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Alan S. Kliger, MD

JAMA. 2007;298:1331-1333.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Dialysis treatments sustain the lives of nearly 400 000 US residents with end-stage renal disease (ESRD).¹ The mortality rate for dialysis patients is approximately 10 times that of the general population,^2-3 and each year more than 20% of dialysis patients die.¹ These statistics have hardly changed in the past decade. Morbidity also remains high: dialysis patients frequently also have cardiovascular disease, anemia, bone disease, poor nutrition, inflammation, depression, and physical and cognitive impairment.

Even though ESRD is a worldwide problem, outcomes differ in various regions. For instance, survival for patients receiving dialysis is better in Japan and Europe than in the United States.⁴ Are ESRD patients in the United States older or sicker than their Japanese or European counterparts? Goodkin et al⁴ reported that when survival was adjusted for patient demographics and comorbidities, the mortality differences narrowed, but persisted. Might genetic factors or geographic differences explain the . . . [Full Text of this Article]

Author Affiliations: Hospital of St. Raphael and Yale University, New Haven, Connecticut.

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