WEDNESDAY, Oct. 14 (HealthDay News) -- Dialysis may not be worth undertaking for many older Americans in nursing homes who suffer kidney failure in addition to other ailments, a study finds.

The research, published in the Oct. 15 issue of the New England Journal of Medicine, found that this intervention failed to lengthen or improve most patients' lives.

"The hope was that even if dialysis [artificial kidney treatment] doesn't extend life, it might improve quality of life," said study lead author Dr. Manjula Kurella Tamura, assistant professor of nephrology at Stanford University School of Medicine. "We wanted to look at whether this might be true."

But the study of more than 3,700 nursing home residents found that few were better able to perform activities of daily living, such as eating, dressing and using the bathroom, following dialysis, and many actually suffered declines in those areas.

Indeed, only one of every eight of the people in the study was able to maintain pre-dialysis functional capacity, Kurella Tamura said.

In the 12 months after starting dialysis, 58 percent of the participants died.

Americans over the age of 80 are the fastest-growing segment of the 400,000-strong U.S. dialysis population, and at least a third of them have other chronic illnesses, such as heart disease or diabetes, she said.

"In these types of patients, kidney failure often occurs in the context of other serious conditions," Kurella Tamura noted. "The failure to show improvement may be a manifestation of these other conditions."

And dialysis itself can tax weak, elderly people, she added. "They have to travel to treatment centers, and treatment can take three to four hours three times a week," Kurella Tamura said. "That takes a lot of time and can be cumbersome. It also takes away time when patients might be in programs to improve functional capacity."

The study results can help both doctors and older nursing home patients make educated decisions about dialysis, she said. "These results will be surprising even for doctors who care for dialysis patients on a daily basis," Kurella Tamura said. "They can lead to more informed discussions with patients about the expected prognosis and options for palliative care. They can help patients make informed decisions about treatment options."

Even now, one-fourth to one-third of such elderly people who opt for dialysis choose to end it, she said.

The findings help build a case for appropriate expectations, another expert said.

"There has been some earlier work that suggested that the course of frail elderly people was not very promising when they started dialysis," said Dr. Peter Aronson, professor in the nephrology section at Yale School of Medicine, who was familiar with the study. "This is the first to look at the subject in detail and document what happens when they start dialysis."

A weakness of the study was that it did not have a control group of elderly nursing home residents with a similar degree of kidney failure who did not receive dialysis, Aronson said. But there are obvious reasons why such a controlled study would be difficult to conduct, he said.

The study "does not make the case that if you are old, you shouldn't have dialysis," Aronson said. "And it should not be turned into an argument that we should ration dialysis, but it is important to have realistic expectations about whether dialysis will help you get better."

The issue of medical care for such old, frail people is "very difficult, both medically and ethically," Aronson said. "We should not ration it or withhold it from anybody, but it is important for doctors and patients to have realistic expectations about what to expect and to have appropriate discussions about end-of-life care."

More information

For more on dialysis, see the U.S. National Library of Medicine.

TUESDAY, Sept. 29 (HealthDay News) -- Most Americans don't eat the recommended amounts of fruits and vegetables, says a U.S. government study released Tuesday. And no state has achieved national objectives for consumption of fruits and vegetables, it found.

The goal for the Healthy People 2010 program is to get at least 75 percent of Americans to eat the recommended two or more daily servings of fruit and for at least 50 percent of Americans to consume three or more daily servings of vegetables.

But surveys from the U.S. Centers for Disease Control and Prevention show that only 33 percent of adults meet the fruit consumption target and only 27 percent eat the recommended amount of vegetables. The statistics are worse for high school students -- only 32 percent eat the recommended amount of fruit and 13 percent meet the goal for vegetables.

"A diet high in fruits and vegetables is important for optimal child growth, maintaining a healthy weight, and prevention of chronic diseases such as diabetes, heart disease and some cancers, all of which currently contribute to health care costs in the United States," Dr. William H. Dietz, director of the CDC's Division of Nutrition, Physical Activity and Obesity, said in a CDC news release.

