Better Preparation Before Dialysis Improves Survival

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ORLANDO, Fla.—Patients with renal disease who are well prepared to start dialysis are significantly more likely to survive their first year of treatment, a study found.

“Most of the research in the area of predialysis care has focused on getting patients to see kidney specialists early to allow for adequate time for dialysis preparation,” said one of the investigators, Yelena Slinin, MD, of the Minneapolis VA Medical Center and the University of Minnesota in Minneapolis. “Our study revealed that even patients who have been seen by kidney specialists for over a year come to dialysis poorly prepared.”

As part of its Kidney Disease Outcomes Quality Initiative, the National Kidney Foundation has issued guidelines to help identify renal disease sooner in order to improve dialysis care. These guidelines recommend that patients should have an arteriovenous graft (AVG) or arteriovenous fistula (AVF) in place prior to the start of dialysis and that they have adequate blood hemoglobin levels and albumin levels.

Dr. Slinin and her colleagues looked at 192,307 patients who began dialysis between June 1, 2005 and May 31, 2007 to ascertain whether those who attained these goals would have a survival advantage. They found that 59% of subjects did not meet any of these goals, 30% met one, 9% achieved two, and only 2% met all three.

Compared with subjects who met none of the goals, those who met one goal had a 19% reduced risk of death within the first year; those who met two and three goals had a 47% and 66% reduced risk, respectively. Having an AVG or AVF in place by itself reduced the risk of death by 44%.

Many of the infection-related deaths potentially can be prevented by having vascular access other than a catheter at the start of dialysis, Dr. Slinin said.
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