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Early Initiation of Hemodialysis May Be Harmful

Early start of hemodialysis appears to be more harmful than beneficial in relatively healthy group

WEDNESDAY, Nov. 10 (HealthDay News) -- Initiating hemodialysis early, at an estimated glomerular filtration rate (eGFR) of at least 10 mL/min/1.73 m², may be harmful to relatively healthy patients, according to a study published online Nov. 8 in the Archives of Internal Medicine.

Steven J. Rosansky, M.D., of Wm. Jennings Bryan Dorn Veterans Hospital in Columbia, S.C., and colleagues evaluated demographics, year of dialysis initiation, primary etiology of renal failure, body mass index, hemoglobin, and serum albumin levels in 81,176 in-center incident hemodialysis patients, 20 to 64 years of age, without diabetes and other comorbidities, aside from hypertension. The investigators also performed time-dependent adjusted analysis stratified by initial serum albumin 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 investigators found that the unadjusted one-year mortality by eGFR ranged from 6.8 percent in the reference group to 20.1 percent in the highest eGFR group. The hazard ratios for the HG compared to the reference groups were 1.27 (eGFR, 5.0 to 9.9 mL/min/1.73m²), 1.53 (eGFR, 10.0 to 14.9 mL/min/1.73 m²), and 2.18 (eGFR, ≥15.0 mL/min/1.73 m²). In the first year of dialysis for the early-start group, the hazard ratios ranged from 1.50 to 3.53 mL/min/1.73 m².

"I believe that recent studies should make us think carefully about the timing of dialysis initiation," writes the author of an accompanying editorial. "From a research perspective, we need to focus our efforts on examining the quality-of-life implications of timing of dialysis initiation."

One study author disclosed financial relationships with pharmaceutical and medical technology companies.

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