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Starting dialysis early in course of kidney disease linked to worse outcomes

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Patients who begin dialysis when kidney disease is at a relatively early stage have an increased risk of dying in the following year, according to a November 8 online report in the Archives of Internal Medicine.

Mortality in the first year after starting dialysis increased from 6.8% among patients with an estimated glomerular filtration rate (eGFR) below 5 up to 20.1% among those with the highest eGFR. Relative to the lowest eGFR group, the adjusted mortality hazard ratios for the three higher eGFR groups were 1.23, 1.47, and 1.74.

“The appropriate timing for initiating hemodialysis relative to estimated levels of residual renal function is an important, but as yet unresolved, question having considerable patient outcome and financial consequences,” the authors state.

Dr. Steven J. Rosansky with the Wm. Jennings Bryan Dorn Veterans Hospital in Columbia, South Carolina, and colleagues note that there’s been a “dramatic increase” since 1996 in the number of US kidney disease patients starting dialysis when their eGFR is 10 mL/min/1.73m