Dialysis Starts Earlier, Yet the Benefit Is Not Clear

Patients are starting dialysis approximately an average of five months earlier, but with no discernable evidence of benefits, according to the results of a recent analysis of 10 years worth of data.

Dialysis is an intensive, time-consuming, and expensive procedure for patients, said Ann O’Hare, MD, who led the research team. “It’s a substantial commitment, taking place three times a week, for three or four hours per treatment, and costing several hundred dollars per treatment,” she said in a statement. “When you look at the overall chronic dialysis population, our findings are significant.”

It has become increasingly clear over the years that patients in the US are starting dialysis at higher and higher levels of kidney function. A team of researchers, led by O’Hare, an associate professor of medicine at the University of Washington and affiliate investigator at Group Health Research Institute, set out to explore what this meant.

Researchers from Washington state and California found that from 1997 to 2007, patients were starting dialysis earlier on average. Changes in measured patient characteristics do not explain the changes in timing, which most likely reflect a shift in dialysis initiation practices over this time, researchers said of the study, which was published in the Annals of Internal Medicine.

That shift translates into 63 additional hemodialysis treatments, 189 or more hours of treatment, and approximately $14,490 in additional payments for dialysis for each patient, or more than $1.5 billion if extrapolated to patients in the study who initiated dialysis in 2007, according to the researchers’ estimates.

The researchers used two sources for the study, the United States Renal Data System, a national registry of end-stage renal disease, and a detailed renal database from Group Health Research Institute.

O’Hare said the findings are also important in light of other recent research that found starting dialysis earlier did not improve a range of health outcomes. “Patients are starting chronic dialysis significantly earlier, but there is no real evidence that it is beneficial.”

Upon reviewing the data, the researchers said the findings call for more careful evaluation of current dialysis initiation practices in the United States. “We really need to take a good critical look at what we’re doing,” said O’Hare. “Our study did not reveal the rationale for initiating chronic dialysis sooner, nor did it provide details on circumstances, signs, and symptoms that might have prompted dialysis initiation. It’s an open question as to why this is happening, but these findings provide a rationale for more detailed study to better understand practices and what’s driving this trend.”

SourceChronic Dialysis for Kidney Disease Now Starts Earlier [Group Health Research Institute]