The results of the initiating dialysis early and late trial.

Abstract

Background: There is considerable clinical practice variation in the timing of initiation of maintenance dialysis for stage 5 chronic kidney disease (CKD), with a worldwide trend towards earlier commencement. This study from 32 Australian and New Zealand centers examined whether the timing of initiation of maintenance dialysis influenced survival of patients with CKD. Method(s): Patients aged 18 years or more with progressive CKD and a Cockcroft-Gault estimated glomerular filtration rate (GFR) between 10 and 15 ml/min/1.73 m2 were randomly assigned to commence dialysis at a GFR of either 10-14 ml/min/1.73 m2 (early start) or 5-7 ml/min/1.73 m2 (late start). The primary outcome was all cause mortality. Result(s): Between July 2000 and November 2006, 828 adults (mean age 60.4 years; 286 females and 542 males; 355 diabetics) underwent randomization. The median time to dialysis initiation following randomization was 1.80 months in the early-start group and 7.40 months in the late-start group (hazard ratio 2.09, 95% CI 1.81 to 2.41, p < 0.0001). During a median follow-up period of 3.59 years, 152 (of 404 (37.6%)) in the early-start group and 155 (of 424 (36.6%)) in the late start group died (hazard ratio 1.04, 95% CI 0.83 to 1.30, p = 0.75). The frequency of secondary outcomes (cardiovascular events, infections and dialysis complications) was no different between groups. Conclusion(s): Planned early initiation of dialysis in patients with stage 5 CKD is not associated with improved survival and clinical outcomes.