Letters

Is there a rationale for rationing chronic dialysis?

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7198.1619 (Published 12 June 1999) Cite this as: BMJ 1999;318:1619

Two points need clarification

  1. Rasheed Ahmad (TheAhmads@aol.com), Consultant renal physician
  1. Royal Liverpool University Hospital, Liverpool L7 8XP
  2. Jersey General Hospital, St Helier, Jersey, Channel Islands
  3. Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen AB25 2ZD
  4. Renal Unit, Aberdeen Royal Infirmary, Aberdeen AB9 2ZB
  5. Department of Nephrology, Lister Hospital, Stevenage SG1 4AB

    EDITOR—I agree with Chandna et al that late referral is an important factor in the survival of patients receiving dialysis.1 I am unaware, however, of the source of their information that an NHS consensus statement recommends that nephrology referrals be made at a serum creatinine concentration >135 μmol/l in women and >180 μmol/l in men. The workload generated by this practice would be so enormous that British renal units under present conditions would be unable to cope.

    I am also concerned that of the authors' 292 patients receiving dialysis, 26 (admittedly high risk) patients spent 44% of their lives in hospital. The costs of inpatient treatment for these high risk patients would be substantially higher than the average cost of £250 a day that the authors quote.

    References

    Study's objectives were not achieved

    1. T Farrant (106712.1276@compuserve.com), Specialist registrar in gastroenterology
    1. Royal Liverpool University Hospital, Liverpool L7 8XP
    2. Jersey General Hospital, St Helier, Jersey, Channel Islands
    3. Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen AB25 2ZD
    4. Renal Unit, Aberdeen Royal Infirmary, Aberdeen AB9 2ZB
    5. Department of Nephrology, Lister Hospital, Stevenage SG1 4AB

      EDITOR—Chandna et al's study asking whether there is a rationale for rationing chronic dialysis does not fulfil its stated purpose.1 The study successfully shows the groups of patients already receiving dialysis who could be expected to do poorly, and this might be used as a rationale for withdrawing treatment in this small group. The cost savings that their unit would accrue are nevertheless small (just 3.2% of the cost of their chronic dialysis programme).

      Even in the authors' high risk group five of the 26 patients were long term survivors. This is similar to the effect of interferon treatment in hepatitis C in terms of long term response and better than results of in vitro fertilisation programmes. One could …

      View Full Text

      Sign in

      Log in through your institution

      Free trial

      Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
      Sign up for a free trial

      Subscribe