Mortality and duration of hemodialysis treatment

Article Abstract:

Hemodialysis (a process whereby a patient's blood is filtered mechanically to remove toxic waste products, then returned to the body) is an accepted treatment for complete kidney failure (end-stage renal disease, ESRD), and its effectiveness is a consequence of several aspects of the procedure. To learn more concerning the relationship between the length of the treatment and its effectiveness, survival data were analyzed from 36 dialysis units throughout the US, covering patients treated in 48 metropolitan areas. Dialysis periods were classified as short (less than 3.5 hours; 121 patients); intermediate- or conventional-length (between 3.5 and 4.25 hours; 450 patients); and long (longer than 4.25 hours; 35 patients). Extensive investigation was done concerning the types of patients who underwent each dialysis protocol and the type of institutions in which each protocol tended to be carried out (i.e. for-profit versus freestanding); for instance, the short-time group contained a higher proportion of female and black patients. The mortality risk associated with treatments longer than 3.5 hours was assigned the value of 1.0: using this standard, it was found that the short-time group had a considerably increased relative risk (at least 1.17 times that of the long-time group). The risk was still greater for patients who had been receiving dialysis 60 months or longer, with the lowest relative risk (1.17) for those who had received it for one year or less. These differences were not seen in the conventional-length group. Other factors that might affect the results were evaluated, such as levels of waste products in patients' blood, side effects due to the treatment, and possible experimental biases, but very few were found to be significantly related to the outcome. The results are important for evaluating the quality of dialysis treatment, and indicate that the length of the dialysis treatment strongly affects survival. Moreover, the practice of determining that dialysis is effective because certain results are obtained on patients' blood tests should be questioned. (Consumer Summary produced by Reliance Medical Information, Inc.)

Quality management, Dialysis, Dialysis (Chemical process)

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Predictors of type of vascular access in hemodialysis patients

Article Abstract:

Many surgeons appear to be moving away from using an arteriovenous fistula in favor of synthetic grafts to create access for hemodialysis in patients with kidney disease. This was seen in a sample of 2,741 patients who began hemodialysis in 1986-1987 and 1,409 who began in 1990. In 1986-1987, 51% received a graft and this percentage rose to 65% in 1990. There were wide regional variations in the use of a graft, from a low in New England to a high in the East South Central region. Women were more likely to receive a graft, as were the elderly, and those with diabetes, obesity and peripheral vascular disease.

Usage, Surgery, Blood vessels, Vascular surgery, Fistula, Arteriovenous, Arteriovenous fistula

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Effect of dialyzer reuse on survival of patients treated with hemodialysis

Article Abstract:

Survival may be slightly shorter in dialysis patients who are put on dialyzers that have been sterilized with peracetic/acetic acid. This was demonstrated in a study that followed 27,938 patients receiving dialysis in the US in 1986 and 1987. Median survival was 1.6 months shorter in those clinics that sterilized the dialyzer with peracetic/acetic acid compared to those that did not reuse the dialyzer. Median survival was 2.2 months shorter than in clinics that sterilized the dialyzer with formaldehyde.

Medical equipment, Hemodialyzers, Hemodialysis equipment, Hemodialysis patients, Medical equipment sterilization

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