VARIATION IN END-STAGE RENAL-DISEASE PATIENT OUTCOMES - WHAT WE KNOW,WHAT SHOULD WE KNOW, AND HOW DO WE FIND IT OUT

The size and expense of the ESRD program exceed all predictions made w hen the program was first initiated. Although the effectiveness of dia lytic therapy is unquestioned, its value (quality/cost) is actively de bated in this era of constricting resources. To better evaluate the qu ality of the ESRD program, it is essential to first define and quantit ate the outcomes of dialytic care. Although mortality is a convenient outcome measure, it may be affected by many patient-specific as well a s other factors that must be considered when evaluating and comparing new and existing technologies or advances. Quality of life is only beg inning to be used in depth as an outcome measure, and much work is nee ded to standardize research methodology and thus move this area forwar d. The following review describes the current state of knowledge regar ding outcomes of ESRD patients and proposes areas for future investiga tion, which should help increase the understanding of the value of the ESRD program to patients, providers, and payors.