Better Dialysis?

End stage renal disease, or what is known in the common vernacular as kidney failure, isn't a diagnosis anyone wants to hear.  The definitive treatment is kidney transplant, but organ availability and compatibility fall woefully short of need.  Enter dialysis, hopefully as a temporary bridge to transplant.

Dialysis is, of course, a man made way to cleanse the blood of multiple toxins built up by normal metabolism, a task usually undertaken by the kidneys.  Two methods are routine:  hemodialysis, where one's blood is circulated through a machine, cleansed, and returned.  The other requires a catheter to be placed permanently into the abdominal space called the peritoneum.  Fluid is periodically run through the catheter into the abdomen and removed later.  The fluid exchanges waste products out of the blood.  This method is called peritoneal dialysis.

Is peritoneal or hemodialysis better?  That's the question being addressed in this study in Archives of Internal Medicine. The question is important because although people who need dialysis comprise only 1% of the Medicare population, they account for almost 6% of the cost of the program.  That's huge.  Then there's the human factor.  People who require dialysis are literally tethered to a life-sustaining routine.  Those who choose hemodialysis must have a surgery to create an access to their bloodstream, usually travel to a dialysis center at least several times a week, and spend several hours there each time.  Peritoneal dialysis requires the previously mentioned abdominal catheter and also frequent changes of the fluid in the abdomen.  Peritoneal dialysis is undeniably more flexible, since people do the majority of the heavy lifting themselves, at home.  Yet only about 7% of those who require dialysis choose this method.

The study examined short and long term outcomes data from two huge populations of dialysis patients, and found that there was essentially no difference in survival related to which method of dialysis was chosen.  Rick and I agree in this week's podcast that the evidence is compelling on the benefits of peritoneal dialysis.  We would of course love the see the need for dialysis reduced by better control of high blood pressure and diabetes, the two major bad actors involved in kidney failure.  In the meantime encouraging people to consider the peritoneal method for dialysis would help control healthcare costs and empower patients.

Other topics this week include more evidence on the benefits of breastfeeding in one BMJ journal, lack of benefit from early detection and treatment of recurrent ovarian cancer in the Lancet and a urine marker for detection of a very common cause of pneumonia, also in Archives of Internal Medicine.  Until next week, y'all live well.

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