CHICAGO (AP) -- A program to improve kidney dialysis appeared to narrow the racial and gender gaps in the quality of care given to patients.
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February 26, 2003
By James Winshall, M.D.
Harvard Medical School
How does this article relate to me?
This medical story tells us two pieces of good news: Dialysis is getting better, and it's getting more equitable, too.
The invention of dialysis machines — also known as artificial kidneys — revolutionized the care of people who suffered kidney failure. What was previously a fatal illness has become a chronic condition that can be treated. However, ask anyone on dialysis and they will tell you that the machines do not restore them to perfect health.
More importantly, there has been a lingering concern that some people don't get an adequate amount of dialysis. For example, some studies have shown that European kidney failure patients — who get longer, more intense dialysis — live longer than Americans. Other studies have suggested that people dialyzed in for-profit centers get less effective dialysis than their counterparts in not-for-profit centers. Lastly, there is evidence that a "one size fits all" approach leads to inadequate dialysis for large people (men more than women) and certain ethnic groups (African-Americans in particular). This latter point has been especially concerning, since it confirms other evidence that racial minorities in the United States receive substandard medical care.
This study shows that, over the seven years between 1993 and 2000, the proportion of people receiving an adequate amount of dialysis jumped two-fold. There are undoubtedly several factors that explain this improvement, but at least some of the gains are related to a specific quality improvement initiative funded by Medicare, which pays for almost all dialysis in the United States. The improvements in adequacy of dialysis were most striking for men and African-Americans, although some sex and racial disparities have persisted. In particular, the study suggests that more work needs to be done on addressing gaps in the nutrition and anemia status of kidney failure patients.
What changes do I need to make?
If you are presently on dialysis, consider talking to your doctor about whether you are getting optimal treatment. Although the process of determining the right amount of dialysis treatment involves a lot of technical jargon, ask your doctor about how you compare to other kidney failure patients with regards to:
- Prescribed dialysis "dose" (also known as Kt/V), and how close you are coming to this target
- Nutritional status (often measured by your blood albumin level)
- Amount of anemia (measured by your hemoglobin or hematocrit level)
Although some of these factors may be out of your or your doctor's control, there may be some straightforward issues — for example, how long your dialysis session lasts — that could improve your treatment and quality of life.
What can I expect in the future?
The topic of inequality in health care is just beginning to receive the attention that it deserves. In the same way that we worry about equal access to education and social services, ensuring high quality care across racial, ethnic, gender and age lines should be part of our commitment to a just and fair society. This study is one of many that looks at how much inequality exists, and what can be done to erase these gaps.
Related Areas:
Kidney Disease
Populations At Risk
Hemodialysis Dose And Adequacy
