Another issue that has attracted attention in recent years is patient withdrawal from dialysis.
"Older patients are the ones who most frequently withdraw from dialysis, in patients who are 75 or older this is between 30 and 35 percent of patients, that's an issue," Blagg said. "They withdraw due to multiple complications and this has become increasingly common. The USRDS data show that approximately one in five patients voluntarily withdraws from dialysis sooner or later."
The Renal Physicians Association has recently published a clinical practice guideline to help nephrologists and others: "Shared Decision-Making on the Appropriate Initiation and Withdrawal from Dialysis."
Progress has been made due to the knowledge that is out there right now about dialysis. Education, clinical research, and prevention are main areas of focus for the future.
In the first 50 years, innovation was focused on better dialysis, both hemodialysis and peritoneal dialysis, adequacy of dialysis, anemia and other complications and dialysis equipment and Blagg thinks that it went on fairly steadily. A big change over the last decade was the focus on increasing HHD and the benefits of more frequent and/or longer hemodialysis and on peritoneal dialysis. There needs to be a continued focus on home therapies, prevention and education, he added.
Where will the next 40 years take us? No one really knows. No one knows where the next 10 years will take us. The only thing we can do is to strive for improvement, fight for patient care and educate the world to prevent this devastating and rapidly growing disease.
