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What factors influence timing of start of dialysis?

A new study used electronic medical records from the Department of Veterans Affairs to examine factors that influence the timing of the initiation of dialysis, according to an article published online by JAMA Internal Medicine.

The article by Susan P.Y. Wong, M.D., of the University of Washington, Seattle, and coauthors suggests interrelated processes were at play, including physician practices, the momentum for the initiation of dialysis including precipitating clinical events, and patient-physician dynamics, which were sometimes adversarial.

“Our findings offer insight into the complex processes that shape the timing of maintenance dialysis in real-world clinical settings and suggest that there may be opportunities to make these processes more patient centered” the article concludes.

Article: Timing of Initiation of Maintenance Dialysis, Susan P. Y. Wong MD, Elizabeth K. Vig MD, MPH, Janelle S. Taylor PhD, Nilka R. Burrows MPH, Chuan-Fen Liu PhD, Desmond E. Williams MD, PhD, Paul L. Hebert PhD, Ann M. O’Hare MD, MA, JAMA Internal Medicine, doi:10.1001/jamainternmed.2015.7412, published online 25 January 2016.

Commentary: Honoring Patient Preferences in Initiation of Dialysis, Vishnu S. Potluri MD, MPH, Laura M. Dember MD, Peter P. Reese MD, MSCE, JAMA Internal Medicine, doi:10.1001/jamainternmed.2015.7796, published 25 online January 2016.