How Providers First Did More Harm This Week
The second story about unintended harm has to do with dialysis centers. Researchers working with a Centers for Disease Control and Prevention project found patients who are put on dialysis early on in their disease process, in an effort to deal with more minor symptoms of their disease, end up with a nearly triple rate of death in one year than patients who enter dialysis later on.
The authors suggested several possible mechanisms for what might be causing higher mortality rates, such as rapid lowering of blood pressure that could cause unanticipated cardiac events.
But as the authors noted in their report in the Archives of Internal Medicine, () the percentage of patients who were put on hemodialysis much earlier in the course of their disease increased from 20% in 1996 to 52% in 2008. "This trend has occurred despite no substantial evidence of benefit of early initiation of hemodialysis and many recent publications suggesting potential harm," wrote Steven Rosansky, principal author and senior research fellow at Dorn Research Institute in Columbia, SC.
In an accompanying editorial, Kristen Johansen MD of the San Francisco VA Medical Center, concurred, saying research to date does not support current practice of initiating dialysis—a costly and time-consuming and dangerous process—in patients who are not yet that sick.
"The bar for these symptoms has been dramatically lowered in recent years with no data to support a benefit to patients," she wrote.
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