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In Stage V Kidney Disease Early Dialysis Start Unneeded

Does not improve survival or outcomes compared with late initiation in stage V CKD

MONDAY, June 28 (HealthDay News) -- In patients with stage V chronic kidney disease, early initiation of dialysis does not result in improved survival rates or clinical outcomes, according to a study published online June 27 in the New England Journal of Medicine to coincide with press conferences at the European Renal Association—European Dialysis and Transplant Association Congress, held from June 25 to 28 in Munich, Germany.

In the Initiating Dialysis Early and Late (IDEAL) study, Bruce A. Cooper, Ph.D., of Sydney Medical School in Australia, and colleagues randomized 828 individuals (542 men and 286 women; 355 with diabetes), 18 years of age or older, with progressive chronic kidney disease and an estimated glomerular filtration rate (GFR) between 10 and 15 ml/min per 1.73 m² of body surface to an early dialysis start group (GFR between 10 and 14 ml/min) or a late start group (GFR between 5 and 7 ml/min).

The authors note that, in the early start group, the median time to the initiation of dialysis was 1.8 months, whereas it was 7.4 months in the late start group, with 75.9 percent of those in the late start group beginning dialysis due to symptom development, even though estimated GFR was above the target. The researchers found that, during median follow-up of 3.59 years, 37.6 percent of individuals in the early start group and 36.6 percent in the late start group died (hazard ratio with early initiation, 1.04; P = 0.75). The frequency of adverse events did not differ significantly between the early and late start groups.

"In our view, the IDEAL trial supports the currently recommended practice, in which most nephrologists start patients on renal-replacement therapy on the basis of clinical factors rather than numerical criteria such as the estimated GFR alone," write the authors of an accompanying editorial.

The study was funded in part by Baxter Healthcare, Amgen Australia, and Janssen-Cilag; three study authors disclosed financial ties to these and other pharmaceutical and medical device companies.

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