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Study Questions Use of Acute Hemodialysis Treatment

Authors link dialysis to increased mortality

A common approach to treating kidney failure by removing waste products from the blood did not improve survival chances for people who suddenly developed the condition, according to an analysis led by experts at the University of Pittsburgh School of Medicine.

Their report, published online in PLOS One, suggests that acute hemodialysis — an aggressive method that is commonly used for people with sudden kidney failure — may not provide a definitive benefit to the patient.

“Our findings question the accepted notion that acute hemodialysis decreases mortality,” said senior author Amber Barnato, MD. She acknowledges, however, that the study is far from conclusive because it lacks detailed clinical data.

“It is impossible to draw conclusions based on an observational study,” she said, “but I do wonder whether it is time to do a clinical trial on the timing and delivery of acute hemodialysis in the context of acute renal failure and critical illness.”

Barnato and her colleagues examined medical records for 2,131,248 patients admitted to Pennsylvania hospitals between October 2005 and December 2007. Some of the patients had varying degrees of kidney failure without end-stage renal disease; 6,657 of those patients received acute hemodialysis. At 1 year, patients who received acute hemodialysis had nearly twice the risk of death compared with similarly ill patients who did not receive acute hemodialysis.

“The most striking finding is the increased mortality risk for patients who received acute hemodialysis, even after risk adjustment, which limited the sample to the sickest patients,” said lead author Sarah Ramer, MD. “We know that there is variation in how doctors decide if and when to dialyze a hospitalized patient. If patients given acute hemodialysis are not carefully chosen, some patients might end up not being helped by the treatment.”

Source: UPMC; August 20, 2014.

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