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Effect of timing of dialysis commencement on clinical outcomes of patients with planned initiation of peritoneal dialysis in the IDEAL trial.
Perit Dial Int. 2012 Nov-Dec; 32(6):595-604.PD

Abstract

BACKGROUND

Since the mid-1990s, early dialysis initiation has dramatically increased in many countries. The Initiating Dialysis Early and Late (IDEAL) study demonstrated that, compared with late initiation, planned early initiation of dialysis was associated with comparable clinical outcomes and increased health care costs. Because residual renal function is a key determinant of outcome and is better preserved with peritoneal dialysis (PD), the present pre-specified subgroup analysis of the IDEAL trial examined the effects of early-compared with late-start dialysis on clinical outcomes in patients whose planned therapy at the time of randomization was PD.

METHODS

Adults with an estimated glomerular filtration rate (eGFR) of 10 - 15 mL/min/1.73 m(2) who planned to be treated with PD were randomly allocated to commence dialysis at an eGFR of 10 - 14 mL/min/1.73 m(2) (early start) or 5 - 7 mL/min/1.73 m(2) (late start). The primary outcome was all-cause mortality.

RESULTS

Of the 828 IDEAL trial participants, 466 (56%) planned to commence PD and were randomized to early start (n = 233) or late start (n = 233). The median times from randomization to dialysis initiation were, respectively, 2.03 months [interquartile range (IQR):1.67 - 2.30 months] and 7.83 months (IQR: 5.83 - 8.83 months). Death occurred in 102 early-start patients and 96 late-start patients [hazard ratio: 1.04; 95% confidence interval (CI): 0.79 - 1.37]. No differences in composite cardiovascular events, composite infectious deaths, or dialysis-associated complications were observed between the groups. Peritonitis rates were 0.73 episodes (95% CI: 0.65 - 0.82 episodes) per patient-year in the early-start group and 0.69 episodes (95% CI: 0.61 - 0.78 episodes) per patient-year in the late-start group (incidence rate ratio: 1.19; 95% CI: 0.86 - 1.65; p = 0.29). The proportion of patients planning to commence PD who actually initiated dialysis with PD was higher in the early-start group (80% vs 70%, p = 0.01).

CONCLUSION

Early initiation of dialysis in patients with stage 5 chronic kidney disease who planned to be treated with PD was associated with clinical outcomes comparable to those seen with late dialysis initiation. Compared with early-start patients, late-start patients who had chosen PD as their planned dialysis modality were less likely to commence on PD.

Authors+Show Affiliations

Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia. david_johnson@health.qld.gov.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23212859

Citation

Johnson, David W., et al. "Effect of Timing of Dialysis Commencement On Clinical Outcomes of Patients With Planned Initiation of Peritoneal Dialysis in the IDEAL Trial." Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis, vol. 32, no. 6, 2012, pp. 595-604.
Johnson DW, Wong MG, Cooper BA, et al. Effect of timing of dialysis commencement on clinical outcomes of patients with planned initiation of peritoneal dialysis in the IDEAL trial. Perit Dial Int. 2012;32(6):595-604.
Johnson, D. W., Wong, M. G., Cooper, B. A., Branley, P., Bulfone, L., Collins, J. F., Craig, J. C., Fraenkel, M. B., Harris, A., Kesselhut, J., Li, J. J., Luxton, G., Pilmore, A., Tiller, D. J., Harris, D. C., & Pollock, C. A. (2012). Effect of timing of dialysis commencement on clinical outcomes of patients with planned initiation of peritoneal dialysis in the IDEAL trial. Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis, 32(6), 595-604. https://doi.org/10.3747/pdi.2012.00046
Johnson DW, et al. Effect of Timing of Dialysis Commencement On Clinical Outcomes of Patients With Planned Initiation of Peritoneal Dialysis in the IDEAL Trial. Perit Dial Int. 2012 Nov-Dec;32(6):595-604. PubMed PMID: 23212859.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of timing of dialysis commencement on clinical outcomes of patients with planned initiation of peritoneal dialysis in the IDEAL trial. AU - Johnson,David W, AU - Wong,Muh Geot, AU - Cooper,Bruce A, AU - Branley,Pauline, AU - Bulfone,Liliana, AU - Collins,John F, AU - Craig,Jonathan C, AU - Fraenkel,Margaret B, AU - Harris,Anthony, AU - Kesselhut,Joan, AU - Li,Jing Jing, AU - Luxton,Grant, AU - Pilmore,Andrew, AU - Tiller,David J, AU - Harris,David C, AU - Pollock,Carol A, PY - 2012/12/6/entrez PY - 2012/12/6/pubmed PY - 2013/5/23/medline SP - 595 EP - 604 JF - Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis JO - Perit Dial Int VL - 32 IS - 6 N2 - BACKGROUND: Since the mid-1990s, early dialysis initiation has dramatically increased in many countries. The Initiating Dialysis Early and Late (IDEAL) study demonstrated that, compared with late initiation, planned early initiation of dialysis was associated with comparable clinical outcomes and increased health care costs. Because residual renal function is a key determinant of outcome and is better preserved with peritoneal dialysis (PD), the present pre-specified subgroup analysis of the IDEAL trial examined the effects of early-compared with late-start dialysis on clinical outcomes in patients whose planned therapy at the time of randomization was PD. METHODS: Adults with an estimated glomerular filtration rate (eGFR) of 10 - 15 mL/min/1.73 m(2) who planned to be treated with PD were randomly allocated to commence dialysis at an eGFR of 10 - 14 mL/min/1.73 m(2) (early start) or 5 - 7 mL/min/1.73 m(2) (late start). The primary outcome was all-cause mortality. RESULTS: Of the 828 IDEAL trial participants, 466 (56%) planned to commence PD and were randomized to early start (n = 233) or late start (n = 233). The median times from randomization to dialysis initiation were, respectively, 2.03 months [interquartile range (IQR):1.67 - 2.30 months] and 7.83 months (IQR: 5.83 - 8.83 months). Death occurred in 102 early-start patients and 96 late-start patients [hazard ratio: 1.04; 95% confidence interval (CI): 0.79 - 1.37]. No differences in composite cardiovascular events, composite infectious deaths, or dialysis-associated complications were observed between the groups. Peritonitis rates were 0.73 episodes (95% CI: 0.65 - 0.82 episodes) per patient-year in the early-start group and 0.69 episodes (95% CI: 0.61 - 0.78 episodes) per patient-year in the late-start group (incidence rate ratio: 1.19; 95% CI: 0.86 - 1.65; p = 0.29). The proportion of patients planning to commence PD who actually initiated dialysis with PD was higher in the early-start group (80% vs 70%, p = 0.01). CONCLUSION: Early initiation of dialysis in patients with stage 5 chronic kidney disease who planned to be treated with PD was associated with clinical outcomes comparable to those seen with late dialysis initiation. Compared with early-start patients, late-start patients who had chosen PD as their planned dialysis modality were less likely to commence on PD. SN - 1718-4304 UR - https://www.unboundmedicine.com/medline/citation/23212859/Effect_of_timing_of_dialysis_commencement_on_clinical_outcomes_of_patients_with_planned_initiation_of_peritoneal_dialysis_in_the_IDEAL_trial_ L2 - https://journals.sagepub.com/doi/10.3747/pdi.2012.00046?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -