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Conference Paper: What is the optimal timing of dialysis initiation?

TitleWhat is the optimal timing of dialysis initiation?
Authors
Issue Date2006
PublisherMultimed, 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?
AbstractBackground: 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.
DescriptionSession - Rehabilitation, Quality of Life, and Survival
This journal suppl. entitled: Abstracts of the 11th Congress of the ISPD
Persistent Identifierhttp://hdl.handle.net/10722/101946
ISSN
2015 Impact Factor: 1.298
2015 SCImago Journal Rankings: 0.683

 

DC FieldValueLanguage
dc.contributor.authorTang, SCWen_HK
dc.contributor.authorHo, YWen_HK
dc.contributor.authorTang, AWen_HK
dc.contributor.authorYip, Ten_HK
dc.contributor.authorTse, KCen_HK
dc.contributor.authorWang, AYMen_HK
dc.contributor.authorLo, WKen_HK
dc.contributor.authorChan, DTMen_HK
dc.contributor.authorLai, KNen_HK
dc.contributor.authorLui, SLen_HK
dc.date.accessioned2010-09-25T20:10:51Z-
dc.date.available2010-09-25T20:10:51Z-
dc.date.issued2006en_HK
dc.identifier.citationThe 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. S90en_HK
dc.identifier.issn0896-8608en_HK
dc.identifier.urihttp://hdl.handle.net/10722/101946-
dc.descriptionSession - Rehabilitation, Quality of Life, and Survival-
dc.descriptionThis journal suppl. entitled: Abstracts of the 11th Congress of the ISPD-
dc.description.abstractBackground: 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.languageengen_HK
dc.publisherMultimed, Inc. The Journal's web site is located at http://pdiconnect.comen_HK
dc.relation.ispartofPeritoneal Dialysis Internationalen_HK
dc.titleWhat is the optimal timing of dialysis initiation?en_HK
dc.typeConference_Paperen_HK
dc.identifier.openurlhttp://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.emailTang, SCW: scwtang@hku.hken_HK
dc.identifier.emailWang, AYM: aymwang@HKUCC.hku.hken_HK
dc.identifier.emailLo, WK: wkloc@HKUCC.hku.hken_HK
dc.identifier.emailChan, DTM: dtmchan@hku.hken_HK
dc.identifier.emailLai, KN: knlai@hku.hken_HK
dc.identifier.emailLui, SL: sllui@HKUCC.hku.hken_HK
dc.identifier.emailS90-
dc.identifier.authorityTang, SCW=rp00480en_HK
dc.identifier.authorityChan, DTM=rp00394en_HK
dc.identifier.authorityLai, KN=rp00324en_HK
dc.identifier.hkuros136783en_HK
dc.identifier.volume26en_HK
dc.identifier.issuesuppl. 2-
dc.identifier.spageS90en_HK

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