Skip to main content
SpringerLink
Log in

Dialysis

'Early' dialysis start based on eGFR is no longer appropriate

  • News & Views
  • Published:

From Nature Reviews Nephrology

View current issue Sign up to alerts

The randomized, controlled IDEAL study reports no survival advantage of 'early' dialysis initiation and data from this study support an estimated glomerular filtration rate of around 7 ml/min/1.73 m2 as a guideline for dialysis initiation. The results of the IDEAL study supplement data from eight observational studies involving over 1.2 million patients which showed a comorbidity-adjusted incremental survival disadvantage of 'early' dialysis initiation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1: Percentage of patients initiating dialysis 'early' in the USA during the years 1996–2008.

References

  1. Cooper, B. A. et al. A randomized, controlled trial of early versus late initiation of dialysis. N. Engl. J. Med. 363, 606–619 (2010).

    Article  Google Scholar 

  2. Hwang, S., Yang, W., Lin, M., Mau, L. & Hung-Chen, C. Impact of the clinical conditions at dialysis initiation on mortality in incident hemodialysis patients' national cohort study in Taiwan. Nephrol. Dial. Transplant. 25, 2616–2624 (2010).

    Article  Google Scholar 

  3. Wright, S. et al. Timing of dialysis initiation and survival in ESRD. Clin. J. Am. Soc. Nephrol. doi:10.2215/CJN.06230909.

  4. National Kidney Foundation. United States Renal Data System. 2007 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Am. J. Kidney Dis. 51 (Suppl. 1), S1–S304 (2008).

  5. Curtis, B. M. et al. Canadian survey of clinical status at dialysis initiation 1998–1999: a multicenter prospective survey. Clin. Nephrol. 58, 282–288 (2002).

    CAS  PubMed  Google Scholar 

  6. Friedman, A. N. & Fadem, S. Z. Reassessment of albumin as a nutritional marker in kidney disease. J. Am. Soc. Nephrol. 21, 223–230 (2010).

    Article  CAS  Google Scholar 

  7. Rocco, M. V. et al. The effect of dialysis dose and membrane flux on nutritional parameters on hemodialysis patients: Results of the HEMO Study. Kidney Int. 65, 2321–2334 (2004).

    Article  CAS  Google Scholar 

  8. O'Hare, A. M. et al. Age affects outcomes in chronic kidney disease. J. Am. Soc. Nephrol. 18, 2758–2765 (2007).

    Article  Google Scholar 

  9. Wang, A. Y. & Lai, K. N. The importance of residual renal function in dialysis patients. Kidney Int. 69, 1726–1732 (2006).

    Article  Google Scholar 

  10. Wingard, R. L, Chan, K. E., Lazarus, M. & Hakim, R. M. The “right” of passage: surviving the first year of dialysis. Clin. J. Am. Soc. Nephrol. 4, S114–S120 (2009).

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dorn Research Institute, William Jennings Bryan Dorn VA Hospital, 6439 Garners Ferry Road, Columbia, 29209, SC, USA

    Steven Rosansky

  2. 8 Bethany, Laguna Niguel, 92677, CA, USA

    Richard J. Glassock

Authors
  1. Steven Rosansky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard J. Glassock
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven Rosansky.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rosansky, S., Glassock, R. 'Early' dialysis start based on eGFR is no longer appropriate. Nat Rev Nephrol 6, 693–694 (2010). https://doi.org/10.1038/nrneph.2010.131

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrneph.2010.131

  • Springer Nature Limited

This article is cited by

Search

Navigation