BACKGROUND During the past decade, a trend has been observed in the United States toward initiation of chronic dialysis at higher levels of estimated glomerular filtration rate. This likely reflects secular trends in the composition of the dialysis population and a tendency toward initiation of dialysis earlier in the course of kidney disease. METHODS The goal of this study was to generate mo...

Acute kidney injury (AKI) is now well recognized as an independent risk factor for increased morbidity and mortality, particularly when dialysis is needed. The wide variation in dialysis utilization contributes to a lack of consensus on what parameters should guide the decision to start dialysis. While the association of early initiation of dialysis with survival benefit was first demonstrated ...

BACKGROUND Little is known about trends in the timing of first nephrology consultation and associated outcomes among older patients initiating dialysis. METHODS Data from patients aged 67 years or older who initiated dialysis in the United States between January 1, 1996, and December 31, 2006, were stratified by timing of the earliest identifiable nephrology visit. Trends of earlier nephrolog...

BACKGROUND Physicians' perceptions and opinions may influence when to initiate dialysis. OBJECTIVE To examine providers' perspectives and opinions regarding the timing of dialysis initiation. DESIGN Online survey. SETTING Community and academic dialysis practices in Canada. PARTICIPANTS A nationally-representative sample of dialysis providers. MEASUREMENTS AND METHODS Dialysis provide...

BACKGROUND Patients with end-stage renal disease (ESRD) have symptoms related to severe anemia, edema, and heart failure. Although dialysis improves ESRD syndromes, the optimum timing for initiation of dialysis is unclear. Recent observational studies have suggested that early commencement of dialysis can be harmful. Given that early dialysis may increase the risk of death, avoiding an early st...

BACKGROUND/AIMS Arteriovenous fistulas (AVFs) appear to be clinically superior to catheters as vascular access for maintenance hemodialysis, but higher insertion costs and high disease burden and mortality obscure the issue of whether AVF placement before hemodialysis initiation represents a net cost savings. We aimed to investigate Medicare costs for patients beginning maintenance hemodialysis...

BACKGROUND Multiple factors influence timing of dialysis initiation. The impact of supply of nephrology workforce on timing and incidence of dialysis initiation is not well known. METHODS We determined the number of pediatric and adult nephrologists in each state using data from the American Medical Association and American Boards of Internal Medicine and Pediatrics. We ascertained state popu...