The Problem with Dialysis

Dialysis is life-saving, and we are lucky to have it to extend the lives of those with kidney failure. The difficulty with this program, apart from its high cost, is that it is a far from ideal solution for most patients. Regular dialysis is an enormous physical burden. Many dialysis patients do not feel well and suffer from fatigue or sometimes more specific complaints, such as weakness, itching, muscle cramps, shortness of breath, and nausea. Only about half continue working; the others collect disability benefits.

The death rate of patients on dialysis in the United States is still alarmingly high, over 20 percent per year, although it has fallen steadily since 1988. Part of this high mortality is attributable to the fact that a significant number of new dialysis patients are near death from other causes. Most of these deaths are apparently from cardiovascular disease, but the proportion is difficult to pin down from the available government reports. The 1999 summary, entitled U.S. Renal Data System, stated that "1 out of 5 dialysis patients withdraws from dialysis before death." In other words, these patients voluntarily stopped treatment. This depressing cause of death has disappeared in the more recent summaries. Sad as it may seem, withdrawal from dialysis is reported to be a "good death," meaning that suffering is minimized.

Now that we have looked at dialysis, let's consider kidney transplants.

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