"This report will help states determine what is taking place in their communities and schools and come up with ways to encourage people to eat more fruits and vegetables," Dietz said.

The report -- the State Indicator Report on Fruits and Vegetables, 2009 -- is the first to detail state-by-state data about fruit and vegetable consumption and policies that may help boost fruit and vegetable consumption.

It spotlights three important policy and environmental areas associated with fruit and vegetable consumption: healthier food retail, availability of healthier foods in schools, and food system support.

Food stores that stock a variety of high-quality fruits and vegetables can play a key role in residents' health, the report notes. But only eight states have a policy for healthier food retail improvements that can increase the number of full-service grocery stores in areas where they're lacking, increase the availability of healthier foods in small food stores, and promote healthier foods by providing information to consumers in food stores.

Schools can influence better eating by students, staff, parents and other members of the community. But the report found that only 21 percent of U.S. middle schools and high schools offer fruits and non-fried vegetables in vending machines, school stores or snack bars. Fewer than half the states (21) have policies to support farm-to-school programs that can increase access to fruits and vegetables and teach students about nutrition and agriculture.

The report also mentioned food policy councils, which are organizations that look at access to fresh produce at the community and state levels. Food policy councils make recommendations about policies and programs such as community gardens, farmers' markets, availability of fresh produce in supermarkets and farm-to-school programs. Currently, 59 local food policy councils operate across the United States, and 20 states have a state-level food policy council.

"We have seen the tremendous benefit of state and local officials, health professionals, employers, food store owners, farmers, school staff, and community members working together on food and nutrition issues," CDC epidemiologist Heidi Michels Blanck said in the news release. "Their efforts can help to increase the availability of affordable healthier food choices such as fruits and vegetables."

More information

Here's where you can learn more about Healthy People 2010.

WEDNESDAY, July 1 (HealthDay News) -- Despite recent studies suggesting that the injected diabetes drug Lantus (insulin glargine) might boost cancer risk, the U.S. Food and Drug Administration on Wednesday urged patients who are on the medication to continue using it.

Three of four studies published last Friday in Diabetologia showed a potential link between Lantus -- an insulin analogue made by French drug company Sanofi-aventis -- and increased risks for various tumor types.

But, "the duration of patient follow-up in all four studies was shorter than what is generally considered necessary to evaluate for cancer risk from drug exposure," the FDA said in its first comment on the issue. "Further, inconsistencies in findings within and across individual studies raise concerns as to whether an association between the use of insulin glargine and cancer truly exists."

The agency also believes that differences in the various types of patients selected for each study may have swayed the results.

"Based on the currently available data, the FDA recommends that patients should not stop taking their insulin therapy without consulting a physician, since uncontrolled blood sugar levels can have both immediate and long-term serious adverse effects," the agency wrote.

A statement released Friday by the American Diabetes Association echoed the FDA's position. "For patients using glargine and considering switching to another form of insulin, the data in these studies make it unclear as to whether any one type of insulin increases the risk of cancer more than other types of insulin," the ADA said. "Patients concerned about these studies or their insulin regimen should talk to their doctor and should not stop taking their insulin on the basis of the findings reported here."

Lantus is an "analogue," or artificial version, of insulin and is used by both type 1 and type 2 diabetics to help control blood sugar over an extended period of time. It is given by injection once daily.

The FDA says it is "currently reviewing many sources of safety data for Lantus," including completed and ongoing observational and clinical trials, and may ask Sanofi to conduct further trials should they be deemed necessary.

According to the Wall Street Journal, a spokesman for Sanofi said that the company is working with the FDA on this issue and continues to stand behind the drug's safety.

In the meantime, the FDA says it "encourages both health care professionals and patients to report side effects from the use of insulin glargine to the FDA's MedWatch Adverse Event Reporting Program."

More information

Find out more about diabetes at the American Diabetes Association  .