Dialysis outside U.S.

[BigSteve]

I'm having an argument with my internist about universal health care. He is
alledging that in countries outside the U.S. that people over 65 are not
put on dialysis. I don't believe that is true in the Western democracies.
They may be denied transplants, but not dialysis. What is the situation
in Australia, Canada, or Europe?

[charee]

Here in Australia thats BS , I did home hemo training with a couple that were in there 80's and a man who was 69 , so tell them they don't know what they are talking about.

Cheers

[Lucinda]

I am with Cheree.  That really annoys me that a professional would give you that information.  My father is 78 and went on dialysis at 75 here in Australia.  Someone at his clinic started dialysis last week on his 90th birthday and they gave him a little party.  My aunt in Canada when on dialysis at 71 and one of my friends lives in France and her father went on dialysis because of diabetes when he was 82. That is so much crap and not true of any other country.  Man, that pisses me off when people talk about things they obviously know nothing about.   You go give him a big serve bigsteve and tell him to clamp it shut until he does his homework!!!

[Wattle]

I third that  Tell him he is talking BS. Also depending on a patients overall health, in their 60's and 70's, they are NOT denied a transplant.  We have a low donor rate so the wait is long and that may be seen as a refusal.

[stauffenberg]

The myth that older patients are denied dialysis in countries with socialized medicine -- which is all the industrialized nations of the world except the U.S. -- arises from the fact that back in the 1960s and early 1970s many Western countries were still in the process of purchasing enough dialysis machines to handle all the renal patients.  Even the United States used to have so-called 'God committees' or 'death committees' in the 1960s to determine who would get dialysis and who would die.  The reason for the worldwide shortage of dialysis machines at the time was because the technology of dialysis access was first improving on a large scale at that time, making dialysis for the first time a sensible treatment for everyone who could benefit from it. The medical industry was slow in catching up by producing suffiicient dialysis machines to hangle the expansion of dialysis candidates from this technological advance.  Even a prosperous country like West Germany, which could afford to buy dialysis machines, used to send some of its patients to England in those days to be dialyzed because they could not get enough additional dialyzing capacity fast enough.  But once the number of dialysis machines caught up with the demand in the mid-1970s, dialysis rationing ceased in the industrialized world.

I have been dialyzed in the United States, England, and Canada, and conducted a statistical study in a German dialysis center as part of a nephrology course when I was a student in Germany in 1987, and in every one of those settings, I saw exactly the same patient demographics: mainly people older than 60, with a good number in their 70s and some in their 80s, with just a few people younger than 60.  I have seen in England and Canada ancient people out of their minds with senility, raving and flailing about, being brought in and taken out of dialysis centers stapped to a stretcher, so I don't think anyone was exclused. In Canada there was a dialysis patient next to me who had spina bifida, travelled around in a motorized wheelchair, and had to perform all his bodily functions via catheterization, so if he was accepted for treatment, who would be excluded?

More important is the statistic (from a series of articles published on dialysis in the New York Times in 1996) that the death rate among dialysis patients in U.S. for-profit centers was 26% per year, thanks to the cost cutting in treatment to generate greater profits for the dialysis companies, while the death rate in the dialysis centers run by socialized medicine in other countries ranged from 9% per year in Japan to 13% in Canada.  Significantly, the death rate at U.S. not for profit dialysis centers was the same as that in countries with socialized medicine.  The U.S. government, which conceives of itself essentially as the agent of capitalist interests rather than of the people it purportedly represents, is deliberately lax in inspecting and enforcing compliance with medicare rules governing the standards of dialysis care at for-profit centers, since this helps the capitalists make more money by cutting corners on treatment, and so what if that means more sick people have to die?

[kitkatz]

A party at 90 for going on dialysis? What a crock!

[Bear]

Stauff' - "The U.S. government, which conceives of itself essentially as the agent of capitalist interests rather than of the people it purportedly represents, is deliberately lax in inspecting and enforcing compliance with medicare rules governing the standards of dialysis care at for-profit centers, since this helps the capitalists make more money by cutting corners on treatment, and so what if that means more sick people have to die?"
 Which is why, in discussions with people on "civilized countries" and which ones would you live in? I never include the U.S. (sorry guys!! )
But my definition of "civilized country" is one where the sick, elderly & disadvantaged are looked after. Apparently, according to certain archaeological evidence, even Neanderthals did this. Not that I'd call them civilized.
 Anyway, "NO!" that 'health professional' was talking pure bovine excreter. . And the folk at in-center dx run from mid=teens to mid 80s.
There are several retired people at my hospital with transplants too !   
 Pity about Stauff's assessment of U.K. dx tho.....I've been planning on going over to visit my Dad for some years (well since the last time) but dx & its complications have prevented me, so far...one of the "Cons" in the pros & cons of migrating, was leaving the NHS behind...but it seems to have turned into one of the "Pros" over the decades.

