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Dialysis timing does not affect mortality in ESRD patients with heart disease

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – New research indicates that whether hemodialysis is given early or delayed has no bearing on morbidity or mortality in patients with end-stage renal disease (ESRD) who have had an acute MI.

After an MI, the common practice is to delay dialysis, which increases the risk of cardiac events and of mortality after MI, but whether dialysis really improves outcomes is unclear, Dr. George Coritsidis, from Elmhurst Hospital Center, New York, and colleagues note in the July 9th online issue of the Clinical Journal of the American Society of Nephrology.

To investigate, the researchers analyzed data from 131 long-term hemodialysis patients who were admitted with an acute MI to one of three New York City hospitals from 1997 to 2005. The subjects were divided into three groups based on the timing of dialysis after MI: less than 24 hours, 24 to 48 hours, and more than 48 hours.

Seventeen (13%) patients died, including 10 (59%) who had an arrhythmia or hypotension during their first dialysis session in the cardiac care unit, the report indicates.

The timing of dialysis had no statistically significant effect on morbidity or mortality. With dialysis <24 hours, 24 to 48 hours, and >48 hours after MI, the morbidity rates were 26%, 36%, and 20%, respectively. The corresponding mortality rates were 11%, 18%, and 13%.

Correlates of peridialysis morbidity included elevated predialysis potassium, greater change in potassium after dialysis, prior cardiac disease, and greater APACHE scores.

“Our study does not indicate that timing of dialysis poses a risk,” the authors conclude. “What may be of greater importance is the K+ status and its treatment and the severity of the patient’s condition on admission, as identified by APACHE scores.”

Clin J Am Soc Nephrol 2009.