Early-Start Dialysis Does Not Improve Acute Kidney Injury Outcomes

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Earlier initiation of dialysis does not improve outcomes among patients with community-acquired acute kidney injury (AKI), and it may be associated with delayed recovery of kidney function, according to researchers.

Tukaram E. Jamale, MD, of KEM Hospital in Parel, Mumbai, and colleagues prospectively studied 208 adults with AKI and progressively worsening azotemia. They were randomly assigned to receive earlier-start dialysis (102 patients) or usual-start dialysis (106 patients).

Earlier-start dialysis was initiated when serum urea nitrogen and/or creatinine levels increased to 70 and 7 mg/dL, respectively. Usual-start dialysis patients (controls) received dialysis when clinically indicated as judged by treating nephrologists. The primary outcome was in-hospital mortality and dialysis dependence at three months.

In-hospital mortality was 20.5% in the earlier-start group and 12.2% in the control arm, a non-significant difference, Dr. Jamale's group reported online ahead of print in the American Journal of Kidney Diseases. The study also revealed no significant difference between the groups with respect to dialysis dependence at three months (4.9% and 4.7%, respectively). Furthermore, the time to recovery of kidney function was significantly longer in the earlier-start than the usual-start group (mean 6.63 vs. 4.70 days).

Uremic symptoms were the most common reason patients in the usual-start group were placed on dialysis.

“Our results do not mean that one should wait for a life-threatening uremic complication to develop before initiation of dialysis therapy; close clinical and laboratory monitoring can identify patients who need dialysis early,” the investigators wrote.

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