HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Press Release All Versions of this Article: CJN.04470908v1 4/8/1324    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Coritsidis, G. Articles by Acharya, A. PubMed PubMed Citation Articles by Coritsidis, G. Articles by Acharya, A.

Does Timing of Dialysis in Patients with ESRD and Acute Myocardial Infarcts Affect Morbidity or Mortality?

George Coritsidis^*, Dharmeshkumar Sutariya^*, Aaron Stern^*, Garima Gupta^*, Christos Carvounis, Robin Arora, Serge Balmir, and Anjali Acharya

^* Department of Medicine, Elmhurst/Queens Hospital Center/Mount Sinai School of Medicine, Queens, and Department of Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York; and Department of Medicine, Kyanos Stavros Medical Center, Athens, Greece

Correspondence: Dr. George Coritsidis, 79-01 Broadway, Elmhurst Hospital Center, B2-01 Elmhurst, NY 11373. Phone: 718-334-6020; Fax: 718-334-6019; E-mail: coritsg{at}nychhc.org

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⁺, K⁺ 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.