Prescription and practice of dialysis in Australia, 1988

Facilities for provision of treatment of end-stage renal failure with hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) are available in many centers, most of which are government-funded. Medicare provides free treatment for all patients. There are no specific criteria for determining a patient's acceptance for dialysis treatment: age, quality of life, and capacity for independent living are important factors. The usual HD prescription is three dialysis periods weekly, hollow-fiber dialyzer, 1.0-1.2 m2 surface area, for 4 to 5 hours, with blood flow rate 250 mL/min and acetate-based dialysate flow rate 500 mL/min. Reuse of the dialyzer is common, but many units practice single use to reduce the expense and time necessary for processing the dialyzer and the risks of formalin exposure. There is only limited use of hemofiltration, or highly efficient dialyzers for shortened hours at higher blood flow rates. The choice of dialysis prescription is influenced by the physician's preference for the patient to be treated at home or in a self-care center with limited assistance. CAPD is preferred for home dialysis, especially for elderly or diabetic patients. There is no personal financial incentive to the physician to favor any particular form of dialysis. The costs of dialysis do influence the provision and prescription of treatment, causing the reuse of dialyzers and the limited use of bicarbonate-based HD and highly permeable dialyzers. Nevertheless, adequate dialysis should be available to all patients, and noncompliance with prescribed dialysis is infrequent. Quality-assurance programs have been developed both for nursing and medical care.(ABSTRACT TRUNCATED AT 250 WORDS)