Dialysis Is Starting Earlier, Study Finds

From the late 1990s to the late 2000s, long-term dialysis was initiated an average of nearly 150 days earlier, according to a study in the Archives of Internal Medicine.

Trends in the timing of initiation of long-term dialysis were assessed by use of information from the U.S. Renal Data System end stage renal disease registry. Information on estimated GFR (eGFR) at the time of the first long-term dialysis treatment was modeled for patients who started dialysis in 1997 versus those who began dialysis in 2007. Data from an integrated health care system were used to assess the predialysis eGFR slope.

Dialysis was initiated a mean of 147 days earlier in 2007 than in 1997, after differences in patient characteristics were taken into account. The difference was fairly consistent across most patient subgroups but was largest for patients 75 or older: mean 233 days. The mean eGFR before dialysis increased from 6.8 mL/min/1.73 m2 for those starting dialysis in 1997 to 9.9 mL/min/1.73 m2 for those starting dialysis in 2007.

As reflected by the new study, there is a trend toward starting long-term dialysis at higher rates of eGFR. The results suggest that patients in the United States are starting dialysis about 5 months earlier on average, and nearly 8 months earlier for patients 75 or older. “In the absence of strong evidence to suggest that earlier initiation of long-term dialysis is beneficial, these findings call for careful evaluation of contemporary dialysis initiation practices in the United States,” the researchers write. [O’Hare AM, et al. Trends in timing of initiation of chronic dialysis in the United States. Arch Intern Med 2011; 171:1663–1669.]

December 2011 (Vol. 3, Number 12)