Cost-Effectiveness of Initiating Dialysis Early: A Randomized Controlled Trial

Harris, Anthony; Cooper, Bruce A.; Li, Jingjing; Bulfone, Liliana; Branley, Pauline; Collins, John; Craig, Jonathan C.; Fraenkel, Margaret; Johnson, David W.; Kesselhut, Joan; Luxton, Grant; Pilmore, Andrew; Rosevear, Martin; Tiller, David J.; Pollock, Carol; Harris, David C.H.

doi:10.1053/j.ajkd.2010.12.018

Cited by 110 publications

(77 citation statements)

References 16 publications

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“…Recently, the Initiating Dialysis Early and Late (IDEAL) randomized controlled trial demonstrated, in 828 patients with stage 5 chronic kidney disease (CKD), that planned early initiation of any form of dialysis at a GFR between 10 mL/min/1.73 m 2 and 14 mL/ min/1.73 m 2 -compared with late dialysis commencement (GFR < 7 mL/min/1.73 m 2 or when traditional clinical indicators of uremia supervene)-was not associated with improved survival, cardiovascular events, infectious events, dialysis-associated complications, or quality of life (2,3), but was associated with increased health care costs (3).…”

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confidence: 99%

Effect of Timing of Dialysis Commencement on Clinical Outcomes of Patients with Planned Initiation of Peritoneal Dialysis in the Ideal Trial

et al. 2012

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ORIGINAL ARTICLES♦ Background: Since the mid-1990s, early dialysis initiation has dramatically increased in many countries. The Initiating Dialysis Early and Late (IDEAL) study demonstrated that, compared with late initiation, planned early initiation of dialysis was associated with comparable clinical outcomes and increased health care costs. Because residual renal function is a key determinant of outcome and is better preserved with peritoneal dialysis (PD), the present prespecified subgroup analysis of the IDEAL trial examined the effects of early-compared with late-start dialysis on clinical outcomes in patients whose planned therapy at the time of randomization was PD.

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confidence: 99%

Effect of Timing of Dialysis Commencement on Clinical Outcomes of Patients with Planned Initiation of Peritoneal Dialysis in the Ideal Trial

et al. 2012

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“…29 Furthermore, patients in the IDEAL trial started in the higher eGFR arm were initiated, on average, 6 months earlier than patients in the low eGFR arm, with a direct dialysis cost increase of greater than $10,000 per patient. 30 eGFR reporting also has led to increases in resource use by increasing the referral rate from 3% to 270%. 9 Subsequently, it would be concerning if eGFR reporting was associated with an increase in early dialysis initiation, because the benefit of early CKD detection, cardiovascular disease protection, and planning for dialysis would be offset by potential harm for those patients who initiate early dialysis and a significant increase in costs and health resource use.…”

Section: Discussionmentioning

confidence: 99%

The Association of eGFR Reporting with the Timing of Dialysis Initiation

Sood

Komenda

Rigatto

et al. 2014

Journal of the American Society of Nephrology

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Automated reporting of eGFR by laboratories has been widely implemented during the last decade. Over this same period, a steady increase in eGFR at dialysis initiation has been reported. This study examined trends in eGFR at dialysis initiation over time among incident dialysis patient populations before and after eGFR reporting. All patients who initiated dialysis between January of 2001 and December of 2010 in four Canadian provinces that implemented province-wide automated eGFR reporting and had an eGFR measure at dialysis initiation were included in the study (n=22,208). The primary outcome was change over time in eGFR among patients at dialysis initiation. An interrupted time series and adjusted multilevel regression models were used to determine the differences in eGFR at dialysis initiation before and after reporting. We observed a linear increase in the mean eGFR at dialysis initiation from 9.1 to 10.8 ml/min per m 2 during the study period. There was no change in the trajectory of the eGFR at dialysis initiation before or after eGFR reporting in crude or adjusted models accounting for case mix and facility characteristics. These findings were consistent among age and sex strata and when the proportions of patients with an eGFR$10.5 or $12 ml/min per m 2 were examined. In conclusion, automated laboratory-based eGFR reporting did not influence eGFR at dialysis initiation among incident dialysis patient populations. Concerns that widespread eGFR reporting leads to earlier dialysis initiation are not supported by this study.

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“…Development of a more individualized, patient-centered approach to the care of patients with advanced kidney disease will require changes to regulatory and care structures. Such changes would likely include greater flexibility in the approach to preparation, timing, and prescription of dialysis with the development of quality metrics to address the extent to which treatment practices support patient goals (21,57,58). Stronger efforts are also needed to ensure access to treatment modalities that best address each patient's goals at different points in their illness trajectory, such as home therapies (59) and kidney transplantation.…”

Section: The Csckp's Vision For the Medicare Esrd Programmentioning

confidence: 99%

Patient-Centered Care

O’Hare

Armistead²,

Schrag

et al. 2014

Clinical Journal of the American Society of Nephrology

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In light of mounting federal government debt and levels of Medicare spending that are widely viewed as unsustainable, commentators have called for a transformation of the United States health care system to deliver better care at lower costs. This article presents the priorities of the Coalition for Supportive Care of Kidney Patients for how clinicians might achieve this transformation for patients with advanced CKD and their families. The authors suspect that much of the high-intensity, high-cost care currently delivered to patients with advanced kidney disease may be unwanted and that the "Three Aims" put forth by the National Quality Strategy of better care for the individual, better health for populations, and reduced health care costs may be within reach for patients with CKD and ESRD. This work describes the coalition's vision for a more patient-centered approach to the care of patients with kidney disease and argues for more concerted efforts to align their treatments with their goals, values, and preferences. Key priorities to achieve this vision include using improved prognostic models and decision science to help patients, their families, and their providers better understand what to expect in the future; engaging patients and their families in shared decision-making before the initiation of dialysis and during the course of dialysis treatment; and tailoring treatment strategies throughout the continuum of their care to address what matters most to individual patients.

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Cost-Effectiveness of Initiating Dialysis Early: A Randomized Controlled Trial

Cited by 110 publications

References 16 publications

Effect of Timing of Dialysis Commencement on Clinical Outcomes of Patients with Planned Initiation of Peritoneal Dialysis in the Ideal Trial

Effect of Timing of Dialysis Commencement on Clinical Outcomes of Patients with Planned Initiation of Peritoneal Dialysis in the Ideal Trial

The Association of eGFR Reporting with the Timing of Dialysis Initiation

Patient-Centered Care

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