Timing of dialysis initiation in transplant-naive and failed transplant patients

Miklos Z. Molnar, Akinlolu O. Ojo, Suphamai Bunnapradist, Csaba Kovesdy, Kamyar Kalantar-Zadeh

Research output: Contribution to journalReview article

26 Citations (Scopus)

Abstract

Over the past two decades, most guidelines have advocated early initiation of dialysis on the basis of studies showing improved survival in patients starting dialysis early. These recommendations led to an increase in the proportion of patients initiating dialysis with an estimated glomerular filtration rate (eGFR) >10 ml/min/1.73 m 2 , from 20% in 1996 to 52% in 2008. During this period, the percentage of patients starting dialysis with an eGFR ≥15 ml/min/1.73 m 2 increased from 4% to 17%. However, recent studies have failed to substantiate a benefit of early dialysis initiation and some data have suggested worse outcomes for patients starting dialysis with a higher eGFR. Several reasons for this seemingly paradoxical observation have been suggested, including the fact that patients requiring early dialysis are likely to have more severe symptoms and comorbidities, leading to confounding by indication, as well as biological mechanisms that causally relate early dialysis therapy to adverse outcomes. Patients with a failing renal allograft who reinitiate dialysis encounter similar problems. However, unique factors associated with a failed allograft means that the optimal timing of dialysis initiation in failed transplant patients might differ from that in transplant-naive patients with chronic kidney disease. In this Review, we discuss studies of dialysis initiation and compare risks and benefits of early versus late initiation and reinitiation of dialysis therapy.

Original languageEnglish (US)
Pages (from-to)284-292
Number of pages9
JournalNature Reviews Nephrology
Volume8
Issue number5
DOIs
StatePublished - May 1 2012
Externally publishedYes

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Dialysis
Transplants
Glomerular Filtration Rate
Allografts
Secondary Prevention
Chronic Renal Insufficiency
Comorbidity
Observation
Guidelines
Kidney
Survival

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Timing of dialysis initiation in transplant-naive and failed transplant patients. / Molnar, Miklos Z.; Ojo, Akinlolu O.; Bunnapradist, Suphamai; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar.

In: Nature Reviews Nephrology, Vol. 8, No. 5, 01.05.2012, p. 284-292.

Research output: Contribution to journalReview article

Molnar, Miklos Z. ; Ojo, Akinlolu O. ; Bunnapradist, Suphamai ; Kovesdy, Csaba ; Kalantar-Zadeh, Kamyar. / Timing of dialysis initiation in transplant-naive and failed transplant patients. In: Nature Reviews Nephrology. 2012 ; Vol. 8, No. 5. pp. 284-292.
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