The Authors Reply:

Abstract

change the National Kidney Foundation guidelines recommending early start (estimated glomerular filtration rate over 10 ml/min per m 2 ) fail to consider the fact that dialyzer clearances have not been shown to relate to patient survival in two randomized controlled trials. 2 Indeed it is illogical to think that small-molecule dialyzer clearance provides a more significant benefit than a patient's own residual renal function, which provides middle molecular as well as other kidneyspecific benefits. Early dialysis leads to loss of this important predictor of survival and is another reason why we caution the nephrology community to examine the wisdom of the trend to start dialysis early.1. Bargman J. The CANUSA study and the importance of residual kidney function in dialysis patients.