File Download
There are no files associated with this item.
Supplementary
-
Citations:
- Appears in Collections:
Conference Paper: What is the optimal timing of dialysis initiation?
Title | What is the optimal timing of dialysis initiation? |
---|---|
Authors | |
Issue Date | 2006 |
Publisher | Multimed, Inc. The Journal's web site is located at http://pdiconnect.com |
Citation | The 11th Congress of the International Society for Peritoneal Dialysis (ISPD 2006), Hong Kong 25-29 August 2006. In Peritoneal Dialysis International, 2006, v. 26 suppl. 2, p. S90 How to Cite? |
Abstract | 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 of all consecutive patients (n=233) deemed suitable for peritoneal dialysis (PD) after predialysis counseling over a 2-year period. 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, estimated by averaging urea and creatinine clearances obtained from plasma and 24-hour urine samples, reached 10 mL/min/1.73 m2 or below. The remaining 82 subjects (53.7% male, mean±SD age 58.4±11.3 yr, 46.3% diabetic, p=0.33 vs elective starters) declined dialysis initially (refusers). On follow-up, 45 (55%) initial refusers developed a uremic emergency after a median of 12 weeks, 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 (15.9% vs 4.0%, p=0.0003, log-rank test) and cardiovascular (9.8% vs 1.3%, p=0.0008) mortality among the initial refusers. Late starters also had higher rates of peritonitis (18 vs 42 patient-months/episode, p=0.003), hospitalization (3.14±1.17 vs 2.13±1.13 episodes, p=0.05), blood transfusion (0.8±0.35 vs 0.38±0.07 episodes, p=0.033), and less favorable nutritional indices during PD. Conclusion: Delaying dialysis initiation until the onset of symptomatic uremia adversely affects survival and well-being during the first year of dialysis. |
Description | Session - Rehabilitation, Quality of Life, and Survival This journal suppl. entitled: Abstracts of the 11th Congress of the ISPD |
Persistent Identifier | http://hdl.handle.net/10722/101946 |
ISSN | 2023 Impact Factor: 2.7 2023 SCImago Journal Rankings: 0.933 |
DC Field | Value | Language |
---|---|---|
dc.contributor.author | Tang, SCW | en_HK |
dc.contributor.author | Ho, YW | en_HK |
dc.contributor.author | Tang, AW | en_HK |
dc.contributor.author | Yip, T | en_HK |
dc.contributor.author | Tse, KC | en_HK |
dc.contributor.author | Wang, AYM | en_HK |
dc.contributor.author | Lo, WK | en_HK |
dc.contributor.author | Chan, DTM | en_HK |
dc.contributor.author | Lai, KN | en_HK |
dc.contributor.author | Lui, SL | en_HK |
dc.date.accessioned | 2010-09-25T20:10:51Z | - |
dc.date.available | 2010-09-25T20:10:51Z | - |
dc.date.issued | 2006 | en_HK |
dc.identifier.citation | The 11th Congress of the International Society for Peritoneal Dialysis (ISPD 2006), Hong Kong 25-29 August 2006. In Peritoneal Dialysis International, 2006, v. 26 suppl. 2, p. S90 | en_HK |
dc.identifier.issn | 0896-8608 | en_HK |
dc.identifier.uri | http://hdl.handle.net/10722/101946 | - |
dc.description | Session - Rehabilitation, Quality of Life, and Survival | - |
dc.description | This journal suppl. entitled: Abstracts of the 11th Congress of the ISPD | - |
dc.description.abstract | 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 of all consecutive patients (n=233) deemed suitable for peritoneal dialysis (PD) after predialysis counseling over a 2-year period. 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, estimated by averaging urea and creatinine clearances obtained from plasma and 24-hour urine samples, reached 10 mL/min/1.73 m2 or below. The remaining 82 subjects (53.7% male, mean±SD age 58.4±11.3 yr, 46.3% diabetic, p=0.33 vs elective starters) declined dialysis initially (refusers). On follow-up, 45 (55%) initial refusers developed a uremic emergency after a median of 12 weeks, 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 (15.9% vs 4.0%, p=0.0003, log-rank test) and cardiovascular (9.8% vs 1.3%, p=0.0008) mortality among the initial refusers. Late starters also had higher rates of peritonitis (18 vs 42 patient-months/episode, p=0.003), hospitalization (3.14±1.17 vs 2.13±1.13 episodes, p=0.05), blood transfusion (0.8±0.35 vs 0.38±0.07 episodes, p=0.033), and less favorable nutritional indices during PD. Conclusion: Delaying dialysis initiation until the onset of symptomatic uremia adversely affects survival and well-being during the first year of dialysis. | - |
dc.language | eng | en_HK |
dc.publisher | Multimed, Inc. The Journal's web site is located at http://pdiconnect.com | en_HK |
dc.relation.ispartof | Peritoneal Dialysis International | en_HK |
dc.title | What is the optimal timing of dialysis initiation? | en_HK |
dc.type | Conference_Paper | en_HK |
dc.identifier.openurl | http://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0896-8608&volume=Suppl 26&spage=S90&epage=&date=2006&atitle=What+is+the+optimal+timing+of+dialysis+initiation?+ | en_HK |
dc.identifier.email | Tang, SCW: scwtang@hku.hk | en_HK |
dc.identifier.email | Wang, AYM: aymwang@HKUCC.hku.hk | en_HK |
dc.identifier.email | Lo, WK: wkloc@HKUCC.hku.hk | en_HK |
dc.identifier.email | Chan, DTM: dtmchan@hku.hk | en_HK |
dc.identifier.email | Lai, KN: knlai@hku.hk | en_HK |
dc.identifier.email | Lui, SL: sllui@HKUCC.hku.hk | en_HK |
dc.identifier.email | S90 | - |
dc.identifier.authority | Tang, SCW=rp00480 | en_HK |
dc.identifier.authority | Chan, DTM=rp00394 | en_HK |
dc.identifier.authority | Lai, KN=rp00324 | en_HK |
dc.identifier.hkuros | 136783 | en_HK |
dc.identifier.volume | 26 | en_HK |
dc.identifier.issue | suppl. 2 | - |
dc.identifier.spage | S90 | en_HK |
dc.identifier.issnl | 0896-8608 | - |