In patients with chronic kidney disease, outcomes are similar regardless of the planned timing of dialysis, according to a New England Journal of Medicine study.
Researchers in Australia and New Zealand randomized some 830 adults with progressive, end-stage renal disease to early initiation of dialysis (when estimated glomerular filtration rate reached 10-14 ml/minute) or late initiation (eGFR, 5-7 ml/minute). Ultimately, dialysis began an average of 5.5 months earlier in the early-start group. About three-fourths of "late-start" patients actually began dialysis when eGFR was above 7 ml/minute, owing to symptoms such as uremia.
During a median 3.5 years' follow-up, mortality was similar in the two groups (about 35%). In addition, there were no differences in cardiovascular outcomes, infections, or dialysis complications.
The authors say their findings show that "with careful clinical management, dialysis may be delayed until either the GFR drops below 7.0 ml per minute or more traditional clinical indicators for the initiation of dialysis are present."
NEJM article (Free)
NEJM editorial (Free)
Dato' Dr. Ismail Yaacob
Medical Director/Consultant Physician
Kedah Medical Centre
No comments:
Post a Comment