title: Outcomes of patients with delayed dialysis initiation: Results from the AVENIR study.
abstract: BACKGROUND
  Some patients who reach end-stage renal disease refuse to start dialysis at the time suggested by their nephrologist and delay it. Whether this delay may affect health-related quality of life (HRQoL), clinical and biological parameters at dialysis onset, and then survival and hospitalization during dialysis is unknown.
  
  
  METHODS
  We considered all adult patients who began dialysis in Lorraine (France) in 2005-2006 having previously been followed by a nephrologist. Clinical and biological characteristics at dialysis onset were collected from medical records, and nephrologists were interviewed about compliance with the recommended starting date. HRQoL was measured using the French version of the 'Kidney Disease Quality of Life' V36 questionnaire. Mortality and total duration of hospitalization during the first year of dialysis were recorded as part of the end-stage renal disease French registry. The effects of delaying dialysis on survival and on duration of hospitalization were determined using log-rank test and polychotomous logistic regression, respectively.
  
  
  RESULTS
  Of 541 patients, 88 (16.3%) declined to initiate dialysis at the time recommended by the nephrologist and delayed it. Compared with patients who were compliant with the advice, noncompliers had more comorbidities, poorer clinical and biological profiles at dialysis start, and a higher risk of beginning dialysis in emergency circumstances with greater decline in the 'burden of kidney disease' dimension of HRQoL. However, there were no differences in survival or duration of hospitalization during dialysis.
  
  
  CONCLUSIONS
  Despite a negative effect on clinical and biological parameters at initiation, delaying dialysis did not impact on survival during treatment.
authors.affiliation: CIC-EC CIE Inserm, University Hospital of Nancy, France. n.thilly@chu-nancy.fr
authors.forename: Nathalie
authors.initials: N
authors.lastname: Thilly
authors.forename: Stephanie
authors.initials: S
authors.lastname: Boini
authors.forename: Marc
authors.initials: M
authors.lastname: Soudant
authors.forename: Michele
authors.initials: M
authors.lastname: Kessler
authors.forename: Serge
authors.initials: S
authors.lastname: Briançon
authors.forename: Luc
authors.initials: L
authors.lastname: Frimat
mesh_terms: D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D011788:Quality of Life; D012044:Regression Analysis; D006435:Renal Dialysis / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome