Dialing up the dialysis

Related articles

Patients suffering from kidney disease rely on dialysis in order to stay alive. Without functioning kidneys to remove the waste and fluids that accumulate in the body, the majority of the 400,000 Americans with this condition have their blood purified by a dialysis machine three days a week. Yet a major study suggests that thrice-weekly treatment may not be frequent enough: Researchers led by an expert on kidney disease at the University of Minnesota have found that deaths, heart attacks, and hospitalizations were much higher on the day after the two-day interval between dialysis treatments.

The study, just published in the New England Journal of Medicine, analyzed the medical records of 32,000 people who had in-center dialysis over the course of three years. What they found was striking: On the day following a two-day treatment interval, dialysis patients had a 22 percent greater risk of dying than they did after a one-day treatment interval. Furthermore, hospitalizations for stroke and heart-related problems more than doubled after the longer intervals.

The researchers have confirmed what physicians have long suspected: More frequent dialysis treatment is required. The question remains how to address the problem, which would require a number of fairly daunting changes. Cost is the weightiest issue: Medicare currently spends about $77,000 annually to cover dialysis for a single patient; increasing the number of weekly treatments would raise expenses by 17 percent. Doctors also question how well patients could endure the greater strain of an additional weekly dialysis session, which requires several hours of being hooked up to a machine.

Although some physicians think that further studies are required before any major change to dialysis protocol occurs, ACSH's Dr. Gilbert Ross finds this study convincing. This was a large study with significant results, he says. Certainly, cost is the major impediment here, but with 400,000 people affected by this problem, we need to find a way to address it.