The randomized, controlled IDEAL study reports no survival advantage of 'early' dialysis initiation and data from this study support an estimated glomerular filtration rate of around 7 ml/min/1.73 m2 as a guideline for dialysis initiation. The results of the IDEAL study supplement data from eight observational studies involving over 1.2 million patients which showed a comorbidity-adjusted incremental survival disadvantage of 'early' dialysis initiation.
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Rosansky, S., Glassock, R. 'Early' dialysis start based on eGFR is no longer appropriate. Nat Rev Nephrol 6, 693–694 (2010). https://doi.org/10.1038/nrneph.2010.131
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DOI: https://doi.org/10.1038/nrneph.2010.131