June 27, 2010

A Randomized, Controlled Trial of Early versus Late Initiation of Dialysis

This landmark clinical trial randomized CKD patients to a strategy of early (GFR 10-14 ml/min) vs late (GFR 5-7 ml/min) initiation of dialysis.   After a median follow-up of 3.6 years, no difference was seen in mortality, cardiovascular events, infections, or complications of dialysis.  Careful note should be made that the majority of patient randomized to late initiation (76%) had to start dialysis at a GFR above 7 ml/min due to clinical indications.  Read the accompanying editorial to learn more and please post your own comments on Nephrology Now.

Related Articles:

Hemodialysis, Peritoneal Dialysis
  • Susan Allan

    An interesting paper but I question how generalizable the results are as the vast majority of patients approached for enrollement were excluded. The exceptionally low CVC rate is likely a marker of a highly selected population.

    That being said, for the patient population examined, it seems that holding dialysis initiation until indicated by clinical need, rather than hitting a GFR threshold, is very reasonable and safe.

  • Hector Parra


    This paper is the triumph of a superb predialysis control in Australia and New Zealand.

  • Giancarlo Ruggieri

    I am an Italian nephrologist ; I had occasion to have already read this article elsewhere .Because I am 75 years old, I remember that the present debated dilemma about early or late starting of dialysis was one of the most important dialysis problem in seventies, resolved at that time and at least in Italy with some trend in favour of early dialysis. It seems that the present suggested trend is towards a careful attention of the patients conditions from many points of view, including their psychological behaviour and on these evaluations to choice the moment to prepare the patient and to start dialysis, i.e. I would like to say as I had occasion to say many years ago, not an early neither a late starting, but a well-timed dialysis

  • Ayman Wahbeh

    This study is important, but it indicates that dialysis initiation is usually at about 10-14 ml/min and the patient symptoms and clinical situation is more important than the number of GFR per say.