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Geography may determine kidney failure treatment level

Where you live determines the type of care you get if you have kidney failure, according to a study to be published tomorrow in the Journal of the American Medical Association.

The study, which was conducted at the University of Washington, found that there are pronounced regional differences in treatment practices for older adults with kidney failure including the decisions about starting or stopping dialysis, that don't seem to be explained by differences in patient characteristics, said Manjula Kurella Tamura, MD, senior author of the study and assistant professor of nephrology at Stanford.

The study was motivated by much of the health-care reform debate centered on Medicare cost variations across the country that did not seem to be based on patient preference or clinical guidelines. Certain regions of the country simply practice a more aggressive - or, put another way, more expensive - form of health care at the end of life. But, according to Kurella Tamura, people who live in these high-spending areas don't tend to fare any better than the low-spending areas.

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