Early Dialysis Initiation Failed to Decrease Risk of Death for Kidney Failure Patients: Study

Although Medicare patients were more likely to start dialysis early, new research suggests that they had a higher death rate than those treated by the Veterans Affairs health care system, raising questions about the benefits of early dialysis initiation.

In a study published this month in the medical journal JAMA Internal Medicine, researchers concluded that VA health care that appears to favor lower intensity treatment for kidney failure, without any associated increase in death rates.

In the past, the benefits of “maintenance dialysis” before a person reached end-stage renal disease, or full kidney failure, were unclear. However, the findings of the new study indicate early treatment may not be the best course to prevent death.

The study compared more than 11,000 veterans with kidney failure who were older than 67 years of age. Some received nephrology care, or treatment for kidney problems, from the Veterans Affairs health care system and some through Medicare. Patients were treated from January 1, 2008, to December 31, 2011.

Kidney treatment through Medicare was associated with a 28% increased frequency of starting dialysis. However, those patients had a 5% higher death rate.

Researchers indicated that within two years of kidney failure, about 7,000 patients, or 63%, started dialysis. More than 5,200 died.

Patients who received kidney care before kidney failure with Medicare were more likely to undergo dialysis early compared to those treated at the Veteran’s Affairs health care system. Roughly 82% of patients in Medicare received dialysis early compared to 53% in the VA’s healthcare system.

Despite the fact that patients in Medicare received kidney treatment more frequently, they had a higher death rate from kidney failure than patients in the VA healthcare system. Medicare’s death rate was 53% compared to the VA’s at 44%.

Those who received kidney treatment through Medicare received dialysis more often, but were more likely to die within two years.

Researchers noted that the “VA’s integrated health care system and financing appear to favor lower-intensity treatment for kidney failure in older patients without a concomitant increase in mortality.”