Chertow’s JAMA Editorial Challenges Nephrologists

Out of 5,000,000 hospitalizations in the US each year, 500,000 result in acute kidney injury (AKI), making it a relatively common disease. It is also an important one due to mortality rates of 20 to 40% among patients who require dialysis, considerably longer hospitalizations, and much higher costs than hospitalizations without AKI. Treating AKI with dialysis at the soonest possible opportunity would intuitively save lives, shorten hospitalizations, and reduce costs.

A randomized clinical trial designed to compare the effects of shorter and longer times to initiating dialysis in critically ill hospitalized patients with AKI was just published in the Journal of the American Medical Association and was accompanied by an editorial by Glenn Chertow, MD, MPH.  

The patient groups were small and there was but a single center in the trial, yet the findings were quite positively in favor of earlier dialysis for patients with improvements noted in mortality, hospital length of stay, and consequent costs. Chertow points out the well-designed features of the trial and the tendency to discount such positive outcomes in small studies while challenging the nephrology community to confirm or refute the findings in a larger, equally well-designed study. View the complete editorial here.