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To use dialysis appropriately: the emerging consensus on patient selection guidelines
1Department of Medicine, Robert C. Byrd Health Sciences Center of West Virginia University, Morgantown, WV 25606-9022, USA.
Advances in Renal Replacement Therapy
|April 1, 1995
Summary
Developing practice guidelines for dialysis patient selection is recommended to ensure appropriate care within the Medicare End-Stage Renal Disease (ESRD) Program. This addresses concerns about patient numbers and costs due to expanded eligibility.
Area of Science:
- Nephrology
- Healthcare Policy
- Medical Ethics
Background:
- The Medicare End-Stage Renal Disease (ESRD) Program, established in 1972, has seen significant growth in patient numbers and costs.
- The program's expansion includes patients not initially considered dialysis candidates, raising questions about appropriateness of care.
- The Institute of Medicine recommended practice guidelines for ESRD patient selection to promote appropriate healthcare.
Purpose of the Study:
- To review arguments for and against developing practice guidelines for dialysis patient selection.
- To examine proposed guidelines for dialysis patient selection.
- To describe the emerging consensus on appropriate dialysis use and recommend a guideline establishment process.
Main Methods:
- Literature review of arguments concerning dialysis patient selection guidelines.
- Analysis of proposed dialysis patient selection guidelines.
- Synthesis of emerging consensus on dialysis appropriateness.
Main Results:
- Arguments for and against guideline development were reviewed.
- Proposed guidelines for dialysis patient selection were examined.
- An emerging consensus on appropriate dialysis use was identified.
Conclusions:
- A consensus on appropriate dialysis use is emerging.
- A process for establishing dialysis patient selection guidelines based on this consensus is recommended.
- Guidelines are crucial for promoting appropriate healthcare within the ESRD program.