J Korean Med Sci.  2012 Oct;27(10):1177-1181. 10.3346/jkms.2012.27.10.1177.

Early Start of Dialysis Has No Survival Benefit in End-Stage Renal Disease Patients

• Chang JH
• Rim MY
• Sung J
• Ko KP
• Kim DK
• Jung JY
• Lee HH
• Chung W
• Kim S

• KMID: 1778823
• DOI: http://doi.org/10.3346/jkms.2012.27.10.1177

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.

Keyword

End Stage Renal Disease; Glomerular Filtration Rate; Renal Dialysis; Mortality; Peritoneal Dialysis

MeSH Terms

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
Serum Albumin

Figure

• 

  Fig. 1 Kaplan-Meier survival curves at the initiation of dialysis. (A) Survival of the late-start group is increased in the entire cohort (Log rank tests P = 0.002). (B) There is no significant difference in survival between the patients in the late-start and early-start groups in the propensity score matched cohort (Log rank tests P = 0.172).

• 

  Fig. 2 Adjusted HR of the initiation of dialysis for mortality using a Cox proportional analysis in the propensity-score matched cohort.

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