Wednesday, December 4, 2013

Dialysis in older people

NYTimes discusses.

yes, often they have many other diseases that kill them (usually heart disease or stroke or poor circulation to their legs).

But when I read an article that says "Hard Choices", my bullshit antenna goes up, because it means they will be explaining why we should not treat these people.

The object is to let people die to save money

But in general, the evidence supporting a survival advantage in very old patients on dialysis is weak, according to Dr. Thorsteindottir. And there’s growing concern among experts that too many elderly patients with severe kidney disease may be starting dialysis without the potential for significant benefit.
“Concerns about overtreatment are focused on older adults, especially those who are frail or have other severe or life-limiting conditions,” according to the authors of an editorial in The Journal of the American Medical Association last year.

of course, the dirty little secrets it that my patients on "supportive treatment" have a lousy quality of life: So you have to balance the numerous incidents of shortness of breath and cramps and weakness with the inconvenience of dialyzing three times a week for 8 hours.

And yes, I've had people stop dialysis when their bodies simply were deteriorating: There is a point when you are prolonging dying, not prolonging life. But with the government in charge of health care, I suspect that we'll have more articles full of similar propaganda saying don't dialyze grandmom...

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