Preventive medical screening is not appropriate for many chronic dialysis patients

Establishing guidelines for the appropriate preventive medical care for chr onic dialysis patients requires consideration of many factors. These includ e the population's underlying risk factors and expected survival, the effec tiveness of screening procedures in improving the duration and/or quality o f life, and the potential for renal transplantation. Although many nephrolo gists order and direct routine cancer screening in their dialysis patients, recent studies suggest such screening is not cost effective. Cardiovascula r 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-effectivenes s of screening for peripheral vascular and cardiovascular disease risks in ESRD patients. Despite a recently reported overall standardized cancer inci dence of 1.18 in dialysis patients compared with normal populations, the sh ortened expected survival of dialysis patients argues against routine cance r screening in this population. Dialysis units and nephrologists should foc us 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 co st-effectiveness of screening ESRD patients for cardiovascular and peripher al vascular disease risk factors is needed.