Timeliness of Hemodialysis Necessary for Postoperative Care

by Micaela Harris
April 11, 2023

When patients with end-stage kidney disease undergo surgeries, they receive hemodialysis before the surgical procedure. Hemodialysis is a procedure in which a patient’s blood is cleansed of waste and it is an important step in preparing individuals with end-stage kidney disease for surgery. Although a frequent and essential procedure, the timing at which hemodialysis occurs before elective surgeries may directly impact patients’ survival rates after the surgery. 

Although it’s commonly recommended that hemodialysis take place within one day of the surgery, there are no guidelines to make sure this happens. In order to evaluate the impact of the timing of pre-operative hemodialysis on postoperative mortality, Vikram Fielding, MD, JD of Stanford University recently led a study using patient outcome data for over one million surgeries from patients with end-stage kidney disease who underwent elective surgeries between 2011 and 2018.  The results of the study were recently shared in the Journal of the American Medical Association

Patients with 1-day intervals from hemodialysis to surgery (dark blue) or same-day hemodialysis (light blue) had significantly lower mortality rates over a 90-day period than patients with three days between hemodialysis and surgery (yellow).

The investigators gathered data from 1,147,846 surgical procedures performed in a population of 346,838 patients with end-stage kidney disease. Within these surgical procedures, 65.4% of hemodialysis procedures occurred one day before surgery, 24.9% occurred two days before surgery, and 9.7% occurred three days before surgery. The researchers found that patients withlonger hemodialysis intervals had a higher chance of dying withing 90 days of the surgery. Patients who had hemodialysis 3 days before their surgery had a mortality rate 5.2% and patients who had hemodialysis on the same day of surgery had a mortality rate of 4%. 

The causes of death in these patients were variable and included postoperative myocardial infarction, stroke, sepsis, and surgical site infections. The investigators found that having same-day dialysis significantly reduced the risk associated with the long hemodialysis-to-procedure interval for patients with a 2 or 3 day interval.

This is the first study to evaluate the association of preoperative hemodialysis timing with post-operative mortality. The investigators showed reducing the timing of hemodialysis before surgery may be an important mechanism to improve postoperative survival.

Additional Stanford Cardiovascular Institute-affiliated investigators who contributed to this study include Matthew Vanneman, Tara Chang, and Vincent Liu.

Vikram Fielding, MD, JD