Researchers of this study aimed to determine the optimal estimated glomerular filtration rate (eGFR) for initiating dialysis in patients with advanced chronic kidney disease (CKD). Using data from the National Swedish Renal Registry, researchers mimicked clinical trial conditions to eliminate biases and estimate adjusted hazard ratios and absolute risks for five-year all-cause mortality and major adverse cardiovascular events (MACE) across various eGFR levels.

The study included 10,290 patients with a median eGFR of 16.8 mL/min/1.73 m². Of these, 3,822 began dialysis, 4,160 died, and 2,446 experienced a major adverse cardiovascular event (MACE). Results showed a parabolic relationship for mortality, with the lowest risk at eGFR 15-16 mL/min/1.73 m². Initiating dialysis at this eGFR level reduced the five-year mortality risk by 5.1% and the MACE risk by 2.9%, compared with starting at eGFR 6-7. However, this meant starting dialysis four years earlier, yielding a modest mean postponement of death by 1.6 months over five years. The findings aligned with the IDEAL trial, indicating very early dialysis initiation offers a slight mortality and cardiovascular benefit, but the extended dialysis period may not be justifiable for most patients.

Reference: Fu EL, Evans M, Carrero JJ, et al. Timing of dialysis initiation to reduce mortality and cardiovascular events in advanced chronic kidney disease: nationwide cohort study. BMJ. 2021;375:e066306. doi: 10.1136/bmj-2021-066306.