Early Kidney Dialysis Linked to Premature Deaths

Kathleen Blanchard's picture
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Starting dialysis early could put patients at risk for premature death, despite recommendations to the contrary. Researchers studying dialysis patients in Canada found an unexplained 18 percent higher chance of early mortality when patients with kidney dysfunction started dialysis early.

More Research Needed to Determine Best Time for Dialysis

Between 2001 and 2007, researchers William Clark, MD, a scientist at Lawson Health Research Institute and Professor at The University of Western Ontario, in London, Canada and his colleagues studied 25,901 kidney dialysis patients; noting the trend of starting earlier in the disease.

Compared to patients whose dialysis was initiated later, there was an 18 percent higher death rate that the researchers say cannot be explained by baseline characteristics.

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Between the two groups, mortality rates were higher at 6, 12, 30, and 36 months. Dr. Clark says, “This research indicates that a well intentioned rising trend of early initiation of hemodialysis in patients shows no benefit and possible harm.”

Another recent analysis from Steven J. Rosansky, MD, of Wm. Jennings Bryan Dorn Veterans Hospital and the University of South Carolina, Columbia, and colleagues, published November 8 in the Archives of Internal Medicine looked at data from 81,176 patients who began dialysis between 1996 and 2006, between ages 20 to 64. The results also showed higher death rates - 9.4 percent of patients died within the first year and 7.1 percent died the second year.

The authors wrote, "The appropriate timing for initiating hemodialysis relative to estimated levels of residual renal function is an important, but as yet unresolved, question having considerable patient outcome and financial consequences. Since 1996, more U.S. patients have begun dialysis early as indicated by their estimated glomerular filtration rate (a measure of kidney function).”

The authors concluded dialysis should not be started unless there are definitive indications of end stage kidney disease, pointing out that hemodialysis is “an invasive, lifelong, potentially dangerous intervention. The VA team concluded ongoing research should focus on “examining the quality-of-life implications of timing of dialysis initiation” that could do more harm than good and lead to premature death.

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