Early Dialysis Treatment Increases Mortality Risk

"This trend has occurred despite no substantial evidence of benefit of early initiation of hemodialysis and many recent publications suggesting potential harm. Hemodialysis is an invasive, lifelong, potentially dangerous intervention."

"According to USRDS data, between 1996 and 2008 the fraction of patients initiating hemodialysis with an eGFR higher than 10 mL/min/1.73m2 increased from 20% to 52% and the fraction of those with a starting eGFR of 15 mL/min/1.73m2 or higher increased from 4% to 17% of the incident hemodialysis population," researchers say.

Reasons for the higher rate of death might include:

• Drops in blood pressure
• Heart irregularities
• Ischemia "with fixed dystolic function induced by conventional three-weekly hemodialysis"
• Increasing age
• Being black or male
• Having a lower weight BMI

In a related editorial entitled "Time to Rethink the Timing of Dialysis Initiation," Kirsten Johansen, MD, of the San Francisco VA Medical Center suggests that clinicians take a close look at the data and re-evaluate the timing of initial dialysis.