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Dialysis Timing Shows No Affect On Mortality In ESRD Patients With Heart Disease

According to a new research, there is no affect of hemodialysis, whether given early or is delayed, on morbidity or mortality in patients with end-stage renal disease (ESRD) who have had an acute MI.

Dr. George Coritsidis, from Elmhurst Hospital Center, New York, and team reported that delayed dialysis increases the risk of cardiac events and of mortality after MI, but it is unknown whether the dialysis really improves outcomes.

The team analyzed data collected 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. Based on the timing of dialysis after MI the subjects were divided into three groups: less than 24 hours, 24 to 48 hours, and more than 48 hours.

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

There was no statistically significant effect of dialysis timings 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%.

Peridialysis morbidity correlation 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.