood is passed through a filter to remove waste products, then returned to the body). The investigators found that patients who spent shorter times spent on dialysis had a higher death rate than those who were dialyzed longer. The average mortality among US dialysis patients rose between 1983 and 1988 from 20.1 percent to 24.3 percent, and is the highest in the developed world. This unfortunate trend occurred in parallel with decreasing dialysis times. The cited study provides the clearest indication that these factors are related. While the reasons for this effect are not clear, the fact remains that it is a real effect. Its powerful demonstration could only be made after a large-scale retrospective study was carried out. This kind of study is often held in low esteem by researchers, but it is the only way to actually see the effects of certain treatment approaches. Additional information concerning mortality among dialysis patients needs to be gained from epidemiologically organized study of clinical practice; the ultimate goal should be to improve the quality of care. On the economic front, since dialysis patients are all Medicare recipients (because of their diagnosis of end-stage renal disease), they are subject to the effects of federal attempts to cut back on funding. Dialysis payments fell from $138 per treatment in 1983 to $77 in 1990, a reduction of 44 percent in real resources. Providers of dialysis saw shorter treatments as a good response to cutbacks, and patients, naturally, prefer short treatments. New equipment was touted as facilitating shorter dialysis times, and some biochemical research results showed that these times should be effective. The consequences of these modifications are apparent, and indicate why each reduction in federal reimbursement levels needs careful evaluation by all interested parties. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Causes of, Death, editorial

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Advance directives and withdrawal of dialysis in the United States, Germany, and Japan

Article Abstract:

Dialysis patients in Germany and Japan are much less likely to have advance directives than American dialysis patients. Researchers surveyed 72 American nephrologists, 87 German nephrologists and 73 Japanese nephrologists. The American nephrologists had stopped dialysis for 5% of their patients, while the German nephrologists had withdrawn only 1.6% of their patients and the Japanese nephrologists only 0.7% of their patients. Only 0.3% of Japanese and German patients had advance directives compared to 30% of the American dialysis patients.

Analysis, Statistics, Refusal to treat (Medicine), Advance directives (Medicine)

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Informing resource-poor populations and the delivery of entitled health and social services in rural India: a cluster randomized controlled trial

Article Abstract:

A study aims to determine the impact of informing resource-poor rural populations about entitled health and social services in India. The results concluded that informing the population enhanced delivery of health and social care services.

United States, India, Health aspects, Evaluation, Rural population, Social service, Rural, Rural social services, Health care services accessibility, Clinical report

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