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Article: Delaying initiation of dialysis till symptomatic uraemia - Is it too late?
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TitleDelaying initiation of dialysis till symptomatic uraemia - Is it too late?
 
AuthorsTang, SCW1 2
Ho, YW2
Tang, AWC2
Cheng, YY2
Chiu, FH1
Lo, WK1
Lai, KN1
Wang, AYM3
Lui, SL3
Leung, JCK3
Chan, LYY3
Tang, CSO3
Lam, MF3
Tse, KC3
Yip, TPS3
Lee, LLY3
Poon, J3
Leung, H3
Chan, TM3
Cheng, AYY2
Lam, WO2
Leung, SS2
Ho, YW2
 
KeywordsDialysis initiation
Outcome
Survival
Uraemic symptoms
 
Issue Date2007
 
PublisherOxford University Press. The Journal's web site is located at http://ndt.oxfordjournals.org/
 
CitationNephrology Dialysis Transplantation, 2007, v. 22 n. 7, p. 1926-1932 [How to Cite?]
DOI: http://dx.doi.org/10.1093/ndt/gfm109
 
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 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/ 1.73m 2 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. © The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
 
ISSN0931-0509
2013 Impact Factor: 3.488
 
DOIhttp://dx.doi.org/10.1093/ndt/gfm109
 
ISI Accession Number IDWOS:000248539500021
 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorTang, SCW
 
dc.contributor.authorHo, YW
 
dc.contributor.authorTang, AWC
 
dc.contributor.authorCheng, YY
 
dc.contributor.authorChiu, FH
 
dc.contributor.authorLo, WK
 
dc.contributor.authorLai, KN
 
dc.contributor.authorWang, AYM
 
dc.contributor.authorLui, SL
 
dc.contributor.authorLeung, JCK
 
dc.contributor.authorChan, LYY
 
dc.contributor.authorTang, CSO
 
dc.contributor.authorLam, MF
 
dc.contributor.authorTse, KC
 
dc.contributor.authorYip, TPS
 
dc.contributor.authorLee, LLY
 
dc.contributor.authorPoon, J
 
dc.contributor.authorLeung, H
 
dc.contributor.authorChan, TM
 
dc.contributor.authorCheng, AYY
 
dc.contributor.authorLam, WO
 
dc.contributor.authorLeung, SS
 
dc.contributor.authorHo, YW
 
dc.date.accessioned2012-09-05T05:27:33Z
 
dc.date.available2012-09-05T05:27:33Z
 
dc.date.issued2007
 
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 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/ 1.73m 2 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. © The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
 
dc.description.naturelink_to_OA_fulltext
 
dc.identifier.citationNephrology Dialysis Transplantation, 2007, v. 22 n. 7, p. 1926-1932 [How to Cite?]
DOI: http://dx.doi.org/10.1093/ndt/gfm109
 
dc.identifier.doihttp://dx.doi.org/10.1093/ndt/gfm109
 
dc.identifier.epage1932
 
dc.identifier.f10001090411
 
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dc.identifier.hkuros134584
 
dc.identifier.isiWOS:000248539500021
 
dc.identifier.issn0931-0509
2013 Impact Factor: 3.488
 
dc.identifier.issue7
 
dc.identifier.pmid17400562
 
dc.identifier.scopuseid_2-s2.0-34547839651
 
dc.identifier.spage1926
 
dc.identifier.urihttp://hdl.handle.net/10722/163097
 
dc.identifier.volume22
 
dc.languageeng
 
dc.publisherOxford University Press. The Journal's web site is located at http://ndt.oxfordjournals.org/
 
dc.publisher.placeUnited Kingdom
 
dc.relation.ispartofNephrology Dialysis Transplantation
 
dc.relation.referencesReferences in Scopus
 
dc.rightsNephrology, Dialysis, Transplantation. Copyright © Oxford University Press.
 
dc.subject.meshAged
 
dc.subject.meshCardiovascular Diseases - Mortality
 
dc.subject.meshFemale
 
dc.subject.meshFollow-Up Studies
 
dc.subject.meshGlomerular Filtration Rate
 
dc.subject.meshHumans
 
dc.subject.meshKaplan-Meier Estimate
 
dc.subject.meshKidney Failure, Chronic - Complications - Mortality - Physiopathology - Therapy
 
dc.subject.meshMale
 
dc.subject.meshMiddle Aged
 
dc.subject.meshPeritoneal Dialysis - Methods
 
dc.subject.meshPeritoneal Dialysis, Continuous Ambulatory
 
dc.subject.meshProspective Studies
 
dc.subject.meshTime Factors
 
dc.subject.meshTreatment Outcome
 
dc.subject.meshTreatment Refusal
 
dc.subject.meshUremia - Etiology
 
dc.subjectDialysis initiation
 
dc.subjectOutcome
 
dc.subjectSurvival
 
dc.subjectUraemic symptoms
 
dc.titleDelaying initiation of dialysis till symptomatic uraemia - Is it too late?
 
dc.typeArticle
 
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<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&apos; 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 &apos;elective starters&apos; (50.3% male, mean&#177;SD age=57.7&#177;13.9 years, 39.7% diabetic) who were electively initiated on dialysis when glomerular filtration rate reached 10 ml/min/ 1.73m 2 or below. The remaining 82 subjects (53.7% male, mean&#177;SD age=58.4&#177;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. &#169; The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.</description.abstract>
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Author Affiliations
  1. The University of Hong Kong
  2. United Christian Hospital Hong Kong
  3. Queen Mary Hospital Hong Kong