| No survival benefit from early-start dialysis in a population-based, inception cohort study of Swedish patients with chronic kidney disease. | |
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MedLine Citation:
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PMID: 20831629 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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M Evans; G Tettamanti; O Nyrén; R Bellocco; C M Fored; C-G Elinder |
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Publication Detail:
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Type: Journal Article Date: 2010-09-10 |
Journal Detail:
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Title: Journal of internal medicine Volume: 269 ISSN: 1365-2796 ISO Abbreviation: J. Intern. Med. Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-02-21 Completed Date: 2011-04-14 Revised Date: 2011-08-08 |
Medline Journal Info:
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Nlm Unique ID: 8904841 Medline TA: J Intern Med Country: England |
Other Details:
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Languages: eng Pagination: 289-98 Citation Subset: IM |
Copyright Information:
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© 2010 The Association for the Publication of the Journal of Internal Medicine. |
Affiliation:
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Department of Clinical Sciences, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. marie.evans@ki.se |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Epidemiologic Methods Female Glomerular Filtration Rate Humans Kidney Failure, Chronic / mortality, physiopathology, therapy* Male Middle Aged Renal Dialysis / methods* Sweden / epidemiology Time Factors Young Adult |
| Comments/Corrections | |
Comment In:
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J Intern Med. 2011 Mar;269(3):275-7
[PMID:
21083856
]
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Erratum In:
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J Intern Med. 2011 Jul;270(1):85-6 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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