TY - JOUR
T1 - Does timing of dialysis in patients with ESRD and acute myocardial infarcts affect morbidity or mortality?
AU - Coritsidis, George
AU - Sutariya, Dharmeshkumar
AU - Stern, Aaron
AU - Gupta, Garima
AU - Carvounis, Christos
AU - Arora, Robin
AU - Balmir, Serge
AU - Acharya, Anjali
PY - 2009
Y1 - 2009
N2 - Background and objectives: Patients with ESRD have an increased incidence of coronary events with a relatively higher risk for mortality after acute myocardial infarction (AMI). We evaluated whether it is safer to delay dialysis in AMI or if delay poses separate risks. Design, setting, participants, & measurements: We conducted a retrospective review of 131 long-term hemodialysis patients who had AMI and were admitted between 1997 and 2005 at three New York City municipal hospitals. Patients were separated into three groups on the basis of time between cardiac symptoms and first dialysis (<24 h, 24 to 48 h, and >48 h). Results: A total of 17 (13%) patients died, 10 (59%) of whom had either hypotension or an arrhythmia during their first cardiac care unit dialysis. Although these groups were comparable in acuity and cardiac status, there were no findings of increased morbidity (26, 36, and 20%, respectively) or mortality (11, 18, and 13%, respectively), despite differences in the timing of each group's dialysis. We found that previous cardiac disease, predialysis K+, ΔK+ after dialysis, and APACHE scores were significantly higher in patients with peridialysis morbidity. Conclusions: We conclude that there is no increased morbidity with early dialysis in AMI, but rather close attention needs to be paid to the rate of decrease in serum potassium in patients with ESRD and their level of acuity when undergoing dialysis.
AB - Background and objectives: Patients with ESRD have an increased incidence of coronary events with a relatively higher risk for mortality after acute myocardial infarction (AMI). We evaluated whether it is safer to delay dialysis in AMI or if delay poses separate risks. Design, setting, participants, & measurements: We conducted a retrospective review of 131 long-term hemodialysis patients who had AMI and were admitted between 1997 and 2005 at three New York City municipal hospitals. Patients were separated into three groups on the basis of time between cardiac symptoms and first dialysis (<24 h, 24 to 48 h, and >48 h). Results: A total of 17 (13%) patients died, 10 (59%) of whom had either hypotension or an arrhythmia during their first cardiac care unit dialysis. Although these groups were comparable in acuity and cardiac status, there were no findings of increased morbidity (26, 36, and 20%, respectively) or mortality (11, 18, and 13%, respectively), despite differences in the timing of each group's dialysis. We found that previous cardiac disease, predialysis K+, ΔK+ after dialysis, and APACHE scores were significantly higher in patients with peridialysis morbidity. Conclusions: We conclude that there is no increased morbidity with early dialysis in AMI, but rather close attention needs to be paid to the rate of decrease in serum potassium in patients with ESRD and their level of acuity when undergoing dialysis.
UR - http://www.scopus.com/inward/record.url?scp=70349898464&partnerID=8YFLogxK
U2 - 10.2215/CJN.04470908
DO - 10.2215/CJN.04470908
M3 - Article
C2 - 19590061
AN - SCOPUS:70349898464
SN - 1555-9041
VL - 4
SP - 1324
EP - 1330
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 8
ER -