Influence of early dialysis among patients with advanced chronic renal disease: results of a systematic review

Cantero-Muñoz, P.; Ruano-Raviña, Alberto; Otero-González, Alfonso; Sánchez-Guisande, D; González, Luís

doi:10.1093/ndt/gfq227

Cited by 10 publications

(11 citation statements)

References 20 publications

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“…However, the authors noted higher mortality rates in early-starters of HD but lower mortality in early-starters of PD 28 . Our subgroup analysis is supportive of this finding, whereby higher GFR in patients starting HD was associated with the highest adjusted mortality risk, whereas in the fewer studies restricted to PD populations, higher GFR appeared to not be associated with mortality.…”

Section: Discussionmentioning

confidence: 89%

“…A recently published qualitative systematic review that did not conduct a quantitative analysis was inconclusive regarding timing of dialysis initiation in patients with advanced CKD 28 . However, the authors noted higher mortality rates in early-starters of HD but lower mortality in early-starters of PD 28 .…”

Section: Discussionmentioning

confidence: 99%

“…These controversial findings have prompted several commentaries 22–27 . Although a systematic review of 10 studies recently examined this question, the analysis was qualitative in nature and the results somewhat inconclusive 28 . To gain more information on this subject, we performed a quantitative meta-analysis of all available studies of patients with advanced CKD that examined the association of kidney function at the start of dialysis, as assessed by level of GFR, with all-cause mortality.…”

mentioning

confidence: 99%

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GFR at Initiation of Dialysis and Mortality in CKD: A Meta-analysis

Susantitaphong

Altamimi

Ashkar

et al. 2012

American Journal of Kidney Diseases

102

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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GFR at Initiation of Dialysis and Mortality in CKD: A Meta-analysis

Susantitaphong

Altamimi

Ashkar

et al. 2012

American Journal of Kidney Diseases

102

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“…In an effort to improve mortality, starting dialysis early was promoted by small observational studies (1)(2)(3). The trend to early dialysis initiation (arbitrarily defined as an estimated GFR [eGFR] Ն10 ml/min per 1.73 m 2 utilizing the four variable Modification of Diet in Renal Disease (MDRD) equation) has evolved partially based on conventional wisdoms (CWs) ( Table 1).…”

Section: Introductionmentioning

confidence: 99%

Early Start of Dialysis

Rosansky¹,

Glassock²,

Clark³

2011

Clinical Journal of the American Society of Nephrology

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SummaryIn the US, patients who initiate dialysis "early" (at Modification of Diet in Renal Disease estimated GFR [eGFR]> 10 ml/min per 1.73m 2 ) account for over 50 percent of new dialysis starts. This trend to an early start is based on conventional wisdoms regarding benefits of dialytic clearance, that albumin levels are nutritional markers, and early dialytic therapy is justified to improve nutrition especially in diabetics and that waiting until low levels of eGFR (i.e., <6 ml/min per 1.73m2 ) may be dangerous. In order to justify early dialysis treatment, the therapy must provide a morbidity, mortality, or quality of life benefit. The current review examines whether early dialysis initiation provides any of these benefits and whether the conventional wisdoms that have promoted this early dialysis trend are valid. Utilizing this information and the results of recent large observational studies and the randomized controlled Initiating Dialysis Early and Late (IDEAL) study, we suggest that dialysis initiation is justified at GFR levels of 5-9 ml/min/1.73m 2 , if accompanied by uremia symptoms or fluid management issues.

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“…The study showed that all-cause and cardiovascular mortality was significantly higher at 1 year among initial refusers [31]. In a systemic review of the above and 4 other studies [32,33,34,35] published between 1999 and 2007, no firm conclusion was reached and the need for a well-designed randomized trial to determine ‘in which population subgroups early initiation would be more beneficial’ was stressed [36]. …”

Section: Tide Against ‘Early Start’ and First Randomized Study Seekinmentioning

confidence: 99%

‘Ideal Criteria’ for Starting Chronic Hemodialysis: Numbers, Symptoms or an Alerting ‘Traffic Light’ System?

Arıcı¹

2011

Nephron Clin Pract

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A definite criteria for starting chronic hemodialysis treatment is still lacking even after 50 years of regular hemodialysis treatment. Although none of the current guidelines have designated a certain glomerular filtration rate (GFR) level to start hemodialysis, most favor an ‘earlier’ start after GFR falls below 15 ml/min. Hence, since mid-1990s, more patients have initiated dialysis on higher GFR levels. Most of the observational data and one randomized trial, however, failed to find any benefit, but even harm, from an earlier start in various patient populations including the healthiest groups. This paper has reviewed the available evidence and criticized the use of only ‘GFR level’ in the absence of a validated method in end-stage kidney disease patients. A new patient scoring system mimicking traffic lights was proposed in which patients were placed into green, yellow or red zones for deciding the ideal time to start hemodialysis. This scoring system should include not only validated GFR criteria but also a wide set of demographic and clinical parameters.

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Influence of early dialysis among patients with advanced chronic renal disease: results of a systematic review

Cited by 10 publications

References 20 publications

GFR at Initiation of Dialysis and Mortality in CKD: A Meta-analysis

GFR at Initiation of Dialysis and Mortality in CKD: A Meta-analysis

Early Start of Dialysis

‘Ideal Criteria’ for Starting Chronic Hemodialysis: Numbers, Symptoms or an Alerting ‘Traffic Light’ System?

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