Early Start of Dialysis Has No Survival Benefit in End-Stage Renal Disease Patients

Chang, Jae Hyun; Rim, Min Young; Sung, Jiyoon; Ko, Kwang-Pil; Kim, Yon Su; Jung, Ji Yong; Lee, Hyun Hee; Chung, Wookyung; Kim, Sejoong

doi:10.3346/jkms.2012.27.10.1177

Cited by 14 publications

(14 citation statements)

References 21 publications

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“…In this study, eGFR was used as an indicator to determine the initiation of dialysis. Twenty‐one studies estimated the GFR using a variant (4‐, 5‐, or 6‐variable) of the MDRD study equation , two studies estimated GFR using the Cockcroft‐Gault equation , and one study used the EPI equation . Two studies calculated GFR using the average of creatinine and urea clearance derived from a 24‐h urine collection .…”

Section: Resultsmentioning

confidence: 99%

Timing of Dialysis Initiation and Mortality Risk in Chronic Kidney Disease: A Meta‐Analysis

2018

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The optimal time of dialysis initiation among patients with chronic kidney disease (CKD) is unclear in recent years. We performed a meta-analysis to assess the association of early vs. late initiation of dialysis with estimated glomerular filtration rate. PUBMED, EMBASE, the Cochrane Library, and article reference lists were searched for relevant observational trials. A pooled hazard ratio (HR) with 95% CI was used to estimate the mortality risk. Twenty-six cohort studies and one randomized controlled trial were identified. Early start of dialysis was associated with the increased risk of mortality (HR = 1.23, 95% CI: 1.04-1.43) compared with late start of dialysis. In the subgroup analysis, age younger than 65 years at the early start of dialysis demonstrated higher mortality (HR = 1.20, 95% CI: 1.05-1.35) than the late start. Compared with peritoneal dialysis, the pooled HR with HD was 1.25 (95% CI: 1.17-1.34). Early start of dialysis increased the mortality risk compared with late start among patients with CKD.

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Section: Resultsmentioning

confidence: 99%

Timing of Dialysis Initiation and Mortality Risk in Chronic Kidney Disease: A Meta‐Analysis

2018

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“…While both the CCI and ESRD-CI are frequently used for risk adjustment in studies of dialysis patients [17][18][19][20][21][22], only a few studies have attempted to validate either index [15,23,24]. In addition, these validation studies have limitations including incomplete inclusion of all necessary comorbid conditions, and validation techniques that are not specific to time-to-event analyses [15,23,24].…”

Section: Introductionmentioning

confidence: 99%

Comorbidity Burden at Dialysis Initiation and Mortality: A Cohort Study

Gomez

Kiberd

Royston

et al. 2015

Can J Kidney Health Dis

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BackgroundA high level of comorbidity at dialysis initiation is associated with an increased risk of death. However, contemporary assessments of the validity and prognostic value of comorbidity indices are lacking.ObjectivesTo assess the validity of two comorbidity indices and to determine if a high degree of comorbidity is associated with mortality among dialysis patients.DesignCohort study.SettingQEII Health Sciences Centre (Halifax, Nova Scotia, Canada).PatientsIncident, chronic dialysis patients between 01 Jan 2006 and 01 Jul 2013.MeasurementsExposure: The Charlson Comorbidity Index (CCI) and End-Stage Renal Disease Comorbidity Index (ESRD-CI) were used to classify individual comorbid conditions into an overall score. Comorbidities were classified using patient charts and electronic records.Outcome: All-cause mortality.Confounders: Patient demographics, dialysis access, cause of ESRD and baseline laboratory data.MethodsRegression coefficients were estimated on the CCI and ESRD-CI. Discrimination for death was assessed using Harrell’s c-index. Adjusted Cox proportional hazard models were used to calculate relative hazards and 95 % confidence intervals for each category of the CCI and ESRD-CI.ResultsThe cohort consisted of 771 ESRD patients from 01 Jan 2006 to 01 Jul 2013. Most were male (62 %) and Caucasian (91 %). The cohort had a high proportion of diabetes (48 %), history of previous myocardial infarction (31 %) and heart failure (22 %). Regression coefficients on the CCI and ESRD-CI were 0.55 and 0.52, respectively. The c-index, for the prediction of death, was 0.61 for the CCI and 0.63 for the ESRD-CI. ESRD-CI scores of 4, 5 and ≥6 were associated with a similar mortality risk (adjusted relative hazard of 1.95, 1.89 and 1.99, respectively). There was a small increased mortality risk for CCI scores of 4, 5 and ≥6 (adjusted relative hazard of 1.86, 2.38 and 2.71, respectively).LimitationsClassification of comorbidities for each patient was determined by clinical impression.ConclusionsThe CCI and ESRD-CI have a limited ability to discriminate mortality risk for incident dialysis patients. Acknowledging the frequency with which they are used, this study emphasizes the need to re-examine the usefulness of previously derived comorbidity indices in contemporary dialysis cohorts.

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“…Several similar reports have indicated that decreased serum creatinine levels are associated with increased mortality after AKI (Bagshaw et al 2009(Bagshaw et al , 2012Ostermann and Chang 2009;Jamale et al 2013). Interestingly, several studies have recently reported that in patients with advanced chronic kidney disease, the early initiation of RRT based on eGFR was unable to improve patient survival (Cooper et al 2010;Chang et al 2012), and even led to worse survival and clinical outcomes (Crews et al 2014). Considering these findings, clinicians should not initiate RRT based solely on serum creatinine levels and eGFR.…”

Section: Discussionmentioning

confidence: 99%

Classical Indications Are Useful for Initiating Continuous Renal Replacement Therapy in Critically Ill Patients

Lee

Cho

Chung

et al. 2014

Tohoku J. Exp. Med.

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The optimal timing for initiating continuous renal replacement therapy (CRRT) remains controversial, and it is not obvious which parameters should be considered during this process. We investigated the predictive value of physiological parameters among critically ill patients receiving CRRT due to acute kidney injury (AKI). A total of 496 patients who started CRRT were prospectively enrolled. The following physiological parameters were significantly associated with mortality even after multivariate adjustments: level of pH In conclusion, the physiological parameters are useful in predicting post-AKI mortality and should be considered when initiating CRRT in critically ill patients with AKI.

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Early Start of Dialysis Has No Survival Benefit in End-Stage Renal Disease Patients

Cited by 14 publications

References 21 publications

Timing of Dialysis Initiation and Mortality Risk in Chronic Kidney Disease: A Meta‐Analysis

Timing of Dialysis Initiation and Mortality Risk in Chronic Kidney Disease: A Meta‐Analysis

Comorbidity Burden at Dialysis Initiation and Mortality: A Cohort Study

Classical Indications Are Useful for Initiating Continuous Renal Replacement Therapy in Critically Ill Patients

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