Breaking News
May 3, 2019 - Vaping and Smoking May Signal Greater Motivation to Quit
May 3, 2019 - Dementia looks different in brains of Hispanics
May 3, 2019 - Short-Staffed Nursing Homes See Drop In Medicare Ratings
May 3, 2019 - Study of teens with eating disorders explores how substance users differ from non-substance users
May 3, 2019 - Scientists develop new video game that may help in the study of Alzheimer’s
May 3, 2019 - Arc Bio introduces Galileo Pathogen Solution product line at ASM Clinical Virology Symposium
May 3, 2019 - Cornell University study uncovers relationship between starch digestion gene and gut bacteria
May 3, 2019 - How to Safely Use Glucose Meters and Test Strips for Diabetes
May 3, 2019 - Anti-inflammatory drugs ineffective for prevention of Alzheimer’s disease
May 3, 2019 - Study tracks Pennsylvania’s oil and gas waste-disposal practices
May 3, 2019 - Creating a better radiation diagnostic test for astronauts
May 3, 2019 - Vegans are often deficient in these four nutrients
May 3, 2019 - PPDC announces seed grants to develop medical devices for children
May 3, 2019 - Study maps out the frequency and impact of water polo head injuries
May 3, 2019 - Research on Reddit identifies risks associated with unproven treatments for opioid addiction
May 3, 2019 - Good smells may help ease tobacco cravings
May 3, 2019 - Medical financial hardship found to be very common among people in the United States
May 3, 2019 - Researchers develop multimodal system for personalized post-stroke rehabilitation
May 3, 2019 - Study shows significant mortality benefit with CABG over percutaneous coronary intervention
May 3, 2019 - Will gene-editing of human embryos ever be justifiable?
May 3, 2019 - FDA Approves Dengvaxia (dengue vaccine) for the Prevention of Dengue Disease in Endemic Regions
May 3, 2019 - Why Tonsillitis Keeps Coming Back
May 3, 2019 - Fighting the opioid epidemic with data
May 3, 2019 - Maggot sausages may soon be a reality
May 3, 2019 - Deletion of ATDC gene prevents development of pancreatic cancer in mice
May 2, 2019 - Targeted Therapy Promising for Rare Hematologic Cancer
May 2, 2019 - Alzheimer’s disease is a ‘double-prion disorder,’ study shows
May 2, 2019 - Reservoir bugs: How one bacterial menace makes its home in the human stomach
May 2, 2019 - Clinical, Admin Staff From Cardiology Get Sneak Peek at Epic
May 2, 2019 - Depression increases hospital use and mortality in children
May 2, 2019 - Vicon and NOC support CURE International to create first gait lab in Ethiopia
May 2, 2019 - Researchers use 3D printer to make paper organs
May 2, 2019 - Viral infection in utero associated with behavioral abnormalities in offspring
May 2, 2019 - U.S. Teen Opioid Deaths Soaring
May 2, 2019 - Opioid distribution data should be public
May 2, 2019 - In the Spotlight: “I’m learning every single day”
May 2, 2019 - 2019 Schaefer Scholars Announced
May 2, 2019 - Podcast: KHN’s ‘What The Health?’ Bye-Bye, ACA, And Hello ‘Medicare-For-All’?
May 2, 2019 - Study describes new viral molecular evasion mechanism used by cytomegalovirus
May 2, 2019 - SLU study suggests a more equitable way for Medicare reimbursement
May 2, 2019 - Scientists discover first gene involved in lower urinary tract obstruction
May 2, 2019 - Researchers identify 34 genes associated with increased risk of ovarian cancer
May 2, 2019 - Many low-income infants receive formula in the first few days of life, finds study
May 2, 2019 - Global study finds high success rate for hip and knee replacements
May 2, 2019 - Taking depression seriously: What is it?
May 2, 2019 - With Head Injuries Mounting, Will Cities Put Their Feet Down On E-Scooters?
May 2, 2019 - Scientists develop small fluorophores for tracking metabolites in living cells
May 2, 2019 - Study casts new light into how mothers’ and babies’ genes influence birth weight
May 2, 2019 - Researchers uncover new brain mechanisms regulating body weight
May 2, 2019 - Organ-on-chip systems offered to Asia-Pacific regions by Sydney’s AXT
May 2, 2019 - Adoption of new rules drops readmission penalties against safety net hospitals
May 2, 2019 - Kids and teens who consume zero-calorie sweetened beverages do not save calories
May 2, 2019 - Improved procedure for cancer-related erectile dysfunction
May 2, 2019 - Hormone may improve social behavior in autism
May 2, 2019 - Alzheimer’s disease may be caused by infectious proteins called prions
May 2, 2019 - Even Doctors Can’t Navigate Our ‘Broken Health Care System’
May 2, 2019 - Study looks at the impact on criminal persistence of head injuries
May 2, 2019 - Honey ‘as high in sugars as table sugar’
May 2, 2019 - Innovations to U.S. food system could help consumers in choosing healthy foods
May 2, 2019 - FDA Approves Mavyret (glecaprevir and pibrentasvir) as First Treatment for All Genotypes of Hepatitis C in Pediatric Patients
May 2, 2019 - Women underreport prevalence and intensity of their own snoring
May 2, 2019 - Concussion summit focuses on science behind brain injury
May 2, 2019 - Booker’s Argument For Environmental Justice Stays Within The Lines
May 2, 2019 - Cornell research explains increased metastatic cancer risk in diabetics
May 2, 2019 - Mount Sinai study provides fresh insights into cellular pathways that cause cancer
May 2, 2019 - Researchers to study link between prenatal pesticide exposures and childhood ADHD
May 2, 2019 - CoGEN Congress 2019: Speakers’ overviews
May 2, 2019 - A new strategy for managing diabetic macular edema in people with good vision
May 2, 2019 - Sagent Pharmaceuticals Issues Voluntary Nationwide Recall of Ketorolac Tromethamine Injection, USP, 60mg/2mL (30mg per mL) Due to Lack of Sterility Assurance
May 2, 2019 - Screen time associated with behavioral problems in preschoolers
May 2, 2019 - Hormone reduces social impairment in kids with autism | News Center
May 2, 2019 - Researchers synthesize peroxidase-mimicking nanozyme with low cost and superior catalytic activity
May 2, 2019 - Study results of a potential drug to treat Type 2 diabetes in children announced
May 2, 2019 - Multigene test helps doctors to make effective treatment decisions for breast cancer patients
May 2, 2019 - UNC School of Medicine initiative providing unique care to dementia patients
May 2, 2019 - Nestlé Health Science and VHP join forces to launch innovative COPES program for cancer patients
May 2, 2019 - Study examines how our brain generates consciousness and loses it during anesthesia
May 2, 2019 - Transition Support Program May Aid Young Adults With Type 1 Diabetes
May 2, 2019 - Study shows how neutrophils exacerbate atherosclerosis by inducing smooth muscle-cell death
May 2, 2019 - Research reveals complexity of how we make decisions
Older kidney disease patients starting dialysis die at higher rates than previously thought

