Does timing of dialysis in patients with ESRD and acute myocardial infarcts affect morbidity or mortality?
OBJECTIVE
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.


METHODS
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+, DeltaK+ 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.
Coritsidis
George
G
Department of Medicine, Elmhurst/Queens Hospital Center/Mount Sinai School of Medicine, Queens, NY, USA. coritsg@nychhc.org
Sutariya
Dharmeshkumar
D
Stern
Aaron
A
Gupta
Garima
G
Carvounis
Christos
C
Arora
Robin
R
Balmir
Serge
S
Acharya
Anjali
A
D018806:APACHE; D015415:Biomarkers / Q000097:blood; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D009519:New York City / Q000453:epidemiology; D011188:Potassium / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D011188:Potassium