There are only two outcomes that are important: quantity of life and quality of life. We don’t know how to measure quality of life and haven’t shown an ability to change the former.
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3 Replies to “David Spiegel on the treatment of dialysis patients”
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How right you are!! However, I would put quality of life before quantity of life. Gary Peterson of RenalWEB said it well: "I believe it is time to redefine care in terms of patient life experiences." Ask patients how they feel and if they are able to do all the things that are personally meaningful to them. Qaulity of life measures should be defined by the patient. In my opinion, biochemical markers are a very small part of the equation. I am a huge fan of Dr. John Agar's "Good Dialysis Index" (See article at http://www.kidneytimes.com)
This viewpoint is very personal. My late husband was a HHD patient for 25 years. He worked full time, helped raise our son, played golf,and was involved in our community. That was his definition of quality of life.
Denise Eilers, RN, BSN
Amen. And your view is exactly why we can't put a number on it. It is just too personal.
I agree with Denise that QOL is important, but Quantity is too. I firmly believe I would have died several years ago have I not moved home with my treatments. That alone is responsible for my better QOL today. We obviously have to look at both, and certain markers are most important in determining survivability, and Kt/V surely isn;t one of the highest. Being able to optimally manage fluid and phosphorus are among the highest I look at. Having had a heart attack driving home from an in-center treatment, maintaining my wleectrolytes comes first.
Now that I've survived, I can have a tremendous QOL.
Rich Berkowitz