The Diabetic Foot: Speaking the Language of Risk

Preventive medical screening is not appropriate for many chronic dialysis patients

Establishing guidelines for the appropriate preventive medical care for chronic dialysis patients requires consideration of many factors. These include the population's underlying risk factors and expected survival, the effectiveness of screening procedures in improving the duration and/or quality of life, and the potential for renal transplantation. Although many nephrologists order and direct routine cancer screening in their dialysis patients, recent studies suggest such screening is not cost effective. Cardiovascular disease is the leading cause of death among end-stage renal disease (ESRD) patients and peripheral vascular disease is a leading cause of morbidity among dialysis patients, but even less is known about the cost-effectiveness of screening for peripheral vascular and cardiovascular disease risks in ESRD patients. Despite a recently reported overall standardized cancer incidence of 1.18 in dialysis patients compared with normal populations, the shortened expected survival of dialysis patients argues against routine cancer screening in this population. Dialysis units and nephrologists should focus cancer screening on individual patients and include specific cancer risk as well as expected survival assessments and transplant candidacy in their decisions to screen a patient for cancer. Routine cancer screening of all dialysis patients is not indicated. Additional study of the benefits and cost-effectiveness of screening ESRD patients for cardiovascular and peripheral vascular disease risk factors is needed.