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For critically ill patients with acute kidney injury, early dialysis doesn't reduce death any more than standard care does, new research finds.
"Studying a large number of patients from many countries across different hospital settings gives us a degree of confidence that taking a more conservative approach to treatment may be warranted," said researcher Martin Gallagher, program director of Acute Kidney Injury and Trials at the George Institute for Global Health in Sydney, Australia.
Acute kidney injury is a sudden episode of kidney failure or kidney damage, and it carries a high risk of death and long-term kidney damage.The best time to start dialysis remains uncertain, Gallagher said.
"Starting too early could mean that this costly treatment might be used in patients who would have survived and recovered kidney function anyway," Gallagher said in an institute news release. "There are also risks associated with this intervention, so it was important for us to establish whether earlier initiation was beneficial."
For the paper, Gallagher and colleagues studied more than 3,000 patients in 168 hospitals in 15 countries.
Patients were randomly assigned to dialysis started as soon as possible or until one or more clinical criteria developed, including elevated potassium, respiratory failure or fluid overload.
After 90 days, no significant difference in death was seen between the two groups (43.9% in the accelerated strategy versus 43.7% in the standard strategy).
The study also found no difference in the quality of life between the two groups.
"This study gives clinicians confidence that in patients with acute kidney injury where dialysis is appropriate but not urgent, waiting to start dialysis is likely to be safe and may reduce the need for this valuable but invasive treatment," Gallagher said.
The report was published July 15 in the New England Journal of Medicine.
-- Steven Reinberg
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