VA doctor says dialysis often prescribed unnecessarily

Research by a South Carolina medical doctor shows that many patients who are told that they need dialysis could actually hold off on beginning the procedure for months or even years, in turn preserving what kidney function they have left.
Dr. Steven Rosansky with the Dorn VA Medical Center in Columbia and his colleagues reported that the dialysis prodedure itself can contribute to the loss of a patient’s remaining kidney function much faster than it would decline otherwise.
Dr. Rosansky says that before Medicare began paying for dialysis in the 1970’s, patients wouldn’t begin dialysis until they had lost all but two percent of their kidney function. He says since then an international trend has developed, led by the United States, that starts a patient on dialysis much sooner, in some cases with as much as 20 percent of their kidney function remaining.
Rosansky says there hasn’t been a randomized controlled trial yet, but he still wants patients advised that they should discuss dialysis with their doctor carefully before beginning the procedure. “In my view, unless a doctor can tell a patient that it may keep them alive, and we think it may actually decrease the chance of survival, if they’re going to commit to three times a week dialysis, there’s got to be a clear benefit. And I think many times there is not a clear benefit.”
Diabetes causes approximately half of kidney patients to begin dialysis. High blood pressure is another cause. Dr. Rosansky advises everyone to talk to their physicians about reducing their chance of kidney problems–by controlling diabetes and their blood pressure.
Rosansky says public service announcements from kidney patient support groups have been telling people they should know their “kidney score.” He says the ads are good because they draw attention to kidney health. “The advertisements are from various kidney groups around the country. Some people are worrying about their kidney score, which is the percentage of kidney function you have left.”
But Rosansky says it’s important to know that even if your kidney score is 10 to 20 percent, meaning that’s the level of kidney function you have, that you may stay on that level for many years without requiring dialysis.
And Rosansky points out that a person who has a kidney score of ten percent may not increase that score through dialysis since dialysis may cause a loss of original kidney function.
Dr. Rosansky says he’s very concerned for elderly patients who still have kidney function left who are put on dialysis. “They’ll be subjected to dialysis three times a week and the surgical procedure required, when in fact they could do without the poor quality of life connected to dialysis, with all of its complications.”
Rosansky says he respects the integrity of his colleagues who changed the national guidelines concerning dialysis in 1996. But he says there may have been a misinterpretation of the available research.
And Rosansky says there’s another part of the issue. Dialysis is a 40 billion dollar-a-year industry in the US. “If we go back to where we started this program, when we dialyzed patients with five percent of less of kidney function, we could save 10 to 15 billion dollars a year.”
And Dr. Rosansky says that same truth applies to other areas of American’s health care system and the entire system should be examined, to find expensive practices which aren’t really necessary and may even cause harm.
So the question arises is the growing dialysis trend driven by profit? Rosansky says not necessarily. He says their study showed not-for-profit agencies starting dialysis as early as for-profit ones, and a growing trend as well showing up in countries with nationalized health care like Great Britain.

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