Status of hemodialysis adequacy in the United States: does it account for improved patient survival?
Certain analyses have suggested that the United States has lower patient survival than other comparable industrialized nations, but it remains to be determined whether this is due to the "adequacy" of dialysis in the United States. Substantial evidence exists that the doses of hemodialysis delivered in the United States have increased over the last 6 years. Databases from Fresenius Medical Care and the National Core Indicators Project from the Health Care Financing Administration (HCFA) have shown that as dialysis dose has increased, mortality has decreased. However, commensurate with this has been the introduction of other technologies and practices, such as anemia control and others. Discerning the relative role of these independent factors on outcome remains complicated. While awaiting the results of the National Institutes of Health HEMO study, this article discusses the merits and contributions of the increasing doses of dialysis on outcome.
Owen
W F
WF
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. wfowen@bics.bwh.harvard.edu
D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate; D014481:United States