ORIGINAL INVESTIGATION ONLINE FIRST |LESS IS MORE Steven J. Rosansky, MD; Paul Eggers, PhD; Kirby Jackson, BA; Richard Glassock, MD; William F. Clark, MD Background: A dramatic increase in the “early start” bumin levels lower than 2.5 g/dL, 2.5 to 3.49 g/dL, and of dialysis with an estimated glomerular filtration rate 3.5 g/dL or higher (the “healthiest” group [HG]). (eGFR) at least 10 mL/min/1.73 m has occurred in the United States since at least 1996. Several recent studies Results: Unadjusted 1-year mortality by eGFR ranged from have reported a comorbidity-adjusted survival disadvan- 6.8% in the reference group (eGFR5.0 mL/min/1.73 m ) tage of early start of dialysis. The current study exam- to 20.1% in the highest eGFR group (15.0 mL/min/1.73 ines a relatively “healthy” dialysis cohort to minimize con- m ). Compared with the reference group, the HR for the founding issues and determine whether early initiation HG was 1.27 (eGFR, 5.0-9.9 mL/min/1.73 m ), 1.53 (eGFR, of hemodialysis is associated with a survival benefit or 2 10.0-14.9 mL/min/1.73 m ), and 2.18 (eGFR 15.0 mL/ harm. 2 min/1.73 m ) and ranged from 1.50 to 3.53 mL/min/1.73 m in the first year of dialysis for the early-start group.
JAMA Internal Medicine – American Medical Association
Published: Mar 14, 2011