Preventive health care measures before and after start of renal replacement therapy

Abstract

Preventive health care interventions remain underutilized among RRT patients. Greater attention to such preventive measures could lead to significant improvements in the health status of such vulnerable patients. Thus, quality improvement of the general health care for patients on RRT should become a priority in renal health policy.

Comparison of Stage at Diagnosis of Cancer in Patients Who Are on Dialysis versus the General Population

“…A striking finding of this study was that patients with ESRD were approximately twice as likely to present with a distant and therefore incurable stage at diagnosis of prostate cancer. This may be in part due to lower use of PSA screening in the ESRD population, demonstrated both in this study and in previous work (8,9). In addition, the absence of urinary output may hinder early diagnosis on the basis of urinary tract symptoms (22).…”

“…A cost-effectiveness analysis suggested that a general cancer screening program in this population would be of minimal value, adding Ͻ5 d of life saved per person under the most optimistic assumptions (7). Indeed, population-based assessments suggest that cancer screening does occur less frequently in dialysis patients versus the general population (8,9). Some authors, however, have expressed concern over the low rates of cancer screening in the long-term dialysis population and suggest that the decision to screen may need to be individualized, with consideration given to patients with a reasonable life expectancy (2,3,8).…”

“…Indeed, population-based assessments suggest that cancer screening does occur less frequently in dialysis patients versus the general population (8,9). Some authors, however, have expressed concern over the low rates of cancer screening in the long-term dialysis population and suggest that the decision to screen may need to be individualized, with consideration given to patients with a reasonable life expectancy (2,3,8). In addition, the issue of cancer may become more relevant in dialysis patients with the progressive aging of the population (10) and trends showing improvement in cardiovascular outcomes in recent years (11).…”

Rise of Pay for Performance

“…The deficiencies have been documented across a range of areas, including hypertension management, vascular access placement, transplantation referral, and preventive health services (37)(38)(39)(40)(41). A retrospective analysis of the Third National Health and Nutrition Examination Survey (NHANES III) showed that only 27% of patients with CKD had BP of 140/90 (37).…”

“…Although kidney transplantation is the preferred renal replacement solution because of improved survival, in 2000, only 22% of dialysis patients who were younger than 70 yr were on a kidney transplant list in the United States (40). Although the cost-effectiveness of a variety of screening tools in the ESRD population has been questioned, health maintenance care in the CKD population is also inadequate with 27, 17, and 40% of patients in the United States receiving the recommended frequency of mammography, Papanicolaou smears, and prostate-specific antigen screening respectively (41).…”