[angela515]

Which is why, in discussions with people on "civilized countries" and which ones would you live in? I never include the U.S. (sorry guys!! )

  I disagree.

[Bear]

Wooo that was quick!!   

[George Jung]

A party at 90 for going on dialysis? What a crock!

The party wasn't for starting dialysis, it was for turning 90.  At that age there probably was a reason to celebrate regardless of the setting.  I certainly wouldn't celebrate my b-day there but if I was 90 that may be different.

Health care can always be improved, world wide, in the U.S. or anywhere.  I feel that health care for profit is a very disturbing idea and there is something very wrong with it.

[Lucinda]

Thanks George.....glad you read it in the right context!! 

[RichardMEL]

Heck the average age of patients in my unit would be about 70 I reckon. This is dragged down by me, another young bloke and a 21 year old girl (that I know of).. most of them are more senior... and they're all pretty great !!

[Wattle]

 Which is why, in discussions with people on "civilized countries" and which ones would you live in? I never include the U.S. (sorry guys!! )

Thats a bit harsh.

[Wattle]

More important is the statistic (from a series of articles published on dialysis in the New York Times in 1996) that the death rate among dialysis patients in U.S. for-profit centers was 26% per year, thanks to the cost cutting in treatment to generate greater profits for the dialysis companies, while the death rate in the dialysis centers run by socialized medicine in other countries ranged from 9% per year in Japan to 13% in Canada.  Significantly, the death rate at U.S. not for profit dialysis centers was the same as that in countries with socialized medicine.  The U.S. government, which conceives of itself essentially as the agent of capitalist interests rather than of the people it purportedly represents, is deliberately lax in inspecting and enforcing compliance with medicare rules governing the standards of dialysis care at for-profit centers, since this helps the capitalists make more money by cutting corners on treatment, and so what if that means more sick people have to die?

Where are you getting these statistics from? I would like to know the stats for Australia.   

[rose1999]

My Dad didn't start dialysis until earlier this year and he's nearly 79, however he was told that he was "too old" for CAPD. We live in Shropshire, UK.  I'd be interested to know if any other countries tell people of his age that they are too old for CAPD as he'd like to try it but hasn't the confidence now that the hospital said this.  Maybe it's true and he is too old but any stories from people who did start CAPD or some other form of home dialysis at that age would be interesting.
Thanks

[Lucinda]

Hey Rose

My father was on it for about two years, started at 74 I think but they tried to get him on hemo as soon as possible because at our father's age there is a much higher risk of infection and at their age they have more of a battle fighting the infection.  Also, they really have to be pretty responsible with their own treatment and in my Dad's case he got an infection and he forgot how to use his machine so it was straight onto Hemo but I have to say, I think he did a lot better on CAPD. It seemed to suit him a lot better.

[BigSteve]

Thanks everyone. I knew I would get good and accurate information
from my fellow members of IHD, especially stauffenberg. The truth is
obviously my internist is arguing from a position of vested interest while
I am not since I have excellent private medical insurance along with
Medicare. Universal health care will not help me, but hopefully will prevent
the thousands of deaths each year of people without insurance.

[rose1999]

Hey Rose

My father was on it for about two years, started at 74 I think but they tried to get him on hemo as soon as possible because at our father's age there is a much higher risk of infection and at their age they have more of a battle fighting the infection.  Also, they really have to be pretty responsible with their own treatment and in my Dad's case he got an infection and he forgot how to use his machine so it was straight onto Hemo but I have to say, I think he did a lot better on CAPD. It seemed to suit him a lot better.

Thanks Lucinda, it's great to hear from someone who is in much the same position as I am.  Your reply has confirmed what I was thinking might be the case. Thanks for taking the time to reply.
Rose

[Zach]

Here's one perspective (a bit old from 2000):
http://www.aakp.org/aakp-library/Comparison-ESRD-Therapy-United-States-Overseas/