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A trend toward earlier initiation of dialysis in patients with chronic kidney disease has developed during the past decade, but no compelling evidence supports that trend. In this randomized trial from Australia and New Zealand, 828 adults with chronic kidney disease were assigned to begin dialysis when estimated glomerular filtration rate (GFR) fell to either 10–14 or 5–7 mL/minute/1.73 m2. Patients randomized to the late-start group were permitted to begin dialysis earlier if warranted by their symptoms.
During average follow-up of 3.6 years, mortality was about 37% in both groups. Cardiovascular events, infections, and complications of dialysis also occurred with similar frequency in the two groups. The difference between the early- and l…