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dc.contributor.authorChandna, S.M.
dc.contributor.authorSchulz, J.
dc.contributor.authorLawrence, C.
dc.contributor.authorGreenwood, R.N.
dc.contributor.authorFarrington, Ken
dc.identifier.citationChandna , S M , Schulz , J , Lawrence , C , Greenwood , R N & Farrington , K 1999 , ' Is there a rationale for rationing chronic dialysis? A hospital based cohort study of factors affecting survival and morbidity ' , British Medical Journal (Clinical Research ed) , vol. 318 , no. 7178 , pp. 217-223 .
dc.identifier.otherPURE: 2554709
dc.identifier.otherPURE UUID: ec7aba3c-b5c7-4c89-a3b0-027eda2a0a98
dc.identifier.otherWOS: 000078292300021
dc.identifier.otherScopus: 1842667135
dc.identifier.otherPubMed: 9915728
dc.identifier.otherPubMedCentral: PMC27700
dc.description.abstractObjectives To determine factors influencing survival and need for hospitalisation in patients needing dialysis, and to define the potential basis for rationing access to renal replacement therapy. Design Hospital based cohort study of all patients starting dialysis over a 4 year recruitment period (follow up 15-63 months). Groups were defined on the basis of age, comorbidity, functional status, and whether dialysis initiation was planned or unplanned. Setting Renal unit in a district general hospital, which acts as the main renal referral centre for four other such hospitals and serves a population of about 1.15 million people. Subjects 292 patients, mean age 61.3 years (18-92 years, SD 15.8), of whom 193 (66%) were male, and 59 (20%) were patients with diabetes. Dialysis initiation was planned in 163 (56%) patients and unplanned in 129 (44%). Main outcome measures Overall survival, 1 year survival, and hospitalisation rate. Results Factors affecting survival in the Cox's proportional hazard model were Karnofsky performance score at presentation (hazard ratio 0.979, 95% confidence inter val 0.972 to 0.986), comorbidity severity score (1.240, 1.131 to 1.340), age (1.036, 1.018 to 1.054), and myeloma (2.15, 1.140 to 4.042). The Karnofsky performance score used 3 months before presentation was signficant (0.970, 0.956 to 0.981), as was unplanned presentation in this model (1.796, 1.233 to 2.617). Using these factors, a high risk group of 26 patients was defined, with 19.2% 1 year survival. Denying dialysis to this group would save 3.2% of the total cost of the chronic programme but would sacrifice five long term survivors. Less rigorous definition of the high risk group would save more money but lose more long term survivors. Conclusions Severity of comorbid conditions and functional capacity are more important than age in predicting survival and morbidity of patients on dialysis. Late referral for dialysis affects survival adversely. Denial of dialysis to patients in an extremely high risk group, defined by a new stratification based on logistic regression, would be of debatable benefit.en
dc.relation.ispartofBritish Medical Journal (Clinical Research ed)
dc.subjectActivities of Daily Living
dc.subjectAged, 80 and over
dc.subjectCohort Studies
dc.subjectHealth Care Rationing
dc.subjectHospital Costs
dc.subjectHospital Mortality
dc.subjectKarnofsky Performance Status
dc.subjectKidney Failure, Chronic
dc.subjectMiddle Aged
dc.subjectMultivariate Analysis
dc.subjectPatient Selection
dc.subjectRenal Dialysis
dc.subjectResource Allocation
dc.subjectRetrospective Studies
dc.subjectSurvival Analysis
dc.subjectComparative Study
dc.subjectJournal Article
dc.titleIs there a rationale for rationing chronic dialysis? : A hospital based cohort study of factors affecting survival and morbidityen
dc.contributor.institutionDepartment of Psychology
dc.contributor.institutionSchool of Life and Medical Sciences
dc.contributor.institutionHealth & Human Sciences Research Institute
dc.contributor.institutionCognitive Neuropsychology
dc.contributor.institutionSchool of Health and Social Work
dc.contributor.institutionCentre for Postgraduate Medicine
dc.contributor.institutionPostgraduate Medicine
dc.contributor.institutionHealth Services and Medicine
dc.contributor.institutionPharmacology and Clinical Science Research
dc.description.statusPeer reviewed
dc.relation.schoolSchool of Life and Medical Sciences
dc.relation.schoolSchool of Health and Social Work
rioxxterms.typeJournal Article/Review

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