Rationing dialysis on age alone is unjustified

Renal replacement therapy is expensive, and with the number of patients requiring treatment predicted to rise it is not surprising that ways of limiting access to treatment are being considered. Wiltshire Health Authority recently proposed criteria for accepting patients for dialysis. On p 217 Chandna et al investigate the validity of these criteria in the light of survival and morbidity analyses of patients admitted into their chronic dialysis programme over four years. They found that the functional capacity of the patient, the severity of comorbid conditions, and age (in that order) affect survival. Dialysis initiation was unplanned in 44% of patients owing to late referral, which is a major cause of poor survival and inflated costs. Denying a high risk group access to dialysis as defined by logistic regression seemed, however, to be of debatable benefit. Rationing on the basis of age alone seemed unjustified.