title: The Impact of Timing of Dialysis Initiation on Mortality in Patients with Peritoneal Dialysis.
abstract: ♦
  
  
  BACKGROUND
  The impact of timing of dialysis initiation on mortality is controversial in patients with peritoneal dialysis (PD). In this study, we analyzed the impact of timing of dialysis initiation on mortality in the incident PD population. ♦
  
  
  METHODS
  Incident patients with PD were selected from the Clinical Research Center (CRC) registry for end-stage renal disease (ESRD), a prospective cohort study on dialysis in Korea. Patients were categorized into 3 groups according to the estimated glomerular filtration rate (eGFR) at the initiation of PD using the Modification of Diet in Renal Disease (MDRD) equation. Group A was defined as eGFR < 5 mL/min/1.73m(2), group B as eGFR 5 - 10 mL/min/1.73m(2), and group C as eGFR > 10 mL/min/1.73m(2). Cox regression analysis was used to calculate the adjusted hazard ratio (HR) of mortality with group B as the reference. The primary outcome was all-cause mortality. ♦
  
  
  RESULTS
  A total of 495 incident PD patients were included. The number of patients in group A was 109, group B was 279, and group C was 107. The median follow-up period was 23 months. Multivariate Cox regression analysis showed that group A had a significantly higher risk of all-cause mortality compared with group B (HR 4.13, 95% confidence interval [CI], 1.55 - 11.03, p = 0.005) after adjustment for age, gender, cause of ESRD, serum albumin level, diabetes mellitus, and cardiovascular disease. There was no significant difference in mortality between group C and group B (HR 1.50, 95% CI, 0.59 - 3.80, p = 0.398) after adjustment for clinical variables. ♦
  
  
  CONCLUSIONS
  An eGFR < 5 mL/min/1.73m(2) at the initiation of PD was a significant risk factor for death, while an eGFR >10 mL/min/1.73m(2) at the initiation of PD was not associated with improved survival compared with an eGFR of 5 - 10 mL/min/1.73m(2) at the initiation of PD.
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea Department of Internal Medicine, St. Vincent's Hospital, Suwon, Korea.
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea.
authors.forename: Su-Hyun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Young Ok
authors.initials: YO
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Dong Chan
authors.initials: DC
authors.lastname: Jin
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Ho Chul
authors.initials: HC
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Euy Jin
authors.initials: EJ
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, School of Medicine, Kyungpook National University, Korea.
authors.forename: Yong-Lim
authors.initials: YL
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea.
authors.forename: Yon-Su
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Nam-Ho
authors.initials: NH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea MRC for Cell Death Disease Research Center, The Catholic University of Korea, Seoul, Korea drkimyk@catholic.ac.kr.
authors.forename: Yong Kyun
authors.initials: YK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012307:Risk Factors; D013997:Time Factors
keywords: Peritoneal dialysis; end-stage renal disease; glomerular filtration rate; mortality; survival