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KMID : 0191120120270101177
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Journal of Korean Medical Science
2012 Volume.27 No. 10 p.1177 ~ p.1181
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Early Start of Dialysis Has No Survival Benefit in End-Stage Renal Disease Patients
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Chang Jae-Hyun
Rim Min-Young
Sung Ji-yoon
Ko Kwang-Pil
Kim Dong-Ki
Jung Ji-Yong
Lee Hyun-Hee
Chung Woo-Kyung
Kim Se-Joong
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Abstract
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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 m2 in the early-start group compared with 6.1 mL/min/1.73 m2 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.
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KEYWORD
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End Stage Renal Disease, Glomerular Filtration Rate, Renal Dialysis, Mortality, Peritoneal Dialysis
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