A story in USA Today reported that more than half of older nursing home residents die within a year of starting dialysis, and nearly another third experience a significant decline in their ability to perform simple tasks, such as feeding themselves.
The fastest-growing group of U.S. patients starting dialysis is those 75 and older, many of whom have health problems other than kidney failure, such as dementia or heart disease. Some observers have questioned whether dialysis, which typically is performed three days a week for three or four hours at a time, is the best option for such patients.
The new study, in The New England Journal of Medicine, focused on all 3,702 U.S. nursing home residents who started dialysis between June 1998 and October 2000 and for whom at least one measurement of ability to do simple daily tasks was available.
The study wasn't designed to show what would have happened to the patients if they didn't go on dialysis, the lead author, a Stanford University nephrologist, or kidney doctor, says.
"The results are still important," she says, because most people find it surprising that the patients who received dialysis did so poorly," pointing out the need for doctors to have "open and honest discussions" with elderly patients about the treatment's pros and cons.
Many doctors assume that palliative care is "a death sentence" for patients with permanent kidney failure, two specialists wrote in an editorial accompanying the study.
But, they write, small studies of frail elderly patients with permanent kidney failure suggest that death rates and quality of life don't differ much between those who go on dialysis and those who don't. "We must define who among this population will benefit most from dialysis and who will benefit most from conservative therapy." For more, read the story.
Robert W. Carter,
Jr. is a Virginia attorney whose law practice is dedicated to
protecting the rights of the victims of nursing home and assisted
living neglect and abuse in Richmond, Roanoke, Norfolk, Lynchburg,
Danville, Charlottesville, and across Virginia.
Posted on Thu, October 15, 2009
by Robert Carter