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The Sad Truth About Early Initiation of Dialysis in Elderly Patients

Steven J. Rosansky, MD
JAMA. 2012;307(18):1919-1920. doi:10.1001/jama.2012.3522.
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Forty years ago, an article in JAMA entitled “The Sad Truth About Hemodialysis in Diabetic Nephropathy” highlighted the poor outcomes for patients with diabetes who were treated with dialysis.1 In the early 1970s some patients with diabetes were not offered dialysis because of expected poor outcomes. The problems of visual deterioration and chronic fluid overload have been largely resolved with laser therapy for diabetic retinopathy and vastly improved dialysis techniques. In a report published in 1972, among 9 patients with renal failure resulting from diabetic nephropathy who were treated by hemodialysis, survival was 22% (2 patients) at the end of 1 year,1 whereas in 2008, data from the US Renal Data System indicate that for patients with diabetes who initiated dialysis, survival was 81% at the end of 1 year.2

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