WASHINGTON—Starting hemodialysis early, even in a group of health patients, could be harmful, according to a study published in the March 14 issue of the Archives of Internal Medicine.
“A dramatic increase in the "early start" of dialysis with an estimated glomerular filtration rate (eGFR) at least 10 mL/min/1.73 m2 has occurred in the United States since at least 1996,” the authors wrote. “Several recent studies have reported a comorbidity-adjusted survival disadvantage of early start of dialysis. The current study examines a relatively ‘healthy’ dialysis cohort to minimize confounding issues and determine whether early initiation of hemodialysis is associated with a survival benefit or harm.”
For the study, researchers looked at patient demographics, when they started dialysis, and the reason for the renal failure. They also examined patients’ body mass index, hemoglobin and serum albumin levels in 81,176 non-diabetic, in-center hemodialysis patients, who were between 20 years old and 64 years old with no other reported comorbitities other than hypertension.
Survival was compared, using a piecewise proportional hazards model to estimate covariate-adjusted mortality hazard ratios (HRs) for eGFR at the time of initiation of dialysis. “We also performed time-dependent adjusted analysis stratified by initial serum albumin levels lower than 2.5 g/dL, 2.5 to 3.49 g/dL, and 3.5 g/dL or higher (the ‘healthiest" group [HG]’),” the researchers wrote.
The researchers found the unadjusted one-year mortality by eGFR ranged from 6.8 percent in the reference group (eGFR <5.0 mL/min/1.73 m2) to 20.1 percent in the highest eGFR group (15.0 mL/min/1.73 m2). Compared with the reference group, the HR for the HG was 1.27 (eGFR, 5.0-9.9 mL/min/1.73 m2), 1.53 (eGFR, 10.0-14.9 mL/min/1.73 m2), and 2.18 (eGFR 15.0 mL/min/1.73 m2) and ranged from 1.50 to 3.53 mL/min/1.73 m2 in the first year of dialysis for the early-start group.
Therefore, the researchers concluded that “the increased HR during hemodialysis associated with early start in the healthiest group of patients undergoing dialysis indicates that early start of dialysis may be harmful.”
