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Randomised controlled trial
Early initiation of dialysis in patients with chronic progressive kidney failure does not confer a mortality advantage when compared with an approach of late initiation combined with appearance of symptoms or signs of uraemia
  1. Bruce Spinowitz
  1. Division of Nephrology, New York Hospital Queens, Flushing, New York, USA
  1. Correspondence to Bruce Spinowitz
    Division of Nephrology, New York Hospital Queens, 56-45 Main Street, Flushing, NY 11355, USA; bss9001{at}

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Initiation of dialysis in patients with chronic kidney disease will depend on a combination of biochemical parameters and/or the development of symptoms and signs of uraemia. Waiting for some of these clinical events may well place the patient in jeopardy. This concern, in addition to a number of cohort studies,1 2 lead to the opinion-based guidelines to initiate chronic dialysis at a predefined, ‘early’ level, based on calculated glomerular filtration rate (GFR).3 The consequence of these recommendations resulted in a doubling, between 1996 and 2005, of patients started on chronic dialysis with an estimated GFR >10 ml/min. The impact of this phenomenon on morbidity and mortality has been debated.4 5 The IDEAL (Initiating Dialysis Early and Late) study was designed to answer this important clinical decision-making dilemma.


This was a prospective, multicentre, randomised …

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  • Competing interests None.