Document Detail

No survival benefit from early-start dialysis in a population-based, inception cohort study of Swedish patients with chronic kidney disease.
MedLine Citation:
PMID:  20831629     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To investigate how the timing of dialysis initiation is associated with mortality.
DESIGN: Population-based, prospective, observational cohort study.
SETTING: Clinical laboratories (n = 69) provided information on all patients in Sweden whose serum creatinine level for the first time and exceeded 3.4 mg dL(-1) (men) or 2.8 mg dL(-1) (women) between 20 May 1996 and 31 May 1998.
SUBJECTS: All patients (n = 901), aged 18-74 years, in whom the cause of serum creatinine elevation was chronic kidney disease, were included in the study; participants were interviewed and followed for 5-7 years.
MAIN OUTCOME MEASURES: Information on date of death was obtained from a national Swedish population register. Early-start dialysis [estimated glomerular filtration rate from serum creatinine (eGFR) ≥7.5 mL min(-1) per 1.73 m(2)] was compared to late start of dialysis (eGFR <7.5 mL min(-1) per 1.73 m(2)), and no dialysis. Relative risk [hazard ratio (HR)] of death was modelled with time-dependent multivariate Cox proportional hazards regression.
RESULTS: Mean eGFR was 16.1 mL min(-1) per 1.73 m(2) at inclusion and 7.6 mL min(-1) per 1.73 m(2) at the start of dialysis. Among the 385 patients who started dialysis late, 36% died during follow-up compared to 52% of 323 who started early. The adjusted HR for death was 0.84 [95% confidence interval (CI) 0.64, 1.10] among late versus early starters. The mortality among nondialysed patients increased significantly at eGFR below 7.5 mL min(-1) per 1.73 m(2) (HR 4.65; 95% CI 2.28, 9.49; compared to eGFR 7.5-10 mL min(-1) per 1.73 m(2)). After the start of dialysis, the mortality rate further increased. Compared to nondialysed patients with eGFR ≤15 mL min(-1) per 1.73 m(2), adjusted HR was 2.65 (95% CI 1.80, 3.89) for patients receiving dialysis.
CONCLUSION: We found no survival benefit from early initiation of dialysis.
M Evans; G Tettamanti; O Nyrén; R Bellocco; C M Fored; C-G Elinder
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Publication Detail:
Type:  Journal Article     Date:  2010-09-10
Journal Detail:
Title:  Journal of internal medicine     Volume:  269     ISSN:  1365-2796     ISO Abbreviation:  J. Intern. Med.     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-21     Completed Date:  2011-04-14     Revised Date:  2011-08-08    
Medline Journal Info:
Nlm Unique ID:  8904841     Medline TA:  J Intern Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  289-98     Citation Subset:  IM    
Copyright Information:
© 2010 The Association for the Publication of the Journal of Internal Medicine.
Department of Clinical Sciences, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
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MeSH Terms
Epidemiologic Methods
Glomerular Filtration Rate
Kidney Failure, Chronic / mortality,  physiopathology,  therapy*
Middle Aged
Renal Dialysis / methods*
Sweden / epidemiology
Time Factors
Young Adult
Comment In:
J Intern Med. 2011 Mar;269(3):275-7   [PMID:  21083856 ]
Erratum In:
J Intern Med. 2011 Jul;270(1):85-6

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