title: Effect of dialysis initiation timing on clinical outcomes: a propensity-matched analysis of a prospective cohort study in Korea.
abstract: BACKGROUND
  Controversy persists regarding the appropriate initiation timing of renal replacement therapy for patients with end-stage renal disease. We evaluated the effect of dialysis initiation timing on clinical outcomes. Initiation times were classified according to glomerular filtration rate (GFR).
  
  
  METHODS
  We enrolled a total of 1691 adult patients who started dialysis between August 2008 and March 2013 in a multi-center, prospective cohort study at the Clinical Research Center for End Stage Renal Disease in the Republic of Korea. The patients were classified into the early-start group or the late-start group according to the mean estimated GFR value, which was 7.37 ml/min/1.73 m2. The primary outcome was patient survival, and the secondary outcomes were hospitalization, cardiovascular events, vascular access complications, change of dialysis modality, and peritonitis. The two groups were compared before and after matching with propensity scores.
  
  
  RESULTS
  Before propensity score matching, the early-start group had a poor survival rate (P<0.001). Hospitalization, cardiovascular events, vascular access complications, changes in dialysis modality, and peritonitis were not different between the groups. A total of 854 patients (427 in each group) were selected by propensity score matching. After matching, neither patient survival nor any of the other outcomes differed between groups.
  
  
  CONCLUSIONS
  There was no clinical benefit after adjustment by propensity scores comparing early versus late initiation of dialysis.
authors.affiliation: Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea; Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea.
authors.forename: Jeonghwan
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Jung Nam
authors.initials: JN
authors.lastname: An
authors.affiliation: Department of Internal Medicine, Chung-Ang University Medical Center, Seoul, Korea.
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Hwang
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Yong-Lim
authors.initials: YL
authors.lastname: Kim
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Nam-Ho
authors.initials: NH
authors.lastname: Kim
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Yun Kyu
authors.initials: YK
authors.lastname: Oh
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Chun Soo
authors.initials: CS
authors.lastname: Lim
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yon Su
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Clinical Research Center for End Stage Renal Disease (CRC for ESRD), Daegu, Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Jung Pyo
authors.initials: JP
authors.lastname: Lee
mesh_terms: D002318:Cardiovascular Diseases / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000503:physiopathology; D057216:Propensity Score; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods; D017582:Renal Replacement Therapy / Q000379:methods; D056910:Republic of Korea; D015996:Survival Rate; D013997:Time Factors