title: Repercussions of early versus late initiation of dialysis.
abstract: &nbsp; Despite the widespread use of chronic dialysis, there remains a lack of consensus about the optimal time for initiation of renal replacement therapy. Recommendations from the National Kidney Foundation Kidney Disease Outcome Quality Initiative are generally used as the guideline. This has resulted in a trend in the past decade toward earlier initiation of dialysis, especially in the elderly. The associated burden of comorbidities in the elderly population has resulted in greatly reduced survival outcomes. Here, the data obtained from retrospective cohort studies have been corroborated with a recent randomized control trial conducted in Australia and New Zealand (IDEAL study). There are limitations to consider from the IDEAL study that originate from different confounding factors that intervene in the test population. The present paper is an evidence-based review of the literature, focusing on diminution of survival outcomes following the early initiation of dialysis.
authors.affiliation: Division of Nephrology and Hypertension. University of Miami Miller School of Medicine. Miami, Florida, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Ortega
authors.forename: A
authors.initials: A
authors.lastname: Nayer
mesh_terms: D015331:Cohort Studies; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D003928:Diabetic Nephropathies / Q000191:economics / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D019317:Evidence-Based Medicine; D005919:Glomerular Filtration Rate; D017048:Health Care Costs; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D044342:Malnutrition / Q000453:epidemiology; D015337:Multicenter Studies as Topic; D010530:Peritoneal Dialysis / Q000191:economics / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome