Early start of hemodialysis may be harmful

January 01, 0001

Early start of hemodialysis may be harmful

A dramatic increase in the early start of dialysis with an estimated glomerular filtration rate (eGFR) at least 10 mL/min/1.73 m2 has occurred in the United States since at least 1996. Several recent studies have reported a comorbidity-adjusted survival disadvantage of early start of dialysis. The US and Canadian authors examined demographics, year of dialysis initiation, primary etiology of renal failure, and body mass index, hemoglobin, and serum albumin levels in 81,176 nondiabetic, 20- to 64-year- old, in-center incident hemodialysis patients with no reported comorbidity besides hypertension. They compared survival, using a piecewise proportional hazards model to estimate covariate-adjusted mortality hazard ratios (HRs) for eGFR at the time of initiation of dialysis. They separately analyzed by initial serum albumin levels lower than 2.5 g/dL, 2.5 to 3.49 g/dL, and 3.5 g/dL or higher (the healthiest group {HG}).

They found: "Unadjusted 1-year mortality by eGFR ranged from 6.8% in the reference group (eGFR <5.0 mL/min/1.73 m2) to 20.1% in the highest eGFR group (15.0 mL/min/1.73 m2). Compared with the reference group, the HR for the HG was 1.27 (eGFR, 5.0-9.9 mL/min/1.73 m2), 1.53 (eGFR, 10.0-14.9 mL/min/1.73 m2), and 2.18 (eGFR 15.0 mL/min/1.73 m2) and ranged from 1.50 to 3.53 mL/min/1.73 m2 in the first year of dialysis for the early-start group."

The authors concluded: "The increased HR during hemodialysis associated with early start in the healthiest group of patients undergoing dialysis indicates that early start of dialysis may be harmful."

Caution with the initiation of early hemodialysis unless randomized controlled trial data prove otherwise.

For the full abstract, click here.

Arch Intern Med 171(5):396-403, 14 March 2011
© 2011 to the American Medical Association
Early Start of Hemodialysis May Be Harmful. Steven J. Rosansky, Paul Eggers, Kirby Jackson, Richard Glassock, William F. Clark. Correspondence to Dr. Rosansky: sjrcra@yahoo.com

Category: U. Urinary. Keywords: hemodialysis, estimated glomerular filtration rate, eGFR, hypertension, mortality, cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 29 March 2011

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