Wednesday 18 July 2012

Problems when patients start dialysis too soon.

The glomerular filtration rate (GFR) quantifies the rate at which filtered fluids are processed by the kidneys. By medical consensus, a GFR of 10 is deemed “early” for dialysis. But recently, the number of elderly people (those 75 and over) who started dialysis when their GFR was lower than 10 increased from 1 in 4 (in 1996) to more than 6 in 10 (in 2009), according to an article at The Journal of the American Medical Association.

It is suggested that with medics receiving a referral fee from dialysis centres, patients were being referred sooner than necessary. Whether or not this is a factor, the article says that early introduction to dialysis is not justified. Elderly patients with age related decreases in muscle mass may have higher GFR due to this problem instead. And being subjected to dialysis can lead to a higher risk of death, while a controlled trial found no benefit from starting dialysis early. Indeed the article stated that for those over 80, they were more likely to die from other causes before starting dialysis.

The article ends with the following statement:
"The public perception that pursuit of dialysis is always in patients' best interest should be replaced by a more realistic view of the “sad truth” about early dialysis initiation in elderly patients."