"I am not advocating that we require months of nausea and vomiting before initiating dialysis," she wrote. "But I am suggesting that (in the absence of urgent indications) we shift our paradigm to consider starting dialysis when the symptoms are worse than the anticipated lifestyle burden and effects of dialysis, which are considerable and include a substantial time commitment, frequent fatigue and infections, among other things."
Consumer groups, researchers and payers have been increasing efforts to understand reasons behind the wide variation in death rates for dialysis patients, which range from 10% at some centers to 30% at others. It's a key priority for federal payers, who spend billions on the procedure for more than 400,000 patients each year.
Patients with lower levels of the liver protein albumin had higher risk of death in the first year compared with those who had higher albumin levels (21% vs 4.7%).