Prevention of Kidney Disease and Long-Term Survival

Renal Failure Prevention and Treatment in the 19808 It appears logical to juxtapose in this volume prevention-low cost and nonmorbid-with uremia therapy, which is very morbid and very high cost. Treated uremic patients constitute an important, complex, and demanding group of survivors of a formerly universally fatal disease. Throughout the developed nations of the world, an increasing fraction of the health care budget is devoted to sustaining lives by dialytic therapy and renal transplantation. In the United States, for example, patients in renal failure comprise 0.2% of those eligible for support by Medicare, but consume 5.0% of the Medicare budget. Economic stresses in funding kidney patients have, in some countries such as Great Britain, forced a return to restrictive selection policies abhorrent to empathetic physicians. For third world residents, attention to nutrition, sanitation, and infections such as malaria must take a higher priority than costly uremia therapy. Thus the solution of one problem (retarding death from uremia) created several equally vexing other dilemmas (who should be treated and at what cost?). While sociologists, economists, and ethicists struggle with the new field of psychonephrology,1 a group of investigators and clinicians convened to examine medical aspects of long-surviving treated uremic patients. These proceedings represent the first American analyis of those unique patients who have lived for ten or more years beyond what would have formerly been certain death in uremia.