Longer time between dialysis, surgery correlates with mortality risk in patients with ESKD
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Among Medicare beneficiaries with end-stage kidney disease, a longer interval between last dialysis session and a surgical procedure significantly correlates with an increased risk of 90-day postoperative mortality, results showed.
Data published in JAMA Network revealed that undergoing hemodialysis treatment on the same day as surgery is associated with a lower risk of mortality.
“Although experts recommend performing hemodialysis either on the day prior to surgery or on the day of surgery, there are no consensus statements or guidelines to address the timing of preoperative hemodialysis,” Vikram Fielding-Singh, MD, JD, from the department of anesthesiology, perioperative and pain medicine in the school of medicine at Stanford University, and colleagues wrote. They asked, “Is there an association between the timing of preoperative hemodialysis relative to surgery and postoperative mortality in patients with end-stage kidney disease who are treated with hemodialysis?”
In a retrospective cohort study, researchers examined data of 1,147,846 surgical procedures among 346,828 Medicare beneficiaries with ESKD. Patients were treated with hemodialysis and experienced a procedure between Jan. 1, 2011, and Sept. 30, 2018. Researchers conducted follow-ups until Dec. 31, 2018.
With 90-day postoperative mortality serving as the primary outcome, researchers considered the exposure of the study 1-, 2- or 3-day intervals between the most recent hemodialysis treatment and the surgical procedure. Researchers also compared hemodialysis on the day of the procedure vs. no hemodialysis on that day. Researchers determined the relationship between the dialysis-to-procedure and primary outcome using Cox proportional hazard models.
Ultimately, 65.4% of procedures were performed when the last hemodialysis session occurred 1 day before surgery, 24.9% when the last hemodialysis session occurred 2 days before surgery and 9.7% when the last hemodialysis session occurred 3 days before surgery. A total of 193,277 procedures took place on the same day as a patient’s hemodialysis treatment.
Overall, 3% of procedures resulted in 90-day postoperative mortality. Researchers identified a correlation between longer intervals between dialysis and procedures and a higher risk of 90-day mortality. Further, receiving hemodialysis on the same day as a procedure tended to correlate with a significantly lower risk of morality, compared with not getting treatment on the same day.
Researchers noted that the magnitude of absolute risk differences was small in this study, and the findings are susceptible to residual confounding.
“These findings suggest that hemodialysis timing may be a modifiable risk factor for patients with ESKD undergoing surgery,” Fielding-Singh and colleagues wrote. They added, “This study adds to previous work suggesting that longer intervals between hemodialysis are associated with adverse outcomes, particularly cardiovascular events. The results presented in this article suggested that higher 90-day cardiovascular events and mortality were due to withdrawal of care but not due to stroke, sepsis or infectious causes. Surgical procedures likely exacerbate a delicate equilibrium for patients with ESKD, making the hemodialysis-to-procedure interval an important consideration in perioperative management.”
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