NEW YORK (Reuters Health) – Putting patients on dialysis before they’re symptomatic offers no survival benefit; on the contrary, it may increase their risk of death, according to a study published online today in CMAJ (Canadian Medical Association Journal).
Rather than timing the start of dialysis on the basis of a patient’s glomerular filtration rate, lead author Dr. William F. Clark told Reuters Health by e-mail, “careful clinical assessment of changes in well being, nutritional status, volume control, and signs and symptoms of uremia” should guide the decision.
“In contrast to early initiation of dialysis, early referral to a nephrologist is consistently associated with better survival,” he and his colleagues point out in their article.
Yet dialysis registry data from Europe, the US and Canada indicate a trend toward earlier initiation of dialysis, at increasingly higher estimated glomerular filtration rates (eGFR), Dr. Clark, of the London Health Sciences Center and University of Western Ontario, in London, Ontario, and colleagues note.
These trends persist despite a “consistent absence of a survival benefit with early initiation of dialysis across a variety of study designs, populations and health care delivery systems.” This, they say, “argues against preemptive initiation of dialysis in asymptomatic patients.”
In the current study, Dr. Clark and colleagues analyzed data on 25,910 adult patients in Canada who started dialysis between 2001 and 2007. They looked at the timing of dialysis initiation (early versus late) and the risk of death in these two groups over time. Patients who initiated dialysis at an eGFR above 10.5 mL/min/1.73m
