Early initiation of dialysis in patients with chronic progressive kidney failure does not confer a mortality advantage when compared with an approach of late initiation combined with appearance of symptoms or signs of uraemia

Commentary on: 1. Cooper BA, 2. Branley P, 3. Bulfone L, 4. et al .; IDEAL Study. A randomized, controlled trial of early versus late initiation of dialysis. N Engl J Med 2010;363:609–19. [OpenUrl][1][CrossRef][2][PubMed][3] Initiation of dialysis in patients with chronic kidney disease will depend on a combination of biochemical parameters and/or the development of symptoms and signs of uraemia. Waiting for some of these clinical events may well place the patient in jeopardy. This concern, in addition to a number of cohort studies,1 2 lead to the opinion-based guidelines to initiate chronic dialysis at a predefined, ‘early’ level, based on calculated glomerular filtration rate (GFR).3 The consequence of these recommendations resulted in a doubling, between 1996 and 2005, of patients started on chronic dialysis with an estimated GFR >10 ml/min. The impact of this phenomenon on morbidity and mortality has been debated.4 5 The IDEAL (Initiating Dialysis Early and Late) study was designed to answer this important clinical decision-making dilemma. This was a prospective, multicentre, randomised … [1]: {openurl}?query=rft.jtitle%253DNew%2BEngland%2BJournal%2Bof%2BMedicine%26rft.stitle%253DNEJM%26rft.issn%253D0028-4793%26rft.volume%253D363%26rft.issue%253D7%26rft.spage%253D609%26rft.epage%253D619%26rft.atitle%253DA%2Brandomized%252C%2Bcontrolled%2Btrial%2Bof%2Bearly%2Bversus%2Blate%2Binitiation%2Bof%2Bdialysis.%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJMoa1000552%26rft_id%253Dinfo%253Apmid%252F20581422%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1056/NEJMoa1000552&link_type=DOI [3]: /lookup/external-ref?access_num=20581422&link_type=MED&atom=%2Febmed%2F16%2F2%2F44.atom