Dialysis = Death Sentence?

Report uncovers deadly dialysis details – yet more people are being put on the treatment earlier

/ Author:  / Reviewed by: Joseph V. Madia, MD

Dialysis, the mechanical filtration of blood performed when your kidneys have lost significant function, is getting a bad rap.

A recent year-long investigation of dialysis in the United States has uncovered many problems, including cost (among the highest in the world) and a startling mortality rate: one in four patients will die within 12 months of beginning treatment.  Many dialysis facilities were found to be unsanitary and lacking in adequate care for patients, according to the ProPublica report. In fact, U.S. kidney dialysis patients face one of the highest death rates outside of developing countries.

“Neither government controls nor market forces have kept costs from ballooning or ensured the highest-quality care,” said report author Robin Fields.

Alarmingly, more patients with adequate kidney function are being put on the blood-filtering treatment, increasing their chances of death within one year, according to a recent study from the Dorn Research Institute of the William Jennings Bryan Dorn VA Medical Center in Columbia, S.C.

“The question this research addresses is what is going on with regard to patients being put on dialysis at higher and higher levels of kidney function,” said lead researcher, Dr. Steven J. Rosansky, a senior research fellow at the Dorn Institute. Usually patients with 1 to 2 percent of kidney function left are put on dialysis, but some patients with as much as 15 percent left are being treated. And that number is increasing. The question remains when treatment should being for optimum results.

“Is it beneficial at higher levels of kidney function, over 5 percent, say?” Rosansky said. “We found that there is a remarkably higher risk of death in healthy people that are being put on dialysis at higher levels of kidney function.”

Dr. Barry Straube, director and chief medical officer for the Centers for Medicare and Medicaid, has spoken out on the issue following the damning Propublica report.

“There definitely is truth in the fact that the [Center for Medicare and Medicaid Services (CMS)] in its regulatory role … has not been able to perform as many surveys and therefore perform that type of oversight as well as it might like to have,” Straube said in an interview with National Public Radio. He cited limited funding from Congress as a hindrance to the oversight process.

“The funding that is provided to the agency is insufficient in order to be able to meet the statutory requirements in terms of frequency and thoroughness,” Straube said, referring to the 17 provider sites CMS is charged with overseeing.   

Some 25 million Americans are afflicted with chronic kidney disease (CKD), which may or may not require dialysis at some point. People with diabetes and high blood pressure are at an increased risk of developing CKD.  

If you or someone you know is a dialysis candidate, be sure to discuss kidney-function percentage with your physician and weigh the risks involved.

Review Date: 
November 12, 2010