Timing of dialysis initiation has been in the spotlight in recent years (1). During the last decade, there has been a trend toward initiation of chronic dialysis at higher levels of eGFR (2). The reason for increased attention to the topic is accumulating evidence that early dialysis initiation does not improve patient outcomes and results in unwarranted costs. In observational studies, higher ...

BACKGROUND Early initiation of chronic dialysis (starting dialysis with higher vs lower kidney function) has risen rapidly in the past 2 decades in Canada and internationally, despite absence of established health benefits and higher costs. In 2014, a Canadian guideline on the timing of dialysis initiation, recommending an intent-to-defer approach, was published. OBJECTIVE The objective of th...

PURPOSE OF REVIEW The past 15 years have seen tremendous growth in the initiation of dialysis at higher levels of kidney function in the setting of mixed evidence and at great societal economic cost. We review recent data on the early dialysis initiation trend, the clinical and economic impact of early dialysis initiation and the future implications for the management of advanced chronic kidney...

The number of patients with end-stage renal disease undergoing kidney transplantation - both cadaveric and living-donor - continues to rise. With long-term graft survival relatively fixed, this trend means that increasing numbers of patients are returning to dialysis after graft loss. Most will never be retransplanted, which introduces a host of clinical questions regarding optimal management o...

Much controversy surrounds the establishment of proper planning, placement and management (the best practice pattern) of dialysis access. These include the dialysis type and modality selection, timing of access placement and who places the access. The lack of and the difficulty of performing randomized studies with multiple confounding factors, in an extremely heterogeneous and rapidly changing...

BACKGROUND AND OBJECTIVES The number of elderly patients and those with higher estimated GFR (eGFR) initiating dialysis have recently increased. This study sought to determine rates of withdrawal from dialysis and variables associated with withdrawal. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Canadian Organ Replacement Registry data were used to examine withdrawal rate and identify variab...

BACKGROUND Variations in the timing of dialysis initiation may explain some geographical variations in renal replacement therapy (RRT) incidence, but this effect has never been quantified. METHODS Using data from the French Renal Epidemiology and Information Network registry, we quantified the association between RRT incidence in 2006-07 and median estimated glomerular filtration rate (eGFR) ...