title: Early start of dialysis has no survival benefit in end-stage renal disease patients.
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 m(2) in the early-start group compared with 6.1 mL/min/1.73 m(2) 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 ≥ 70 yr (hazard ratio [HR]: 3.29; P = 0.048) and/or who had albumin levels ≥ 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.
authors.affiliation: Department of Internal Medicine, Gachon University of Medicine and Science, Incheon, Korea.
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Chang
authors.forename: Min Young
authors.initials: MY
authors.lastname: Rim
authors.forename: Jiyoon
authors.initials: J
authors.lastname: Sung
authors.forename: Kwang-Pil
authors.initials: KP
authors.lastname: Ko
authors.forename: Dong Ki
authors.initials: DK
authors.lastname: Kim
authors.forename: Ji Yong
authors.initials: JY
authors.lastname: Jung
authors.forename: Hyun Hee
authors.initials: HH
authors.lastname: Lee
authors.forename: Wookyung
authors.initials: W
authors.lastname: Chung
authors.forename: Sejoong
authors.initials: S
authors.lastname: Kim
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D013997:Time Factors
chemical_list: D012709:Serum Albumin
keywords: End Stage Renal Disease; Glomerular Filtration Rate; Mortality; Peritoneal Dialysis; Renal Dialysis