JAMA Logo Patients with impaired kidney function may be subjected to a dialysis, wherein a machine filters blood of the organ. This procedure seems to be very risky especially for those with an advanced kidney disease. A latest study suggests that initiating dialysis therapy earlier in the development of an advanced kidney disease leads to higher risk of death for some patients in the following year.

During the analysis, data from 81,176 patients aged 20 to 64 years who began dialysis between 1996 and 2006 was scrutinized. None of the patients were diagnosed with diabetes or any other co-occurring illness besides high blood pressure. While 9.4 percent patients died within the first year itself, 7.1 percent passed out in the second year. 20.1 percent patients with an early start to dialysis based on their eGFR and 6.8 percent who started later apparently had greater chances of death in the first year. 21 percent patients reporting lowest levels of albumin, a protein made by the liver, had an elevated risk of death in the first year. Similar threat was seemingly noted in 4.7 percent patients with highest albumin levels.

Experts highlight, “Hemodialysis is an invasive, lifelong, potentially dangerous intervention. These results and those of other recent studies have failed to find benefit in early dialysis and suggest the potential of harm. Initiation of hemodialysis should not be based on an arbitrary level of eGFR or serum creatinine level unless this measure is accompanied by definitive end-stage renal failure-related indications for hemodialysis.”

Increased risk of death may also be influenced by other factors such as age progression, being black or male and having a lower body mass index (BMI). Higher levels of hemoglobin, treatment in a later year, being Asian and having certain types of kidney disease like polycystic kidney disease or glomerular disease were presumably related to survival. Steven J. Rosansky, M.D., of Wm. Jennings Bryan Dorn Veterans Hospital and the University of South Carolina, Columbia, and colleagues believe that those starting dialysis early have greater death rate because of sudden cardiac death or recurring myocardial ischemia. In recurring myocardial ischemia, blood flow to the heart may be interrupted resulting in lasting defects in the heart’s left ventricle.

The study is online and will be published in the March 14 print issue of Archives of Internal Medicine, one of the JAMA/Archives journals.