Impact of timing of initiation of dialysis on long-term prognosis of patients undergoing hemodialysis

There are a lot of controversies pertaining to correctness of timing for the initiation of dialysis in chronic kidney disease (CKD) patients. The present study was conducted to examine the potential association of initiation timing of dialyses with long-term prognosis in CKD patients. In total, 294 patients confirmed as end-stage renal disease (ESRD) were included as study subjects. According to the estimated glomerular filtration rate (eGFR) at initiation time, the patients were classified into four groups based on eGFR: >= 10.5, 8-10.4, 6-8 and <6 ml/min x (1.73 m(2))(-1) The primary outcomes were defined by all-cause mortality. The median eGFR of the 294 patients at initiation time was 5.43 (2.27-13.92) ml/min x (1.73 m(2))(-1) The patients with lower eGFR at the start of hemodialysis had a higher proportion of Charlson comorbidity index (CCI) scores of 0-2 and had lower hematocrit. The multivariate Cox regression analysis indicated that CO, cerebrovascular diseases and chronic obstructive pulmonary disease were significantly associated with all-cause mortality, but not eGFR at the dialysis initiation. Furthermore, stratified analyses confirmed elevated eGFR that had no advantage on long-term prognosis. The present findings have shown that the prevalence of anemia, hyperuricemia and calcium and phosphorus metabolism disorders of patients with low eGFRs at the initiation of hemodialysis was higher in comparison to the patients with high eGFRs. Therefore, the long-term prognosis of patients with high eGFRs prior to hemodialysis was not improved.