The timing of dialysis initiation affects the incidence of renal replacement therapy

Nephrol Dial Transplant. 2010 May;25(5):1576-8. doi: 10.1093/ndt/gfp675. Epub 2010 Jan 6.


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) values before starting dialysis at the administrative district level with geographically appropriate methods.

Results: Crude RRT incidence varied from 80.4 to 238.6 pmi between administrative districts, and median eGFR at dialysis initiation from 5.9 to 11.8 ml/min/1.73 m(2). Age- and sex-adjusted RRT incidence, associated with a 1.2-ml/min/1.73m(2) increase in median eGFR, rose 8% (4-13%) before and 9% (5-13%) after controlling for the effect of nine potential socioeconomic and medical risk factors.

Conclusion: The impact of increased eGFR at initiation should be taken into account in guidelines recommending earlier dialysis start.

MeSH terms

  • Adult
  • Glomerular Filtration Rate
  • Humans
  • Incidence
  • Middle Aged
  • Renal Dialysis*
  • Renal Replacement Therapy / statistics & numerical data*
  • Time Factors