Most Read Articles
Jairia Dela Cruz, 22 days ago
Statins appear to have a dose-dependent association with the risk of tuberculosis (TB), with a nationwide population-based study showing that statin users have 47 percent lower incidence of TB compared with nonusers.
one month ago
At a recent lunch symposium during the 14th Annual Scientific Meeting of the Malaysian Society of Hypertension, Dr Chow Yok Wai spoke on the importance of patient adherence in the management of hypertension, highlighting the role of combination therapy in improving treatment outcomes.
Pearl Toh, 4 days ago
Individuals with high fasting plasma glucose (FPG) lost more weight than those who had low FPG in response to a high-fibre, low glycaemic load diet, suggesting that FPG could be used as a biomarker to predict dietary weight loss success and to guide selection of the most effective diet, in particular for those with prediabetes and diabetes, according to studies presented at ADA 2017.
6 days ago
Mesalazine is not superior to placebo in terms of preventing recurrence in patients with diverticulitis, according to data from two phase III trials.

Early dialysis tied to increased death risk in non-elderly Singapore adults

Pearl Toh
12 days ago

Early initiation of dialysis at higher eGFR* levels of ≥10 mL/min/1.73m2 was associated with a significantly increased risk of death compared with late initiation (at eGFR <5 mL/min/1.73m2) in non-elderly adults (<65 years) in Singapore, a new study has shown.

“Our findings suggest that early commencement of dialysis offers no advantage over late dialysis, especially for younger patients in Singapore with advanced chronic kidney disease, and possibly other Southeast Asian populations,” according to researchers led by Professor Tazeen Jafar from Duke-NUS Medical School in Singapore.

The study included data from 3,286 patients (mean age, 61.5 years) with new-onset end-stage renal disease in the Singapore Renal Registry database. Participants were divided into three categories based on their eGFR at the start of dialysis: early (≥10 mL/min/1.73m2), intermediate (5 to <10 mL/min/1.73m2), and late (<5 mL/min/1.73m2). [BMC Nephrology 2017;18:176-186]

Compared with patients who initiated dialysis later, a greater risk of death was observed in those who initiated dialysis early (hazard ratio [HR], 2.47, 95 percent confidence interval [CI], 2.04–2.99) and at intermediate stage (HR, 1.54, 95 percent CI, 1.37–1.72). The risk remained significant even after adjusting for comorbidities, demographic factors, nutritional parameter, and modality of dialysis (p<0.001).

A multivariate analysis revealed age as a significant modifier of the association between dialysis initiation and mortality risk (p=0.04), with the association being more prominent in patients <65 years.  

After stratifying the analysis by age, mortality risk was shown to increase progressively with earlier dialysis initiation for patients in the age groups of 18–54 years (p=0.006) and 55–64 years (p<0.001), but not >65 years (p=0.12).    

“It is possible that younger patients commencing dialysis have more aggressive underlying kidney disease with more rapid loss of residual renal function … [which] has been associated with increased mortality,” said the researchers. “[Early] initiation of dialysis … appeared to offer no survival advantage among the elderly.”

Being a registry-based observational study, the authors could not rule out the possibility of lead time bias and indication bias in their findings.

Noting an upward trend in average eGFR at dialysis initiation, which rose from 7.9 to 8.6 mL/min/1.73m2 in Europe between 1999 and 2003, [Nephrol Dial Transplant 2009;24:3175-3182] the researchers attributed this to the differences in recommendations for consideration of dialysis among different guidelines.

“In agreement with IDEAL study, our results do not support early initiation of maintenance dialysis in the absence of any compelling clinical indication. Our findings support the 2015 update of Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines for initiation of maintenance dialysis which are based on compelling indications,” said Jafar and co-authors. [N Engl J Med 2010;363:609-619; https://www.kidney.org/sites/default/files/KDOQI-Clinical-Practice-Guideline-Hemodialysis-Update_Public-Review-Draft-FINAL_20150204.pdf. Last accessed 12 Jun 2017]

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
Jairia Dela Cruz, 22 days ago
Statins appear to have a dose-dependent association with the risk of tuberculosis (TB), with a nationwide population-based study showing that statin users have 47 percent lower incidence of TB compared with nonusers.
one month ago
At a recent lunch symposium during the 14th Annual Scientific Meeting of the Malaysian Society of Hypertension, Dr Chow Yok Wai spoke on the importance of patient adherence in the management of hypertension, highlighting the role of combination therapy in improving treatment outcomes.
Pearl Toh, 4 days ago
Individuals with high fasting plasma glucose (FPG) lost more weight than those who had low FPG in response to a high-fibre, low glycaemic load diet, suggesting that FPG could be used as a biomarker to predict dietary weight loss success and to guide selection of the most effective diet, in particular for those with prediabetes and diabetes, according to studies presented at ADA 2017.
6 days ago
Mesalazine is not superior to placebo in terms of preventing recurrence in patients with diverticulitis, according to data from two phase III trials.