Predialysis Factors and the Timing of Dialysis Initiation among Older Adults

In a study of 70,662 patients who initiated dialysis at 67 years or older, Deidra C. Crews, MD, of Johns Hopkins Medical Institutions in Baltimore, and colleagues found that a greater burden of comorbidities, frequent nephrology visits, and hospitalization for congestive heart failure were associated with early dialysis initiation.

The researchers adjusted analyses for demographics, years of dialysis initiation, cause of end-stage renal disease, hemoglobin, and use of erythropoiesis stimuating agents and/or intravenous iron. The researchers noted that in recent years, patients with chronic disease have been starting dialysis at increasing estimated glomerular filtration rates despite an absence of evidence showing benefit and some data suggesting harm.