Older kidney disease patients starting dialysis die at higher rates than previously thought

Older adults with end-stage kidney disease who start dialysis–a treatment that keeps their blood free of toxins–appear to die at higher rates than previously thought, according to findings of a new study by researchers at Harvard Medical School, Brigham and Women’s Hospital, Veterans Affairs Boston Healthcare System and Icahn School of Medicine at Mount Sinai, among other institutions.

More than half of older adults who started dialysis died within a year of beginning treatment, according to the research, and nearly one in four succumbed to the disease within a month of doing so.

Results of the analysis are published April 22 in JAMA Internal Medicine.

More than 120,000 people in the United States started dialysis in 2015, half of them older than 65. Dialysis, which involves the use of a machine to purify a patient’s blood from toxins, is commonly used as a treatment for end-stage kidney disease. For some dialysis is a bridge to kidney transplantation, but the majority of dialysis patients, particularly those who are older, do not get kidney transplants.

The newly reported death rates are almost twice as high as widely cited statistics from government data sources, a finding that suggests physicians and patients may be basing treatment decisions on overly optimistic survival estimates, the researchers said.

“Dialysis can seem like a magical cure for someone whose kidneys are failing, but our finding that half of older adults die within the first year after starting dialysis is sobering,” said lead author Melissa Wachterman, an assistant professor of medicine at Harvard Medical School, and a physician at VA Boston.

“When time is short, how you spend that time becomes even more important,” she said. “Spending the better part of three days a week doing dialysis may not be the right choice for everyone and people should factor this new evidence into their decisions.”

The results are based on an analysis of a small but representative sample of national outcomes data among Medicare patients, 65 and older, who started receiving dialysis between 1998 and 2014. The sample included outcomes for 391 such patients. Of those, 68 were 85 years of age or older, 89 required assistance with daily activities and 267 had four or more major medical problems. Of the 391 patients in the analysis, 286 (73 percent) started dialysis in the hospital rather than on outpatient basis. Nearly 23 percent of patients (88 people) died within a month of starting dialysis. Nearly 45 percent (173 people) died within six months, and nearly 55 percent (213) died within the year. The study also reveals higher death rates among several groups: those over age 85, those who had four or more major medical problems in addition to kidney failure, those who started dialysis in the hospital, and those who, even before starting dialysis, needed help from other people with basic tasks of daily living such as eating or bathing.

The most common source for mortality statistics for patients on dialysis is the U.S. Renal Data Registry (USRDS), maintained by the National Institutes of Health, which shows a mortality rate of approximately 30 percent among older adults starting dialysis. However, this source only includes patients well enough to receive dialysis outside of the hospital. In reality, almost three-quarters of patients start dialysis in the hospital and some do not survive long enough to make it to outpatient dialysis, the researchers said. The new analysis includes outcomes among such hospitalized individuals. Including hospitalized dialysis patients in the final tally boosted the previously reported death rates to more realistic levels, Wachterman said.

The researchers say their findings should help older patients, their families and the physicians who treat them make better-informed choices based on more realistic outcomes.

Contrary to a popular belief among many patients, dialysis is not the only choice for end-stage kidney disease, Wachterman noted. Another approach to managing kidney failure is conservative care in which patients receive medications and other therapies to relieve the symptoms of kidney disease, without starting dialysis.

People generally don’t live as long, but they can avoid the burden and potential harms of dialysis, the researchers said. This conservative approach to care, which focuses on aggressive management of symptoms such as pain and trouble breathing, is well-established in the United Kingdom and other countries, but, generally has not been developed as a common model of care in the United States.

“The goal in difficult clinical situations like this is shared decision-making, where patients and clinicians can work together to make choices that best balance patients’ goals and values with the objective medical evidence,” Wachterman said.

“We may have been painting an overly rosy picture for some patients as to what things will look like after starting dialysis,” she said. “We hope this new evidence can help patients and families cope with what lies ahead and empower them to make informed treatment decisions that are most aligned with their goals and preferences.”

Tagged with:

About author

Related Articles