title: Timing of peritoneal dialysis initiation and mortality: analysis of the Canadian Organ Replacement Registry.
abstract: BACKGROUND
  Several observational studies of hemodialysis patients show an association between early dialysis therapy initiation and increased mortality. Few studies have examined this association among peritoneal dialysis patients.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A cohort of 8,047 incident peritoneal dialysis patients who started dialysis therapy in 2001-2009 and were treated in Canada.
  
  
  METHODS
  Estimated glomerular filtration rate (eGFR) at dialysis therapy initiation. Defined early, mid, and late starts as eGFR>10.5, 7.5-10.5, and <7.5mL/min/1.73m(2), respectively.
  
  
  RESULTS
  Time to death.
  
  
  METHODS
  Proportional piecewise exponential survival models to compare mortality (overall and early) for the 3 predictor groups.
  
  
  RESULTS
  Between 2001 and 2009, the proportion of patients starting peritoneal dialysis therapy as early starts increased from 29% (95% CI, 26%-32%) to 44% (95% CI, 41%-47%). Compared with the late-start group, the overall mortality rate was not higher for the early- (adjusted HR, 1.08; 95% CI, 0.96-1.23) or mid-start (adjusted HR, 0.96; 95% CI, 0.86-1.09) groups. However, when examined yearly, patients in the early-start group were significantly more likely to die within the first year of dialysis therapy compared with those in the late-start group (adjusted HR, 1.38; 95% CI, 1.10-1.73), but not in subsequent years.
  
  
  CONCLUSIONS
  Bias and residual confounding may have influenced the observed relationship between predictor and outcome.
  
  
  CONCLUSIONS
  Patients are initiating peritoneal dialysis therapy at increasingly higher eGFRs. Contrary to most observational studies assessing hemodialysis, the early initiation of peritoneal dialysis therapy, at eGFR>10.5mL/min/1.73m(2), is not associated with increased mortality.
authors: Division of Nephrology, Department of Medicine, Western University, London, ON, Canada. Electronic address: arsh.jain@lhsc.on.ca.
authors: Arsh K
authors: AK
authors: Jain
authors: Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
authors: Jessica M
authors: JM
authors: Sontrop
authors: Department of Medicine, Division of Nephrology, University of Toronto, Toronto, ON, Canada.
authors: Jeffery
authors: J
authors: Perl
authors: Division of Nephrology, Department of Medicine, Western University, London, ON, Canada.
authors: Peter G
authors: PG
authors: Blake
authors: Division of Nephrology, Department of Medicine, Western University, London, ON, Canada.
authors: William F
authors: WF
authors: Clark
authors: Division of Nephrology, Department of Medicine, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
authors: Louise M
authors: LM
authors: Moist
mesh_terms: D002170:Canada / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014015:Tissue Banks / Q000706:statistics & numerical data*
keywords: Estimated glomerular filtration rate (eGFR); mortality; peritoneal dialysis; retrospective cohort study; timing