Dialysis-Surgery Gap Linked to Post-Operative Mortality - EMJ

Longer Intervals Between Dialysis and Surgery Associated with Post-operative Mortality

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DATA from the United States Renal Data System (USRDS) has been used to investigate disparities related to age, sex, race, ethnicity, and social deprivation to the timing of haemodialysis in patients preparing for surgery. Previous research has shown an association between longer intervals of pre-operative haemodialysis and surgery and post-operative mortality, but the current study has provided new insights on socially vulnerable patients with end-stage kidney disease.

The researchers identified adults with prevalent end-stage kidney disease receiving haemodialysis from 1st January 2011–30th September 2018. A total of 1,120,763 surgical procedures were included in the analysis of 338, 391 patients; 18% of these procedures had a long interval (2 or 3 days) between last outpatient haemodialysis and surgery. The data suggested older patients had longer haemodialysis-to-surgery intervals (aged 60–79 years) compared with younger patients (aged 18–39 years). Additionally, more females, non-Hispanic Black, and socially deprived individuals were all significantly associated with longer intervals when compared with their counterparts in the analysis.

Vikram Fielding-Singh, Stanford University, California, USA, was the lead investigator in this study, and summarised their findings: “Longer intervals were associated with higher risk of post-operative mortality, so we suspect that shorter intervals are better for patients.” Fielding-Singh also acknowledged that, “as this is a retrospective study, we do not know who is deciding the pre-operative haemodialysis schedule,” as an avenue that future study can investigate further, bringing greater use of this research to the clinician teams weighing in on this issue.

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