title: When to initiate dialysis--is early start always better?
abstract: The question when to initiate dialysis is attracting increasing attention. In recent years, there has been a tendency to initiate dialysis earlier in terms of estimated glomerular filtration rate (eGFR) in an attempt to achieve better patient outcomes. However, several observational studies and one randomized controlled trial have found no benefit for early dialysis initiation. On the contrary, they have found that starting dialysis with a higher eGFR is associated with increased mortality. These studies need to be carefully interpreted in light of their reliance on eGFR to estimate kidney function at dialysis initiation. The decision to start dialysis should not be based solely on a predefined eGFR value, but more importantly on a careful clinical assessment of the individual patient.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Liberek
authors.forename: Alicja
authors.initials: A
authors.lastname: Warzocha
authors.forename: Joanna
authors.initials: J
authors.lastname: Galgowska
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Taszner
authors.forename: William F
authors.initials: WF
authors.lastname: Clark
authors.forename: Boleslaw
authors.initials: B
authors.lastname: Rutkowski
mesh_terms: D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis; D012107:Research Design; D013997:Time Factors