Effect of timing of dialysis commencement on clincial outcomes of patients with planned initiation of peritoneal dialysis in the ideal trial

Johnson, David W., Wong, Muh Geot, Cooper, Bruce A., Branley, Pauline, Bulfone, Liliana, Collins, John F., Craig, Jonathan C., Fraenkel, Margaret B., Harris, Anthony, Kesselhut, Joan, Li, Jing Jing, Luxton, Grant, Pilmore, Andrew, Tiller, David J., Harris, David C. and Pollock, Carol A. 2012, Effect of timing of dialysis commencement on clincial outcomes of patients with planned initiation of peritoneal dialysis in the ideal trial, Peritoneal dialysis international, vol. 32, no. 6, pp. 595-604.

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Title Effect of timing of dialysis commencement on clincial outcomes of patients with planned initiation of peritoneal dialysis in the ideal trial
Author(s) Johnson, David W.
Wong, Muh Geot
Cooper, Bruce A.
Branley, Pauline
Bulfone, Liliana
Collins, John F.
Craig, Jonathan C.
Fraenkel, Margaret B.
Harris, Anthony
Kesselhut, Joan
Li, Jing Jing
Luxton, Grant
Pilmore, Andrew
Tiller, David J.
Harris, David C.
Pollock, Carol A.
Journal name Peritoneal dialysis international
Volume number 32
Issue number 6
Start page 595
End page 604
Total pages 10
Publisher Multimed, Inc.
Place of publication Milton, Ont.
Publication date 2012-12
ISSN 0896-8608
1718-4304
Keyword(s) dialysis timing
mortality
outcomes
peritonitis
Summary Background: Since the mid-1990s, early dialysis initiation has dramatically increased in many countries. The Initiating Dialysis Early and Late (IDEAL) study demonstrated that, compared with late initiation, planned early initiation of dialysis was associated with comparable clinical outcomes and increased health care costs. Because residual renal function is a key determinant of outcome and is better preserved with peritoneal dialysis (PD), the present pre-specified subgroup analysis of the IDEAL trial examined the effects of early-compared with late-start dialysis on clinical outcomes in patients whose planned therapy at the time of randomization was PD.

Methods: Adults with an estimated glomerular filtration rate (eGFR) of 10 - 15 mL/min/1.73 m2 who planned to be treated with PD were randomly allocated to commence dialysis at an eGFR of 10 - 14 mL/min/1.73 m2 (early start) or 5 - 7 mL/min/1.73 m2 (late start). The primary outcome was all-cause mortality.

Results: Of the 828 IDEAL trial participants, 466 (56%) planned to commence PD and were randomized to early start (n = 233) or late start (n = 233). The median times from randomization to dialysis initiation were, respectively, 2.03 months [interquartile range (IQR):1.67 - 2.30 months] and 7.83 months (IQR: 5.83 - 8.83 months). Death occurred in 102 early-start patients and 96 late-start patients [hazard ratio: 1.04; 95% confidence interval (CI): 0.79 - 1.37]. No differences in composite cardiovascular events, composite infectious deaths, or dialysis-associated complications were observed between the groups. Peritonitis rates were 0.73 episodes (95% CI: 0.65 - 0.82 episodes) per patient-year in the early-start group and 0.69 episodes (95% CI: 0.61 - 0.78 episodes) per patient-year in the late-start group (incidence rate ratio: 1.19; 95% CI: 0.86 - 1.65; p = 0.29). The proportion of patients planning to commence PD who actually initiated dialysis with PD was higher in the early-start group (80% vs 70%, p = 0.01).

Conclusion: Early initiation of dialysis in patients with stage 5 chronic kidney disease who planned to be treated with PD was associated with clinical outcomes comparable to those seen with late dialysis initiation. Compared with early-start patients, late-start patients who had chosen PD as their planned dialysis modality were less likely to commence on PD.
Language eng
Field of Research 110399 Clinical Sciences not elsewhere classified
Socio Economic Objective 920199 Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Persistent URL http://hdl.handle.net/10536/DRO/DU:30052509

Document type: Journal Article
Collection: School of Health and Social Development
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