Early dialysis does not significantly increase survival in end-stage renal disease
- Shemin, Douglas MD
BACKGROUND
US National Kidney Foundation Dialysis Initiative Guidelines recommend early dialysis, but evidence of its effectiveness is limited.
OBJECTIVE
To assess the effect of implementing the US National Kidney Foundation Dialysis Initiative guidelines on the survival of people with end-stage renal disease
SETTING
Twenty-nine dialysis units, The Netherlands; January 1997 to August 2000.
METHOD
Prospective cohort study.
PARTICIPANTS
Two hundred and fifty-three adults with residual renal function data and no previous renal replacement therapy. People were excluded if they had malignant disease; no predialysis care; 24 hour urine collection under 750 mL 7 days before dialysis; a urinary urea concentration of less than 90% of the plasma urea concentration; urinary creatinine excretion of less than 2 mmol in 24 hours, or an increase in renal Kt/Vurea of more than 0.75 per week after dialysis began.
INTERVENTION
Participants were classified as timely or late starters in accordance with the US guidelines. Timely starters had a renal Kt/Vurea above 2 per week; or Kt/Vurea below 2 but an nPNA above 0.8 g/kg daily and minimum body mass index of 20 kg/m2.
OUTCOMES
Survival time; mortality.
MAIN RESULTS
Mortality risk was not significantly greater for people starting dialysis later than recommended. For timely starters, adjusted survival difference after three years on dialysis was 2.5 months (95% CI 1.1 to 4.0 months; Table 1).
AUTHORS' CONCLUSIONS
There was a non-significant trend towards increased survival time with timely dialysis. This could be a real gain, a result of dialysis at an ealier stage of disease, or a countereaction to the average 4.1 dialysis delay for late starters.