Trends in Timing of Initiation of Chronic Dialysis in the United States

Abstract

Chronic dialysis is an intensive and costly therapy used to treat advanced kidney disease. During the past decade, a trend has been observed toward initiation of chronic dialysis at progressively higher levels of estimated glomerular filtration rate (eGFR).^1-4 Because eGFR at dialysis initiation often is higher for older patients and for those with a greater burden of comorbidity, an upward trend in eGFR at initiation may reflect changes in the composition of the dialysis population over time.^2,5 However, it is also likely that such trends reflect changes in practice, whereby chronic dialysis now is initiated earlier in the course of chronic kidney disease compared with previous years.¹ We designed a study to evaluate the latter possibility and to estimate the magnitude of changes in the timing of dialysis initiation.