2023-05-25 15:16:08
If the last hemodialysis session takes place longer before an operation, this results in a higher postoperative mortality risk. This effect is particularly evident in patients who do not undergo dialysis on the day of the procedure itself, researchers from the United States conclude.
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The optimal timing of dialysis prior to elective surgery is unknown. The aim of this study was therefore to investigate whether there is an association between the timing of hemodialysis before surgery and postoperative mortality in renal failure patients on hemodialysis. US researchers conducted a retrospective cohort study in which they analyzed 1,147,846 surgical procedures in 346,828 Medicare insured on hemodialysis. Intervals of 1 day (n = 750,163; 65.4%), 2 days (n = 285,939; 24.9%), or 3 days (n = 111,744; 9.7%) between the last dialysis session and surgery were compared, as well as (n = 193,277; 16.8%) or no hemodialysis on the day of surgery.
The primary endpoint was death within the first 90 days after surgery, which occurred in 34,944 cases (3.0%). Longer intervals between hemodialysis sessions and subsequent surgeries were found to be significantly associated with an increased postoperative mortality risk. The adjusted HR for an interval of 2 days versus 1 day was 1.14 (95% CI 1.10-1.18), for 3 days versus 1 day 1.25 (95% CI 1.19-1, 31) and for 3 versus 2 days 1.09 (95% CI 1.04-1.13). The risk of mortality was lower when a hemodialysis session took place on the same day as the procedure (HR: 0.88; 95% CI 0.84-0.91) compared with no dialysis session on the day of surgery. The researchers emphasize that the HRs are statistically significantly lower, but that the differences in absolute risks are small.
Bron:
Fielding-Singh V, Vanneman MW, Grogan T, et al. Association Between Preoperative Hemodialysis Timing and Postoperative Mortality in Patients With End-stage Kidney Disease. JAMA 2022;328:1837-48.
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