BACKGROUND: The optimal timing of initiating renal replacement therapy in patients with chronic renal failure remains uncertain. The primary objective of our study is to determine whether delaying dialysis initiation as a result of patients' choice may have any impact on survival in subjects with end-stage renal disease. METHODS: We prospectively studied the clinical outcome during the first year of all consecutive patients (n=233) deemed suitable for peritoneal dialysis (PD) after pre-dialysis counselling over a 2-year period from 2002 to 2004. All patients who were offered dialysis were included in the analysis from the day of initial counselling regardless of whether or not they were eventually established on PD. RESULTS: There were 151 'elective starters' (50.3% male, mean+/-SD age=57.7+/-13.9 years, 39.7% diabetic) who were electively initiated on dialysis when glomerular filtration rate reached 10 ml/min/1.73 m2 or below. The remaining 82 subjects (53.7% male, mean+/-SD age=58.4+/-11.3 years, 46.3% diabetic, P=0.33 vs elective starters) declined dialysis initially (initial refusers). On follow-up, 45 (55%) initial refusers developed a uraemic emergency and agreed to undergo dialysis, and 39 (48%) were eventually established on maintenance PD (late starters). Kaplan-Meier analysis of 1-year survival showed a significantly higher rate of all-cause (18.3% vs 6.6%, P=0.004, log-rank test) and cardiovascular (9.8% vs 2.6%, P=0.014) mortality among the initial refusers. CONCLUSION: Patients who refuse timely start of dialysis have worse overall outcome at one year after the offer of dialysis, compared with elective starters.
BACKGROUND: The optimal timing of initiating renal replacement therapy in patients with chronic renal failure remains uncertain. The primary objective of our study is to determine whether delaying dialysis initiation as a result of patients' choice may have any impact on survival in subjects with end-stage renal disease. METHODS: We prospectively studied the clinical outcome during the first year of all consecutive patients (n=233) deemed suitable for peritoneal dialysis (PD) after pre-dialysis counselling over a 2-year period from 2002 to 2004. All patients who were offered dialysis were included in the analysis from the day of initial counselling regardless of whether or not they were eventually established on PD. RESULTS: There were 151 'elective starters' (50.3% male, mean+/-SD age=57.7+/-13.9 years, 39.7% diabetic) who were electively initiated on dialysis when glomerular filtration rate reached 10 ml/min/1.73 m2 or below. The remaining 82 subjects (53.7% male, mean+/-SD age=58.4+/-11.3 years, 46.3% diabetic, P=0.33 vs elective starters) declined dialysis initially (initial refusers). On follow-up, 45 (55%) initial refusers developed a uraemic emergency and agreed to undergo dialysis, and 39 (48%) were eventually established on maintenance PD (late starters). Kaplan-Meier analysis of 1-year survival showed a significantly higher rate of all-cause (18.3% vs 6.6%, P=0.004, log-rank test) and cardiovascular (9.8% vs 2.6%, P=0.014) mortality among the initial refusers. CONCLUSION:Patients who refuse timely start of dialysis have worse overall outcome at one year after the offer of dialysis, compared with elective starters.
Authors: Deidra C Crews; Julia J Scialla; Jiannong Liu; Haifeng Guo; Karen Bandeen-Roche; Patti L Ephraim; Bernard G Jaar; Stephen M Sozio; Dana C Miskulin; Navdeep Tangri; Tariq Shafi; Klemens B Meyer; Albert W Wu; Neil R Powe; L Ebony Boulware Journal: J Am Soc Nephrol Date: 2013-10-24 Impact factor: 10.121
Authors: Deidra C Crews; Julia J Scialla; L Ebony Boulware; Sankar D Navaneethan; Joseph V Nally; Xiaobo Liu; Susana Arrigain; Jesse D Schold; Patti L Ephraim; Stacey E Jolly; Stephen M Sozio; Wieneke M Michels; Dana C Miskulin; Navdeep Tangri; Tariq Shafi; Albert W Wu; Karen Bandeen-Roche Journal: Am J Kidney Dis Date: 2014-02-06 Impact factor: 8.860
Authors: Susan P Y Wong; Elizabeth K Vig; Janelle S Taylor; Nilka R Burrows; Chuan-Fen Liu; Desmond E Williams; Paul L Hebert; Ann M O'Hare Journal: JAMA Intern Med Date: 2016-02 Impact factor: 21.873
Authors: Jae Hyun Chang; Min Young Rim; Jiyoon Sung; Kwang-Pil Ko; Dong Ki Kim; Ji Yong Jung; Hyun Hee Lee; Wookyung Chung; Sejoong Kim Journal: J Korean Med Sci Date: 2012-10-02 Impact factor: 2.153