As the initiation of dialysis at an eGFR greater than 10 mL/min/1.732 was associated with lower survival in children and adolescents, it may be beneficial to delay dialysis until further eGFR decline, according to a published study.
“The trend toward earlier initiation of dialysis is concerning given that observational studies in adults with ESRD have not shown a survival benefit to starting dialysis at higher levels of eGFR,” Erica Winnicki, MD, of the University of California, San Francisco, and colleagues wrote. “The Initiating Dialysis Early and Late (IDEAL) trial in adult patients with [chronic kidney disease] CKD, which randomized patients to earlier (defined as an eGFR 10 [mL/min/1.73m2] to 14 mL/min/1.73m2) vs. later (defined as an eGFR 5 [mL/min/1.73m2] to 7 mL/min/1.73m2) initiation of dialysis did not find a survival benefit to the planned initiation of dialysis at higher eGFR. Fewer studies have focused on how the timing of dialysis initiation in children with CKD has changed over time and the extent to which the timing of dialysis initiation is associated with mortality.”
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This activity is supported by educational grants from Merck & Co., Inc. and Shire.
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