December 7, 2010

Increased Risk Of Death When Dialysis Is Started Too Early

(Ivanhoe Newswire) -- The kidneys are responsible for filtering waste products from the blood, and when renal failure occurs and the kidneys can no longer work adequately, dialysis is used to substitute many of the organ's normal duties.  Starting dialysis early on can save patient's lives, however, starting the procedure too early may increase the risk of death.  A recent report from Canada gives insight into how early is too early when starting dialysis.

Glomerular filtration rate (GFR) describes the flow rate of filtered fluid through the kidney and is furthermore associated with early dialysis initiation.  The test can be calculated by measuring any chemical that has a steady level in the blood, and is freely filtered but neither reabsorbed nor secreted by the kidneys.  Current guidelines in the United States place more emphasis on GFR dialysis timing.  Analysis of dialysis registries in the United States and Europe indicates that patients are starting dialysis earlier.

The study looked at data on 25,91 adult patients in Canada who started dialysis between 2001 and 2007.  Dr. William Clark, Nephrologist at London Health Sciences Centre and Scientist at Lawson Health Research Institute, and co-authors looked at the timing (early vs. late) and the risk of death in both of these groups over time.

"The consistent absence of a survival benefit with early initiation of dialysis across a variety of study designs, populations and health care delivery systems supports the conclusion that early initiation confers no survival benefit, and argues against pre-emptive initiation of dialysis in asymptomatic patients," which Clark was quoted as saying.  "In contrast to early initiation of dialysis, early referral to a nephrologist is consistently associated with better survival."

Further research into detecting the signs, symptoms and laboratory test results associated with a higher death rate and worsened quality of life in patients with kidney failure is needed.

SOURCE: Canadian Medical Association Journal, 6 December 2010