Reducing early mortality in hemodialysis patients.

PURPOSE OF REVIEW

There is increasing recognition of the high morbidity and mortality rate that is associated with initiation of chronic dialysis. The present review examines the recent literature that has addressed this topic.

RECENT FINDINGS

Active interventions to reduce this high morbidity and mortality in the first year on dialysis have been few and infrequent. A recent publication has documented that a broad range of intervention early in the patient's life on dialysis can successfully impact such outcomes. There is also increased recognition that the type of access (catheter, graft, and fistula) with which the patient initiates dialysis has a strong influence on subsequent outcomes.

SUMMARY

The outcome of patients during the first year of dialysis is influenced not only by their comorbidities but also by the quality of care received shortly prior to the initiation of dialysis as well as the level of care they receive once they initiate chronic dialysis.