Why Are Death Rates of Dialysis Patients So Much Higher in the U.S. than the Rest of the World?

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Studies have consistently shown a marked difference in deaths related to dialysis between different countries such as Canada, Italy, Japan, Britain, New Zealand, with the United States being one of the highest. Although the U.S. spends more per dialysis patient than other countries, it does not result in higher survival rates or even a better quality of life. Some suggest that the poor U.S. results are due to conditions associated with dialysis clinic treatment programs. Another possible explanation for such differences in mortality is that it mirrors similar cardiovascular disease trends in the general population of each country. Cardiovascular disease is a major cause of mortality in the US dialysis population as well as the general population. Hence, could differences in practice patterns of the dialysis medical system and/or patients themselves explain the differences in mortality between countries and specifically account for the much higher mortality in the United States?

Recommended Reading: Can a Person Live a Good Long Life on Dialysis?

A growing body of evidence suggests that longer and/or more frequent dialysis treatments, either at home or in a dialysis center, are far superior to the status quo. Longer and/or more frequent dialysis can improve quality of life and survival and reduce hospitalizations. Besides improved blood pressure control and lower use of EPO, dialysis patients generally feel better, with more energy and chances are they will live longer. Also other developed countries have a higher percentage of patients who begin dialysis with AV fistulas instead of catheters, and dialysis units in the U.S. are often staffed by a high percentage of dialysis technicians who have less formal training than dialysis nurses; which are required in greater numbers in countries such as Britain and Italy.

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Can you as the patient do more to ensure your longevity? About 30% of U.S. dialysis patients are able to do home treatment, though only 8% decide to take part. By comparison, about 55% of dialysis patients in New Zealand dialyze at home, as do 30% in Australia and 20% in Canada, all patients in these countries live longer on average than those in the U.S. In addition, do you fully understand your health condition, and the services available to you? Are you following diet, medication, and all treatment plan regimens based on the recommendations of your healthcare team? As you know, dialysis is a grueling procedure that may prevent you from working, going to school, or even caring for your family as you would like. Hence, the solution for increasing your life span and quality of life must multifaceted. Although it is the responsibility of everyone involved, the end result, either positive or negative, can be heavily influenced by you.

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Of course there are other variables between countries which could also potentially explain the difference in mortality. U.S. patients often have a heavier red meat diet than in Japan. Many have also suggested that the U.S. tends to dialyze the very elderly or the very ill with greater frequency than in other countries, which would obviously make our mortality numbers look worse. Explaining the mortality discrepancy likely has a complex answer, but it makes sense to try and figure out what aspects of our dialysis care might be improved directly by yourselves, and what external factors dialysis community can influence and how. This will help lessen the mortality differences between our country and others but more importantly will ensure an extended and improved life for all dialysis patients.

Recommended Reading: Are Survival Rates for Dialysis Patients Considerably Improving?

KidneyBuzz.com would like you to weigh-in. Either below in the comment section or on Facebook, describe what you believe can cause the survival rates and quality of life to improve for dialysis patients. Your collective comments will be shared in a later article.

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"Why Is the Mortality of Dialysis Patients in the United States Much Higher than the Rest of the World?" Journal of the American Society of Nephrology

"Dialysis Treatment in USA: High Costs, High Death Rates - USATODAY.com." USA Today

"Why Do U.S. ESRD Patients Do So Poorly?" Renal Fellow Network.  

"Dialysis Compliance Buy-In..." Nursing Community for Nurses and Nursing Students