2nd October 2023, Mumbai: Exploring the Risk Factors
Dialysis is a life-saving treatment for patients with kidney diseases, but a recent study sheds light on how it may increase the risk of heart disease, infection, organ damage, and even death for some kidney patients. This research, published in the Journal of the American Society of Nephrology, raises questions about the standard care provided to patients with acute kidney injury compared to those with end-stage kidney disease.
Two Sides of Dialysis: Acute Kidney Injury vs. End-Stage Kidney Disease
In the world of kidney care, patients with acute kidney injury often receive the same dialysis treatment as those with end-stage kidney disease. Acute kidney injury can be caused by various factors such as infections, shock, surgeries, or toxic medications. On the other hand, end-stage kidney disease typically results from long-standing conditions like hypertension or diabetes. While some acute kidney injury patients have the potential to recover, those with end-stage kidney disease usually face a lifetime of dialysis or require a kidney transplant.
Unnecessary Risks: The Dangers of Prolonged Dialysis
Dr. Ian E. McCoy, the first author of the study from the UCSF Division of Nephrology, highlights a significant concern. He suggests that for patients who have the potential to recover, prolonged dialysis might expose them to unnecessary risks, including heart disease, infection, organ damage, and death. Unfortunately, the study reveals that the majority of patients, regardless of their kidney condition, receive thrice-weekly dialysis without adequate consideration of their individual needs.
The Harsh Reality: Mortality Rates and Recovery
The study tracked 1,754 patients with acute kidney injury and 6,197 patients with end-stage kidney disease at outpatient dialysis centers. Shockingly, 10% of acute kidney injury patients died within a three-month period, mostly due to the conditions that led to their need for dialysis. However, the study also uncovered a glimmer of hope: 41% of acute kidney injury patients recovered kidney function, and three-quarters of them discontinued dialysis without any changes to the treatment regimen, indicating potential for earlier weaning.
Striking a Balance: The Need for Safe Weaning Strategies
Dr. McCoy emphasizes the importance of research on safe weaning strategies. Rapid weaning can lead to complications such as shortness of breath and dangerous heart rhythms, so finding the right balance is crucial. Continuing dialysis unnecessarily, however, also poses risks, with high rates of heart disease, infection, and mortality.
Challenges and Incentives in Kidney Care
Dialysis providers and kidney specialists face powerful disincentives to wean patients off dialysis. The healthcare system may benefit from deprescribing, but it’s not in the interest of dialysis providers, who prefer to keep their chairs occupied. Moreover, kidney specialists receive lower insurance payments for non-dialysis care, even though managing patients with borderline kidney function can be more complex and time-consuming.
The Uncertain Path Ahead
Approximately half of the patients neither died nor discontinued dialysis by the end of the study, leaving their future uncertain. Many patients are treated as if they will remain on dialysis indefinitely after about three months of treatment. Doctors often overlook early, subtle signs of recovery, and only stop dialysis when the signs are glaringly obvious.
Avoiding the Worst-Case Scenario
The worst-case scenario is a patient who could have recovered enough kidney function to wean off dialysis but remains on it. Repeated dialysis sessions may further damage the kidneys, pushing kidney function below the threshold required for successful weaning. In such cases, the patient may face lifelong dialysis or the need for a kidney transplant, If they are a suitable candidate.
The study underscores the importance of personalized care for kidney patients. Dialysis should not be a one-size-fits-all solution, and healthcare providers must consider each patient’s unique needs and potential for recovery to minimize the risks associated with this life-saving treatment. Further research and the development of safe weaning strategies are essential to improve the quality of care for kidney patients.
1. What is acute kidney injury, and how does it differ from end-stage kidney disease?
– Acute kidney injury is a sudden loss of kidney function, often caused by factors like infections, shock, or toxic medications. In contrast, end-stage kidney disease results from long-standing conditions like hypertension or diabetes and usually requires lifelong dialysis or a transplant.
2. What risks does prolonged dialysis pose to patients with the potential to recover from acute kidney injury?
– Prolonged dialysis for patients who could recover may expose them to unnecessary risks, including heart disease, infection, organ damage, and even death, as highlighted in the study.
3. What percentage of acute kidney injury patients in the study were able to recover kidney function?
– The study revealed that 41% of acute kidney injury patients were able to recover kidney function, with three-quarters discontinuing dialysis without any changes to their treatment regimen.
4. Why is finding the right balance in weaning patients off dialysis important, and what complications can rapid weaning lead to?
– Finding the right balance in weaning patients off dialysis is crucial because rapid weaning can lead to complications such as shortness of breath and dangerous heart rhythms. Striking the right balance is essential for patient safety.
5. What challenges and incentives are faced by dialysis providers and kidney specialists when it comes to weaning patients off dialysis?
– Dialysis providers may have disincentives to wean patients off dialysis as they prefer to keep their chairs occupied. Additionally, kidney specialists may receive lower insurance payments for non-dialysis care, even though managing patients with borderline kidney function can be complex and time-consuming.
-by Kashvi Gala