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Timing of dialysis initiation and survival in ESRD.
Clin J Am Soc Nephrol. 2010 Oct; 5(10):1828-35.CJ

Abstract

BACKGROUND AND OBJECTIVES

The optimal time of dialysis initiation is unclear. The goal of this analysis was to compare survival outcomes in patients with early and late start dialysis as measured by kidney function at dialysis initiation.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We performed a retrospective analysis of patients entering the U.S. Renal Data System database from January 1, 1995 to September 30, 2006. Patients were classified into groups by estimated GFR (eGFR) at dialysis initiation.

RESULTS

In this total incident population (n = 896,546), 99,231 patients had an early dialysis start (eGFR >15 ml/min per 1.73 m(2)) and 113,510 had a late start (eGFR ≤5 ml/min per 1.73 m(2)). The following variables were significantly (P < 0.001) associated with an early start: white race, male gender, greater comorbidity index, presence of diabetes, and peritoneal dialysis. Compared with the reference group with an eGFR of >5 to 10 ml/min per 1.73 m(2) at dialysis start, a Cox model adjusted for potential confounding variables showed an incremental increase in mortality associated with earlier dialysis start. The group with the earliest start had increased risk of mortality, wheras late start was associated with reduced risk of mortality. Subgroup analyses showed similar results. The limitations of the study are retrospective study design, potential unaccounted confounding, and potential selection and lead-time biases.

CONCLUSIONS

Late initiation of dialysis is associated with a reduced risk of mortality, arguing against aggressive early dialysis initiation based primarily on eGFR alone.

Authors+Show Affiliations

Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20634325

Citation

Wright, Seth, et al. "Timing of Dialysis Initiation and Survival in ESRD." Clinical Journal of the American Society of Nephrology : CJASN, vol. 5, no. 10, 2010, pp. 1828-35.
Wright S, Klausner D, Baird B, et al. Timing of dialysis initiation and survival in ESRD. Clin J Am Soc Nephrol. 2010;5(10):1828-35.
Wright, S., Klausner, D., Baird, B., Williams, M. E., Steinman, T., Tang, H., Ragasa, R., & Goldfarb-Rumyantzev, A. S. (2010). Timing of dialysis initiation and survival in ESRD. Clinical Journal of the American Society of Nephrology : CJASN, 5(10), 1828-35. https://doi.org/10.2215/CJN.06230909
Wright S, et al. Timing of Dialysis Initiation and Survival in ESRD. Clin J Am Soc Nephrol. 2010;5(10):1828-35. PubMed PMID: 20634325.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Timing of dialysis initiation and survival in ESRD. AU - Wright,Seth, AU - Klausner,Dalia, AU - Baird,Bradley, AU - Williams,Mark E, AU - Steinman,Theodore, AU - Tang,Hongying, AU - Ragasa,Regina, AU - Goldfarb-Rumyantzev,Alexander S, Y1 - 2010/07/15/ PY - 2010/7/17/entrez PY - 2010/7/17/pubmed PY - 2011/1/22/medline SP - 1828 EP - 35 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 5 IS - 10 N2 - BACKGROUND AND OBJECTIVES: The optimal time of dialysis initiation is unclear. The goal of this analysis was to compare survival outcomes in patients with early and late start dialysis as measured by kidney function at dialysis initiation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a retrospective analysis of patients entering the U.S. Renal Data System database from January 1, 1995 to September 30, 2006. Patients were classified into groups by estimated GFR (eGFR) at dialysis initiation. RESULTS: In this total incident population (n = 896,546), 99,231 patients had an early dialysis start (eGFR >15 ml/min per 1.73 m(2)) and 113,510 had a late start (eGFR ≤5 ml/min per 1.73 m(2)). The following variables were significantly (P < 0.001) associated with an early start: white race, male gender, greater comorbidity index, presence of diabetes, and peritoneal dialysis. Compared with the reference group with an eGFR of >5 to 10 ml/min per 1.73 m(2) at dialysis start, a Cox model adjusted for potential confounding variables showed an incremental increase in mortality associated with earlier dialysis start. The group with the earliest start had increased risk of mortality, wheras late start was associated with reduced risk of mortality. Subgroup analyses showed similar results. The limitations of the study are retrospective study design, potential unaccounted confounding, and potential selection and lead-time biases. CONCLUSIONS: Late initiation of dialysis is associated with a reduced risk of mortality, arguing against aggressive early dialysis initiation based primarily on eGFR alone. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/20634325/Timing_of_dialysis_initiation_and_survival_in_ESRD_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=20634325 DB - PRIME DP - Unbound Medicine ER -