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

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