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Article: Delaying initiation of dialysis till symptomatic uraemia - Is it too late?

TitleDelaying initiation of dialysis till symptomatic uraemia - Is it too late?
Authors
KeywordsDialysis initiation
Outcome
Survival
Uraemic symptoms
Issue Date2007
PublisherOxford University Press. The Journal's web site is located at http://ndt.oxfordjournals.org/
Citation
Nephrology Dialysis Transplantation, 2007, v. 22 n. 7, p. 1926-1932 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 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.
Persistent Identifierhttp://hdl.handle.net/10722/163097
ISSN
2014 Impact Factor: 3.577
2014 SCImago Journal Rankings: 1.373
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorTang, SCWen_HK
dc.contributor.authorHo, YWen_HK
dc.contributor.authorTang, AWCen_HK
dc.contributor.authorCheng, YYen_HK
dc.contributor.authorChiu, FHen_HK
dc.contributor.authorLo, WKen_HK
dc.contributor.authorLai, KNen_HK
dc.contributor.authorWang, AYMen_HK
dc.contributor.authorLui, SLen_HK
dc.contributor.authorLeung, JCKen_HK
dc.contributor.authorChan, LYYen_HK
dc.contributor.authorTang, CSOen_HK
dc.contributor.authorLam, MFen_HK
dc.contributor.authorTse, KCen_HK
dc.contributor.authorYip, TPSen_HK
dc.contributor.authorLee, LLYen_HK
dc.contributor.authorPoon, Jen_HK
dc.contributor.authorLeung, Hen_HK
dc.contributor.authorChan, TMen_HK
dc.contributor.authorCheng, AYYen_HK
dc.contributor.authorLam, WOen_HK
dc.contributor.authorLeung, SSen_HK
dc.contributor.authorHo, YWen_HK
dc.date.accessioned2012-09-05T05:27:33Z-
dc.date.available2012-09-05T05:27:33Z-
dc.date.issued2007en_HK
dc.identifier.citationNephrology Dialysis Transplantation, 2007, v. 22 n. 7, p. 1926-1932en_HK
dc.identifier.issn0931-0509en_HK
dc.identifier.urihttp://hdl.handle.net/10722/163097-
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.en_HK
dc.languageengen_US
dc.publisherOxford University Press. The Journal's web site is located at http://ndt.oxfordjournals.org/en_HK
dc.relation.ispartofNephrology Dialysis Transplantationen_HK
dc.rightsNephrology, Dialysis, Transplantation. Copyright © Oxford University Press.-
dc.subjectDialysis initiationen_HK
dc.subjectOutcomeen_HK
dc.subjectSurvivalen_HK
dc.subjectUraemic symptomsen_HK
dc.subject.meshAgeden_US
dc.subject.meshCardiovascular Diseases - Mortalityen_US
dc.subject.meshFemaleen_US
dc.subject.meshFollow-Up Studiesen_US
dc.subject.meshGlomerular Filtration Rateen_US
dc.subject.meshHumansen_US
dc.subject.meshKaplan-Meier Estimateen_US
dc.subject.meshKidney Failure, Chronic - Complications - Mortality - Physiopathology - Therapyen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshPeritoneal Dialysis - Methodsen_US
dc.subject.meshPeritoneal Dialysis, Continuous Ambulatoryen_US
dc.subject.meshProspective Studiesen_US
dc.subject.meshTime Factorsen_US
dc.subject.meshTreatment Outcomeen_US
dc.subject.meshTreatment Refusalen_US
dc.subject.meshUremia - Etiologyen_US
dc.titleDelaying initiation of dialysis till symptomatic uraemia - Is it too late?en_HK
dc.typeArticleen_HK
dc.identifier.emailTang, SCW: scwtang@hku.hken_HK
dc.identifier.emailLai, KN: knlai@hku.hken_HK
dc.identifier.emailLeung, JCK: jckleung@hku.hken_HK
dc.identifier.emailChan, TM: dtmchan@hku.hken_HK
dc.identifier.authorityTang, SCW=rp00480en_HK
dc.identifier.authorityLai, KN=rp00324en_HK
dc.identifier.authorityLeung, JCK=rp00448en_HK
dc.identifier.authorityChan, TM=rp00394en_HK
dc.description.naturelink_to_OA_fulltexten_US
dc.identifier.doi10.1093/ndt/gfm109en_HK
dc.identifier.pmid17400562en_HK
dc.identifier.scopuseid_2-s2.0-34547839651en_HK
dc.identifier.hkuros134584-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-34547839651&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume22en_HK
dc.identifier.issue7en_HK
dc.identifier.spage1926en_HK
dc.identifier.epage1932en_HK
dc.identifier.isiWOS:000248539500021-
dc.publisher.placeUnited Kingdomen_HK
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dc.identifier.scopusauthoridTang, SCW=7403437082en_HK
dc.identifier.scopusauthoridHo, YW=7402555047en_HK
dc.identifier.scopusauthoridTang, AWC=7201845919en_HK
dc.identifier.scopusauthoridCheng, YY=7404915743en_HK
dc.identifier.scopusauthoridChiu, FH=7005502713en_HK
dc.identifier.scopusauthoridLo, WK=7201502414en_HK
dc.identifier.scopusauthoridLai, KN=7402135706en_HK
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dc.identifier.scopusauthoridLui, SL=7102379130en_HK
dc.identifier.scopusauthoridLeung, JCK=7202180349en_HK
dc.identifier.scopusauthoridChan, LYY=55182644100en_HK
dc.identifier.scopusauthoridTang, CSO=55225422400en_HK
dc.identifier.scopusauthoridLam, MF=7202630163en_HK
dc.identifier.scopusauthoridTse, KC=7102609864en_HK
dc.identifier.scopusauthoridYip, TPS=7004283977en_HK
dc.identifier.scopusauthoridLee, LLY=36984977600en_HK
dc.identifier.scopusauthoridPoon, J=16936614800en_HK
dc.identifier.scopusauthoridLeung, H=36755850800en_HK
dc.identifier.scopusauthoridChan, TM=7402687700en_HK
dc.identifier.scopusauthoridCheng, AYY=18534033500en_HK
dc.identifier.scopusauthoridLam, WO=7203021868en_HK
dc.identifier.scopusauthoridLeung, SS=18536347500en_HK
dc.identifier.scopusauthoridHo, YW=55236239600en_HK

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