Antibiotics for acute sinusitis in general practice

Is there a rationale for rationing chronic dialysis? Two points need clarificationEditor-I agree with Chandna et al that late referral is an important factor in the survival of patients receiving dialysis. 1I am unaware, however, of the source of their information that an NHS consensus statement recommends that nephrology referrals be made at a serum creatinine concentration > 135 mol/l in women and > 180 mol/l in men.The workload generated by this practice would be so enormous that British renal units under present conditions would be unable to cope.I am also concerned that of the authors' 292 patients receiving dialysis, 26 (admittedly high risk) patients spent 44% of their lives in hospital.The costs of inpatient treatment for these high risk patients would be substantially higher than the average cost of £250 a day that the authors quote.