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Nephrologists Defend Rationing Dialysis (Again)

Posted Sep 15 2009 10:11pm
USA Today ran astory, yesterday, reportig on a new brief articlein theJournal of the American Society of Nephrology,

Felix Knauf and Peter Aronson argue that one way to rein in Medicare spending would be to ration dialysis.Through Medicare's End Stage Renal Disease Program, the USA spends more on kidney dialysis than any other country, but that doesn't translate into higher survival rates. In 2007, Medicare spent $8.6 billion on treatment and medications for dialysis patients, plus billions more on hospitalizing them.

Aronson and Knauf question the wisdom of paying for dialysis for patients who are likely to die soon of diseases other than kidney failure. Among patients who begin dialyzing in their 80s and 90s, nearly half are suffering from congestive heart failure and one-third from diabetes or cardiovascular disease. Research suggests that dialysis provides little benefit to the oldest, sickest patients. Its main effect: increasing the chance that the patients will die in a hospital instead of at home or in a hospice.

My first thought on reading this report was that it supports the position of Trinitas Hospital in the Betancourt litigation: dialysis was inappropriate for Mr. Betancourt given his many serious comorbidities. But the article actually really hurts the providers' position because it highlights that the standard of care in the United States is to provide dialysis to everyone. In other words, whether or not we should do it,we do now do it. And that is what creates the standard of care.

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