Wednesday, 18 July 2012

Problems when patients start dialysis too soon.

The glomerular filtration rate (GFR) quantifies the rate at which filtered fluids are processed by the kidneys. By medical consensus, a GFR of 10 is deemed “early” for dialysis. But recently, the number of elderly people (those 75 and over) who started dialysis when their GFR was lower than 10 increased from 1 in 4 (in 1996) to more than 6 in 10 (in 2009), according to an article at The Journal of the American Medical Association.

It is suggested that with medics receiving a referral fee from dialysis centres, patients were being referred sooner than necessary. Whether or not this is a factor, the article says that early introduction to dialysis is not justified. Elderly patients with age related decreases in muscle mass may have higher GFR due to this problem instead. And being subjected to dialysis can lead to a higher risk of death, while a controlled trial found no benefit from starting dialysis early. Indeed the article stated that for those over 80, they were more likely to die from other causes before starting dialysis.

The article ends with the following statement:
"The public perception that pursuit of dialysis is always in patients' best interest should be replaced by a more realistic view of the “sad truth” about early dialysis initiation in elderly patients."

Tuesday, 3 July 2012

Dialysis demand increases after elective surgery

Elective surgery - surgery which can be scheduled in advance as it does not involve a medical emergency.

The number of patients needing dialysis after major elective surgery has tripled since 1995, a Canadian study reported here suggests.

Researchers reviewed data on 552,672 patients in Ontario who had elective major surgery in the province between 1995 to 2009. Out of this group, 2,231 received acute dialysis within 14 days after surgery. This represents an increase from 0.2 percent in 1995 to 0.6 percent in 2009. An extra 0.4 percent might not seem much, but it's 1487 more people!

According to kidney specialist Dr. Amit Garg of London Health Sciences Centre, when someone develops the complication and is sick enough after surgery to need dialysis, 40 per cent will unfortunately have died at 90 days. So it's a very high risk of death in patients who develop this complication. And in those who survive 90 days, one fourth are now left with permanent kidney failure needing ongoing maintenance dialysis and those outcomes haven't changed in the last 15 years.

Older, sicker patients may be higher risk of acute kidney injury, the researchers said, with people who already had weak kidneys, or high blood pressure or diabetes before the surgery at highest risk.