Study Warns of Risks for Early Dialysis11/08/10
MONDAY, Nov. 8 (HealthDay News) -- Putting people on dialysis
early, while their kidneys still have adequate function, may
increase the chances that they'll die in the year after the
procedure is started, a new study suggests.
Dialysis, which mechanically filters the blood, helps people
with advanced kidney disease live longer, control their illness and
improve their quality of life, the researchers say.
"The question this research addresses is what is going on with regard to patients being put on dialysis at higher and higher levels of kidney function," said the lead researcher, Dr. Steven J. Rosansky, senior research fellow at the Dorn Research Institute of the William Jennings Bryan Dorn VA Medical Center in Columbia, S.C., and an adjunct professor at the University of South Carolina.
The assumption is that people are put on dialysis because they
have no kidney function, but that's not the case, Rosansky said.
Though dialysis used to be used for people with 1 or 2 percent of
their kidney function, he said, today people with more than 15
percent kidney function are receiving dialysis, and that number is
But the question remains, he said, as to the optimum time for
putting someone on dialysis: "Is it beneficial at higher levels of
kidney function, over 5 percent, say?"
Apparently not, according to the study, published online Nov. 8
Archives of Internal Medicine.
"We found that there is a remarkably higher risk of death in healthy people that are being put on dialysis at higher levels of kidney function," Rosansky said.
For the study, Rosansky's team collected data on 81,176 people
who started dialysis between 1996 and 2006. None of the
participants had diabetes or any other medical condition except
high blood pressure.
The researchers found that about 9 percent of the participants
died during the first year of treatment, and 7 percent died during
the second year of dialysis.
People who started dialysis early, based on their kidney
function, were more likely to die in the first year than were those
who started dialysis at a later stage of their disease: about 20
percent vs. 7 percent, the study found.
In addition, those with the lowest levels of albumin -- a
protein made by the liver --also were at an increased risk for
dying in the first year, compared with those with the highest
albumin levels (21 percent vs. 5 percent), the researchers
Other factors linked to an increased mortality risk were
increasing age, being black or male and having a lower body mass
Having higher levels of hemoglobin, being treated at a later
stage, being Asian and having certain types of kidney disease were
linked with better survival, the study found.
Rosansky said that other studies have also found no benefit to
"The bodies of physicians that write guidelines need to reexamine their recommendations for putting people on dialysis at higher and higher levels of kidney function since there is no benefit seen in any studies," he said.
Dr. Kirsten L. Johansen, a nephrology professor at the
University of California, San Francisco, and the San Francisco VA
Medical Center, who wrote an editorial that accompanied publication
of the study, said that "we don't have a lot of data to show that
it is beneficial to start dialysis earlier, and it may be
Starting dialysis is a judgment call, Johansen said. "But, over
the years we have been doing it earlier and earlier," she said. "We
really need to step back and say that the question shouldn't be,
'Does the patient have symptoms of kidney disease?' but 'Does this
patient have enough symptoms that they'd be better off on
Years ago, doctors tried to keep people off dialysis as long as
possible, Johansen said. Now, she said, the pendulum had swung too
far in the other direction.
There are downsides to dialysis, such as infection and other
problems, she noted, and "we need to think about [whether they] are
sick enough that the downside is going to be justified in the
improvement in their condition."
Doctors and patients need to discuses dialysis, including when
it would provide the most benefit, Johansen said.
The National Kidney Foundation has more on
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