Early Start of Dialysis Has No Survival Benefit in End-Stage Renal Disease Patients.
10.3346/jkms.2012.27.10.1177
- Author:
Jae Hyun CHANG
1
;
Min Young RIM
;
Jiyoon SUNG
;
Kwang Pil KO
;
Dong Ki KIM
;
Ji Yong JUNG
;
Hyun Hee LEE
;
Wookyung CHUNG
;
Sejoong KIM
Author Information
1. Department of Internal Medicine, Gachon University of Medicine and Science, Incheon, Korea.
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
End Stage Renal Disease;
Glomerular Filtration Rate;
Renal Dialysis;
Mortality;
Peritoneal Dialysis
- MeSH:
Adult;
Age Factors;
Aged;
Female;
Glomerular Filtration Rate;
Humans;
Kaplan-Meier Estimate;
Kidney Failure, Chronic/diagnosis/*mortality;
Male;
Middle Aged;
Propensity Score;
Proportional Hazards Models;
*Renal Dialysis;
Risk Factors;
Serum Albumin/analysis;
Time Factors
- From:Journal of Korean Medical Science
2012;27(10):1177-1181
- CountryRepublic of Korea
- Language:English
-
Abstract:
The timing for dialysis initiationis still debated. The aim of this study was to compare mortality rates, using a propensity-score approach, in dialysis patients with early or late starts. From January 2000 to June 2009, incident adult patients (n = 836) starting dialysis for end-stage renal disease (ESRD) were enrolled. The patients were assigned to either an early- or late-start group depending on the initiation time of the dialysis. After propensity-score-basedmatching, 450 patients remained. At the initiation of dialysis, the mean estimated glomerular filtration rate (eGFR) was 11.1 mL/min/1.73 m2 in the early-start group compared with 6.1 mL/min/1.73 m2 in the late-start group. There were no significant differences in survival between the patients in the early- and late-start groups (Log rank tests P = 0.172). A higher overall mortality risk was observed in the early-start group than in the late-start group for the patients aged > or = 70 yr (hazard ratio [HR]: 3.29; P = 0.048) and/or who had albumin levels > or = 3.5 g/dL (HR: 2.53; P = 0.046). The survival of the ESRD patients was comparable between the patients in the early and late-start groups. The time to initiate dialysis should be determined based on clinical findings as well as the eGFR.
