Longer intervals between hemodialysis and surgery may increase risk of postoperative mortality in CKD: JAMA

A new study published in the Journal of American Medical Association shows that longer intervals between hemodialysis and surgery were substantially linked to a greater risk of postoperative mortality among Medicare seniors with end-stage kidney disease, particularly in those who did not receive hemodialysis on the day of surgery.

It is unknown when hemodialysis should be administered to individuals with end-stage kidney disease who are undergoing elective surgical procedures. In order to determine if a longer gap between hemodialysis and subsequent surgery is linked to a higher postoperative mortality in patients with end-stage kidney disease treated with hemodialysis, this study was carried out by Vikram Fielding-Singh and team.

In this retrospective cohort analysis, 346 828 Medicare enrollees with end-stage kidney disease who received hemodialysis between January 1, 2011, and September 30, 2018, underwent 1 147 846 surgical procedures. Aftercare came to an end on December 31, 2018. One, two, or three days between the most recent hemodialysis treatment and the surgery were the inclusion criteria for this experiment. Comparison of hemodialysis on the day of surgery with no hemodialysis on the day of surgery. The 90-day postoperative death rate was the main result. A Cox proportional hazards model was used to model the connection between the time between dialysis and the procedure and the main result.

The key findings of study were:

1. Of the 1 147 846 surgical procedures carried out on the 346 828 patients, 750 163 (65.4%) were done when the last hemodialysis session was the day before the surgery, 285 939 (24.9%) when it was the next day, and 111 744 (9.7%) when it was the third day before the treatment.

2. Additionally, hemodialysis was carried out for 193 277 procedures (16.8%) on the day of surgery.

3. The 90-day postoperative death rate was 3.0% following 34 944 surgeries. A dose-dependent relationship was found between a longer time between the last hemodialysis session and surgery and a higher risk of 90-day death.

4. When hemodialysis was done the same day as surgery, the risk of death was much lower than when it wasn't done.

Reference:

Fielding-Singh, V., Vanneman, M. W., Grogan, T., Neelankavil, J. P., Winkelmayer, W. C., Chang, T. I., Liu, V. X., & Lin, E. (2022). Association Between Preoperative Hemodialysis Timing and Postoperative Mortality in Patients With End-stage Kidney Disease. In JAMA. American Medical Association (AMA). https://doi.org/10.1001/jama.2022.19626