Starting Dialysis Early May Worsen Outcomes

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Elderly patients who start dialysis early rather than late are at increased risk for death and hospitalization, even after adjusting for patients' predialysis health status and healthcare use, according to study findings published online ahead of print in the Journal of the American Society of Nephrology.

“These findings do not support the common practice of early dialysis initiation among older adults in the United States,” concluded a research team led by Deidra C. Crews, MD, of the Johns Hopkins Bayview Medical Center in Baltimore.

She and her colleagues analyzed data from 84,654 patients aged 67 years or older. Among propensity-matched patients, early dialysis initiation was associated with an 11%, 13%, and 13% increased risk of all-cause, cardiovascular, and infectious mortality, respectively, as well as a 3% and 10% increased risk of all-cause and infectious hospitalizations, respectively.

The researchers defined early initiation as starting dialysis with an estimated glomerular filtration rate (eGFR) of 10 mL/min/1.73 m2 or greater and late initiation as starting dialysis with an eGFR below 10. Fifty-eight percent of the study population started dialysis early.

According to the investigators, the study revealed previously unreported independent risk factors for early initiation, namely congestive heart failure admissions and other hospitalizations prior to initiation.

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