A randomized, controlled trial of early versus late initiation of dialysis.

Area of Science:

• Nephrology
• Clinical Trials
• Public Health

Background:

• Significant variation exists in initiating maintenance dialysis for stage V chronic kidney disease (CKD).
• A global trend towards earlier dialysis initiation is observed.
• This study investigated the impact of dialysis timing on survival in CKD patients.

Purpose of the Study:

• To determine if planned early initiation of maintenance dialysis improves survival in patients with stage V CKD.
• To compare clinical outcomes between early and late dialysis initiation groups.

Main Methods:

• Randomized controlled trial involving 828 adult patients with progressive CKD.
• Patients were assigned to either an early-start dialysis group (eGFR 10.0–14.0 ml/min) or a late-start group (eGFR 5.0–7.0 ml/min).
• Primary outcome was all-cause mortality, with a median follow-up of 3.59 years.

Main Results:

• No significant difference in mortality between the early-start (37.6%) and late-start (36.6%) dialysis groups (HR, 1.04; 95% CI, 0.83–1.30; P=0.75).
• A substantial proportion (75.9%) of the late-start group initiated dialysis above the target eGFR due to symptom development.
• No significant differences in adverse events, including cardiovascular events and infections, were observed between groups.

Conclusions:

• Planned early initiation of maintenance dialysis does not improve survival or clinical outcomes in patients with stage V CKD.
• The timing of dialysis initiation should be carefully considered based on individual patient factors and symptom development.