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
2011 Impact Factor: 3.396
2011 SCImago Journal Rankings: 0.277
DOIhttp://dx.doi.org/10.1093/ndt/gfm109
ReferencesReferences in Scopus
DC Field
Value
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_subscribed_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.issn0931-0509
2011 Impact Factor: 3.396
2011 SCImago Journal Rankings: 0.277
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.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
Author Affiliations
  1. The University of Hong Kong
  2. United Christian Hospital Hong Kong
  3. Queen Mary Hospital Hong Kong